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研究生:余際德
研究生(外文):Chi-Te Yu
論文名稱:利用超音波測量視神經鞘寬度偵測犬隻高腦壓之評估
論文名稱(外文):Detection of intracranial hypertension in dogs using transorbital ultrasonographic measurement of optic nerve sheath diameter
指導教授:蘇璧伶林中天
口試委員:李雅珍張雅珮
口試日期:2015-07-17
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:臨床動物醫學研究所
學門:獸醫學門
學類:獸醫學類
論文種類:學術論文
論文出版年:2015
畢業學年度:103
語文別:中文
論文頁數:45
中文關鍵詞:高腦壓超音波視神經鞘寬度
外文關鍵詞:canineintracranial hypertensiontransorbital ultrasonographyoptic nerve sheath diameter
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侵入式測量顱內壓於獸醫領域並不常使用。由於視神經鞘在顱內壓上升時,其寬度會增加,測量視神經鞘寬度於人醫已成為非侵入式偵測高腦壓的方法。目前已有獸醫文獻評估利用磁振造影影像測量視神經鞘寬度來偵測犬隻顱內壓上升的可行性。然而,考量高腦壓動物進行磁振造影的麻醉風險以及費用,使其臨床的實用性有限。許多人醫文獻指出利用超音波作為測量視神經鞘寬度的工具以偵測病人高腦壓能有良好的正確性,但相關的文獻於獸醫仍缺乏。因此,此篇研究的目的為評估利用超音波測量視神經鞘寬度偵測犬隻高腦壓之可行性。
以至台灣大學附設動物醫院進行磁振造影掃描的犬隻為對象,若犬隻於磁振造影影像上具有任兩項下述高腦壓特徵影像之犬隻,則納入高腦壓組,包含團塊效應、超過3毫米厚度的水腫、超過3毫米的中線位移、異常大腦外側溝、受壓迫的腦室以及具腦室旁水腫之水腦;若犬隻無腦部功能異常,則納入正常對照組。若動物有嚴重系統性疾病以及明顯眼科問題,如:角膜潰瘍、結膜炎以及青光眼等等皆剔除於研究之外。利用Accutome® B-scan plus超音波儀以及15MHz超音波探頭,於眼球後方3毫米處進行視神經鞘寬度的測量。數據利用independent samples t-test 和 Mann-Whitney U test 進行統計分析,當P值大於0.05時,表示具有顯著意義。
高腦壓組和正常對照組的樣本數分別為14和60隻犬。結果顯示高腦壓組之視神經鞘寬度顯著大於正常組。利用體重將犬隻分成小於10公斤的小型犬組別以及10公斤以上的中大型犬組別後進行數據分析,發現於小型犬組別中,雙側視神經鞘寬度於高腦壓組亦顯著大於正常對照組,但此差異並未發現於中大型犬組別中;於中大型犬組別中,雙側視神經鞘寬度與體重的比值,以及雙側視神經鞘寬度與體表面積的比值,於高腦壓組和正常對照組間皆具有顯著差異,計算視神經鞘寬度、雙側視神經鞘寬度與體重的比值,以及雙側視神經鞘寬度與體表面積的比值之接受者操作特徵曲線下面積皆大於0.7,表示視神經鞘寬度具有區分犬隻高腦壓與否之能力。
根據研究結果,利用超音波測量視神經鞘寬度可作為偵測高腦壓之非侵入性診斷工具。


Direct intracranial pressure (ICP) measurement in veterinary medicine is not widely available. Based on the phenomenon of the optic nerve sheath diameter (ONSD) expansion during ICP elevation, ONSD has been applied as a noninvasive method for detecting increased ICP in humans. Measuring ONSD on magnetic resonance imaging (MRI) T2-weighted images for the same purpose has been evaluated in dogs. However, considering the anesthetic risk and cost, serial MRI examinations are impractical, especially in dogs with increased ICP. Transorbital ultrasonographic measurement of ONSD in humans has been reported to provide good diagnostic accuracy for detecting intracranial hypertension; however, relevant information in veterinary medicine is still lacking.
In this research, we aim to evaluate the usefulness of ONSD measured on ultrasonography to predict intracranial hypertension in dogs.
