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標題: | 利用超音波測量視神經鞘寬度偵測犬隻高腦壓之評估 Detection of intracranial hypertension in dogs using transorbital ultrasonographic measurement of optic nerve sheath diameter |
作者: | Chi-Te Yu 余際德 |
指導教授: | 蘇璧伶,林中天 |
關鍵字: | 犬,高腦壓,超音波,視神經鞘寬度, canine,intracranial hypertension,transorbital ultrasonography,optic nerve sheath diameter, |
出版年 : | 2015 |
學位: | 碩士 |
摘要: | 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. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/53171 |
全文授權: | 有償授權 |
顯示於系所單位: | 臨床動物醫學研究所 |
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