Normal Values for Transbulbar Sonography and Magnetic Resonance Imaging of the Optic Nerve Sheath Diameter (ONSD) in Children and Adolescents

Abstract

Purpose: To establish normal values of the optic nerve sheath diameter (ONSD) in children and adolescents for transbulbar sonography and magnetic resonance imaging.

Materials and Methods: In 99 children and adolescents (age: 5.6 – 18.6 years, mean: 12 years) without neurologic or ophthalmologic disease, measurements of the ONSD with transbulbar sonography were performed. For comparison 59 children and adolescents (age: 5.1 – 17.4 years, mean 12.3 years) with a normal MR examination of the brain had measurements of the ONSD on a T2-weighted thin section sequence of the orbit. Besides establishing modality-related normal values, age dependency, accuracy and reproducibility of measurements were assessed.

Results: Overall the mean ONSD was 5.75 ± 0.52 mm for transbulbar sonography and 5.69 ± 0.31 mm for MRI. There was no statistical significance between the 95 % percentiles and age for both transbulbar sonography (p = 0.332) and MRI (p = 0.336). As a parameter for the reproducibility of measurements, the repeatability coefficient (RC) was between 0.34 mm and 0.46 mm. The concordance correlation coefficient (CCC) values revealed a high agreement between readers both for transbulbar sonography (0.868) and MRI (0.796).

Conclusion: Normal values for ONSD in children and adolescents found in this study are significantly higher than assumed. The values found for transbulbar sonography are confirmed by comparable results for MR measurements. A precise sonographic measurement technique and the consideration of normal values found hereby are essential for correct interpretation of ONSD measurements in children and adolescents.

Zusammenfassung

Ziel: Bestimmung von Normwerten des Optikusnervenscheidendurchmessers (ONSD) bei Kindern und Jugendlichen für transbulbäre Sonografie und Magnetresonanztomografie.

Material und Methoden: Bei 99 Kindern und Jugendlichen (Alter: 5,6 – 18,6 Jahre, MW: 12 Jahre) ohne neurologische oder ophthalmologische Grunderkrankung wurde der ONSD mittels transbulbärer Sonografie bestimmt. Als Vergleichsgruppe wurde bei 59 Kindern und Jugendlichen (Alter: 5,1 – 17,4 Jahre, MW: 12,3 Jahre) mit einer unauffälligen MRT-Untersuchung des Schädels der ONSD mittels einer T2-gewichteten Dünnschichtuntersuchung der Orbita ermittelt. Neben der methodenbezogenen Normwertbestimmung wurden Altersabhängigkeit der Messwerte, Messgenauigkeit und Reproduzierbarkeit der Messungen ermittelt.

Ergebnisse: Der Mittelwert des ONSD im Gesamtkollektiv betrug für die transbulbäre Sonografie 5,75 ± 0,52 mm und für die MRT 5,69 ± 0,31 mm. Die Überprüfung der Altersabhängigkeit der 95 % Perzentile war weder für die Sonografie (p = 0,332) noch die MR-Tomografie (p = 0,336) statistisch signifikant. Der repeatability coefficient (RC-Koeffizient) als Maß für die Reproduzierbarkeit der Messungen ergab Werte zwischen 0,34 mm und 0,46 mm. Die Werte für den concordance correlation coefficient (CCC) ergaben eine hohe Übereinstimmung der Messungen zwischen den Betrachtern sowohl für die transbulbäre Sonografie (0,868) als auch die MRT (0,796).

Schlussfolgerung: Die in dieser Studie ermittelten Normwerte des ONSD bei Kindern und Jugendlichen liegen deutlich höher als bisher angenommen. Die Messwerte für die transbulbäre Sonografie werden durch vergleichbare MRT-Werte bestätigt. Eine exakte sonografische Messtechnik und die Berücksichtigung der hierbei ermittelten Normwerte sind für die Interpretation von ONSD-Messungen bei Kindern und Jugendlichen unabdingbar.

Key words

eye - MR imaging - ultrasound

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