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Evaluation of Optical Coherence Tomography to Detect Elevated Intracranial Pressure in Children
Jordan W Swanson1, Tomas S Aleman2, Wen Xu1
1Craniofacial Surgery Center and Division of Plastic Surgery, The Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia.
Insights
Spectral-domain optical coherence tomography (SD-OCT) can noninvasively detect elevated intracranial pressure in children by measuring retinal changes. This method shows promise as a surrogate for invasive measurements, outperforming conventional clinical signs.
Area of Science:
- Ophthalmology
- Pediatric Neurosurgery
- Medical Imaging
Background:
- Elevated intracranial pressure (ICP) in children, often due to conditions like craniosynostosis or tumors, can lead to neurocognitive impairment.
- Conventional methods for detecting elevated ICP are invasive and can be unreliable.
- Structural changes in the peripapillary retina are associated with elevated ICP.
Purpose of the Study:
- To assess the efficacy of spectral-domain optical coherence tomography (SD-OCT) in measuring retinal parameters as a noninvasive surrogate for invasive ICP measurement.
- To evaluate the correlation between SD-OCT-derived retinal measurements and directly measured ICP in pediatric patients.
Main Methods:
- A cross-sectional study involving 79 pediatric patients from a Craniofacial Surgery clinic.
- Patients were categorized into three groups: craniosynostosis (n=40), hydrocephalus with suspected intracranial hypertension (n=5), and healthy controls (n=34).
- Preoperative SD-OCT imaging was performed, and direct intraoperative ICP measurement was conducted in children with cranial pathology.
Main Results:
- ICP showed significant correlations with maximal retinal nerve fiber layer thickness (r=0.60), maximal retinal thickness (r=0.53), and maximal anterior retinal projection (r=0.53).
- SD-OCT parameters achieved 89% sensitivity and 62% specificity for detecting elevated ICP, outperforming conventional clinical signs (11%-42% sensitivity).
- High intereye and intergrader agreement (intraclass correlation ≥0.83) confirmed the reliability of SD-OCT measurements.
Conclusions:
- Noninvasive quantitative retinal measurements using SD-OCT correlate well with invasively measured ICP.
- SD-OCT parameters demonstrate potential as reliable, noninvasive surrogates for ICP monitoring in children.
- This technology could significantly advance the management of elevated ICP in pediatric populations.
Importance:
Detecting elevated intracranial pressure in children with subacute conditions, such as craniosynostosis or tumor, may enable timely intervention and prevent neurocognitive impairment, but conventional techniques are invasive and often equivocal. Elevated intracranial pressure leads to structural changes in the peripapillary retina. Spectral-domain (SD) optical coherence tomography (OCT) can noninvasively quantify retinal layers to a micron-level resolution.
Objective:
To evaluate whether retinal measurements from OCT can serve as an effective surrogate for invasive intracranial pressure measurement.
Design, Setting, And Participants:
This cross-sectional study included patients undergoing procedures at the Children's Hospital of Philadelphia from September 2014 to June 2015. Three groups of patients (n = 79) were prospectively enrolled from the Craniofacial Surgery clinic including patients with craniosynostosis (n = 40). The positive control cohort consisted of patients with hydrocephalus and suspected intracranial hypertension (n = 5), and the negative control cohort consisted of otherwise healthy patients undergoing a minor procedure (n = 34).
Main Outcomes And Measures:
Spectral-domain OCT was performed preoperatively in all cohorts. Children with cranial pathology, but not negative control patients, underwent direct intraoperative intracranial pressure measurement. The primary outcome was the association between peripapillary retinal OCT parameters and directly measured elevated intracranial pressure.
Results:
The mean (SD) age was 34.6 (45.2) months in the craniosynostosis cohort (33% female), 48.9 (83.8) months in the hydrocephalus and suspected intracranial hypertension cohort (60% female), and 59.7 (64.4) months in the healthy cohort (47% female). Intracranial pressure correlated with maximal retinal nerve fiber layer thickness (r = 0.60, P ≤ .001), maximal retinal thickness (r = 0.53, P ≤ .001), and maximal anterior retinal projection (r = 0.53, P = .003). Using cut points derived from the negative control patients, OCT parameters yielded 89% sensitivity (95% CI, 69%-97%) and 62% specificity (95% CI, 41%-79%) for detecting elevated intracranial pressure. The SD-OCT measures had high intereye agreement (intraclass correlation, 0.83-0.93) and high intragrader and intergrader agreement (intraclass correlation ≥0.94). Conventional clinical signs had low sensitivity (11%-42%) for detecting intracranial hypertension.
Conclusions And Relevance:
Noninvasive quantitative measures of the peripapillary retinal structure by SD-OCT were correlated with invasively measured intracranial pressure. Optical coherence tomographic parameters showed promise as surrogate, noninvasive measures of intracranial pressure, outperforming other conventional clinical measures. Spectral-domain OCT of the peripapillary region has the potential to advance current treatment paradigms for elevated intracranial pressure in children.
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