Dogs without cerebral dysfunction and dogs with at least two MRI characteristics of increased ICP were included in the study and further assigned into the control group and the intracranial hypertension group respectively. Dogs with major ocular diseases or systemic diseases were excluded. These MRI characteristics of increased ICP included mass effect, substantial edema, effacement of sulci or hydrocephalus with periventricular edema. Under general anesthesia, ONSD was measured at 3 mm behind the globe via a 15-MHz ultrasonographic probe placing on the cornea. Data were analyzed by using independent samples t-test and Mann-Whitney U test. P<0.05 was considered statistically significant.
Sixty dogs and fourteen dogs were enrolled in the control and intracranial hypertension group respectively. No significant difference was detected in age and body weight between two groups. ONSD in the intracranial hypertension group was significantly larger than that in the control group (P<0.05). Subgroups were further divided by body weight (<10 kg and ≥10 kg). In dogs <10 kg, ONSD in the intracranial hypertension group was significantly larger than that in the control group (P <0.05). Although the difference of ONSD between the control and intracranial hypertension group in dogs ≥10 kg was insignificant, significantly larger ratio of ONSD to body weight and body surface area were noted in the intracranial hypertension group. The area under receiver operating characteristic curve of ONSD in dogs <10 kg and ratio of ONSD to body weight and body surface area in dogs ≥10 kg are both above 0.7. It indicates that ONSD is a discriminating tool in the detection of intracranial hypertension.
Based on the current results, ultrasonographic measurement of ONSD potentially can be applied to detect the presence of intracranial hypertension in dogs.


誌謝 I
中文摘要 II
ABSTRACT IV
CONTENTS V
表次 VII
圖次 VIII
第一章 、序言 1
第二章 、文獻探討 2
第一節 、顱內壓介紹 2
第一項 、顱內壓 2
第二項 、高腦壓 3
第二節 、視神經鞘 12
第一項 、解剖構造 12
第二項 、特性及其影響因素 14
第三項 、影像學 15
第四項 、與高腦壓相關之臨床應用 16
第三章 、材料與方法 19
第一節 、實驗目的 19
第二節 、實驗對象 19
第一項 、正常對照組 19
第二項 、高腦壓組 19
第三節 、實驗方法 20
第一項 、掃描視神經鞘 20
第二項 、測量視神經鞘寬度之位置 20
第三項 、測量視神經鞘寬度之位置 20
第四節 、實驗之統計分析 21
第四章 、結果 22
第五章 、討論 33
第一節 、影響視神經鞘寬度之因素 33
第二節 、測量視神經鞘寬度之位置 34
第三節 、測量視神經鞘寬度之影像工具 35
第四節 、利用視神經鞘寬度偵測犬隻高腦壓 36
第五節 、超音波重複測量視神經鞘寬度之一致性 38
第六節 、偏差 38
第六章 、結論 40
REFERENCE 41


1.Hansen HC, Helmke K: The subarachnoid space surrounding the optic nerves. An ultrasound study of the optic nerve sheath. Surg Radiol Anat 18:323-328, 1996.
2.Scrivani PV, Fletcher DJ, Cooley SD, et al: T2-weighted magnetic resonance imaging measurements of optic nerve sheath diameter in dogs with and without presumed intracranial hypertension. Vet Radiol Ultrasound 54:263-270, 2013.
3.Geeraerts T, Launey Y, Martin L, et al: Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med 33:1704-1711, 2007.
4.Geeraerts T, Merceron S, Benhamou D, et al: Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med 34:2062-2067, 2008.
5.Soldatos T, Karakitsos D, Chatzimichail K, et al: Optic nerve sonography in the diagnostic evaluation of adult brain injury. Crit Care 12:R67, 2008.
6.Kimberly HH, Shah S, Marill K, et al: Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med 15:201-204, 2008.
7.Moretti R, Pizzi B, Cassini F, et al: Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. Neurocrit Care 11:406-410, 2009.
8.Rajajee V, Vanaman M, Fletcher JJ, et al: Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care 15:506-515, 2011.
9.Sturges BK, Lecouteur RA, Tripp LD: Intracranial pressure monitoring in clinically normal dogs using the Codman ICP Express and Codman Microsensor ICP transducer. J Vet Intern Med 14:387, 2000.
10.Platt S: Head trauma. In: Platt S, Garosi L: Small animal neurological emergencies, Manson Publishing Ltd, 363-382, 2012
11.Paulson OB, Strandgaard S, Edvinsson L: Cerebral Autoregulation. Cerebrovasc Brain Metab Rev 2:161-192, 1990.
12.Mokri B: The Monro-Kellie hypothesis -Applications in CSF volume depletion. Neurol 56:1746-1748, 2001.
13.Platt SR, Olby NJ: Neurological emergencies. In: Platt SR, Olby NJ: BASAVA Manual of canine and feline neurology, 3rd ed. British Small Animal Veterinary Association, Gloucester, 388-408, 2013.
14.Sturges BK: Intracranial pressure monitoring. In: Silverstein D, Hopper K: Small animal critical care medicine, 2nd ed. Elsevier Health Sciences, 998-1001, 2014.
15.Bullock R, Chesnut RM, Clifton G, et al: Guidelines for the management of severe head injury. Brain Trauma Foundation, American Association of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care. J Neurotrauma 13:641-734, 1996.
16.Servadei F, Antonelli V, Giuliani G, et al: Evolving lesions in traumatic subarachnoid hemorrhage: prospective study of 110 patients with emphasis on the role of ICP monitoring. Acta Neurochir Suppl 81:81-82, 2002.
17.Palmer S, Bader MK, Qureshi A, et al: The impact on outcomes in a community hospital setting of using the AANS traumatic brain injury guidelines. Americans Associations for Neurologic Surgeons. J Trauma 50:657-664, 2001.
18.Bagley RS, Keegan RD, Greene SA, et al: Intraoperative monitoring of intracranial pressure in five dogs with space-occupying intracranial lesions. J Am Vet Med Assoc 207:588-591, 1995.
19.Walmsley GL, Herrtage ME, Dennis R, et al: The relationship between clinical signs and brain herniation associated with rostrotentorial mass lesions in the dog. Vet J 172:258-264, 2006.
20.Cushing H: Concerning a definite regulatory mechanism of the vaso-motor centre which controls blood pressure during cerebral compression. Bull Johns Hopkins Hosp 12:290, 1901.
21.Barbiro-Michaely E, Mayevsky A: Effects of elevated ICP on brain function: can the multiparametric monitoring system detect the ''Cushing Response''? Neurol Res 25:42-52, 2003.
22.Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care: Initial management. J Neurotrauma 17:463-469, 2000.
23.Toutant SM, Klauber MR, Marshall LF, et al: Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury. J Neurosurg 61:691-694, 1984.
24.Rosenberg JB, Shiloh AL, Savel RH, et al: Non-invasive methods of estimating intracranial pressure. Neurocrit Care 15:599-608, 2011.
25.Kristiansson H, Nissborg E, Bartek J, et al: Measuring Elevated Intracranial Pressure through Noninvasive Methods: A Review of the Literature. J Neurosurg Anesthesiol 25:372-385, 2013.
26.Bittermann S, Lang J, Henke D, et al: Magnetic resonance imaging signs of presumed elevated intracranial pressure in dogs. Vet J 201:101-108, 2014.
27.Klingelhofer J, Conrad B, Benecke R, et al: Evaluation of intracranial pressure from transcranial Doppler studies in cerebral disease. J Neurol 235:159-162, 1988.
28.Riva N, Budohoski KP, Smielewski P, et al: Transcranial Doppler pulsatility index: what it is and what it isn''t. Neurocrit Care 17:58-66, 2012.
29.Homburg AM, Jakobsen M, Enevoldsen E: Transcranial Doppler recordings in raised intracranial pressure. Acta Neurol Scand 87:488-493, 1993.
30.Moreno JA, Mesalles E, Gener J, et al: Evaluating the outcome of severe head injury with transcranial Doppler ultrasonography. Neurosurg Focus 8:E8, 2000.
31.Rainov NG, Weise JB, Burkert W: Transcranial Doppler sonography in adult hydrocephalic patients. Neurosurg Rev 23:34-38, 2000.
32.Bellner J, Romner B, Reinstrup P, et al: Transcranial Doppler sonography pulsatility index (PI) reflects intracranial pressure (ICP). Surg Neurol 62:45-51, 2004.
33.Brandi G, Bechir M, Sailer S, et al: Transcranial color-coded duplex sonography allows to assess cerebral perfusion pressure noninvasively following severe traumatic brain injury. Acta Neurochir 152:965-972, 2010.
34.Fukushima U, Miyashita K, Okano S, et al: Evaluation of intracranial pressure by transcranial Doppler ultrasonography in dogs with intracranial hypertension. J Vet Med Sci 62:353-355, 2000.
35.Shen Q, Stuart J, Venkatesh B, et al: Inter observer variability of the transcranial Doppler ultrasound technique: impact of lack of practice on the accuracy of measurement. J Clin Monit Comput 15:179-184, 1999.
36.Martins BC, Brooks DE: Diseases of the canine optic nerve. In: Gelatt KN, Gilger BC, Kern TJ: Veterinary ophthalmology, John Wiley & Sons,1432-1476, 2012.
37.Steffen H, Eifert B, Aschoff A, et al: The diagnostic value of optic disc evaluation in acute elevated intracranial pressure. Ophthalmol 103:1229-1232, 1996.
38.Palmer AC, Malinowski W, Barnett KC: Clinical signs including papilloedema associated with brain tumours in twenty-one dogs. J Small Anim Pract 15:359-386, 1974.
39.Sakellaridis N, Pavlou E, Karatzas S, et al: Comparison of mannitol and hypertonic saline in the treatment of severe brain injuries. J Neurosurg 114:545-548, 2011.
40.Murphy CJ, Samuelson DA, Pollock RVH: The eye. In: Evans HE, de Lahunta A: Miller''s anatomy of the dog,4th ed. Elsevier Health Sciences, 746-785, 2013.
41.Liu D, Kahn M: Measurement and relationship of subarachnoid pressure of the optic nerve to intracranial pressures in fresh cadavers. Am J Ophthalmol 116:548-556, 1993.
42.Mukherjee N, El-Dairi MA, Bhatti MT: Optic nerve sheath fenestration- Indications and techniques. US ophthalmic Rev 6:125-131, 2013.
43.Morgan WH, Yu DY, Cooper RL, et al: The influence of cerebrospinal fluid pressure on the lamina cribrosa tissue pressure gradient. Invest Ophthalmol Vis Sci 36:1163-1172, 1995.
44.Killer HE, Laeng HR, Flammer J, et al: Architecture of arachnoid trabeculae, pillars, and septa in the subarachnoid space of the human optic nerve: anatomy and clinical considerations. Br J Ophthalmol 87:777-781, 2003.
45.Helmke K, Hansen HC: Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension II. Patient study. Pediatr Radiol 26:706-710, 1996.
46.Helmke K, Hansen HC: Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. I. Experimental study. Pediatr Radiol 26:701-705, 1996.
47.Newman WD, Hollman AS, Dutton GN, et al: Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus. Br J Ophthalmol 86:1109-1113, 2002.
48.Ballantyne J, Hollman AS, Hamilton R, et al: Transorbital optic nerve sheath ultrasonography in normal children. Clin Radiol 54:740-742, 1999.
49.Lee HC, Choi HJ, Choi MC, et al: Ultrasonographic measurement of optic nerve sheath diameter in normal dogs. J Vet Sci 4:265-268, 2003.
50.Soldatos T, Chatzimichail K, Papathanasiou M, et al: Optic nerve sonography: a new window for the non-invasive evaluation of intracranial pressure in brain injury. Emerg Med J 26:630-634, 2009.
51.Spaulding K: Eye and orbit. In: Penninck D, d''Anjou MA: Atlas of small animal ultrasonography, Blackwell Publishing Ltd, 49-90, 2013.
52.Lagreze WA, Lazzaro A, Weigel M, et al: Morphometry of the retrobulbar human optic nerve: Comparison between conventional sonography and ultrafast magnetic resonance sequences. Invest Ophthalmol Vis Sci 48:1913-1917, 2007.
53.Geeraerts T, Newcombe VFJ, Coles JP, et al: Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure. Crit Care 12, 2008.
54.Watanabe A, Kinouchi H, Horikoshi T, et al: Effect of intracranial pressure on the diameter of the optic nerve sheath. J Neurosurg 109:255-258, 2008.
55.Sekhon MS, McBeth P, Zou J, et al: Association between optic nerve sheath diameter and mortality in patients with severe traumatic brain injury. Neurocrit Care 21:245-252, 2014.
56.Tayal VS, Neulander M, Norton HJ, et al: Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med 49:508-514, 2007.
57.Bekar A, Taskapilioglu O, Yilmazlar S, et al: Is supratentorial pressure difference clinically relevant? Analysis of 55 consecutive cases by bilateral intracranial pressure monitoring. Neurol Res 30:465-470, 2008.
58.Kim MS, Bai SJ, Lee JR, et al: Increase in intracranial pressure during carbon dioxide pneumoperitoneum with steep trendelenburg positioning proven by ultrasonographic measurement of optic nerve sheath diameter. J Endourol 28:801-806, 2014.


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