自动评估颅内压等级,结合眼底超声与临床数据提升诊断可靠性
A Fully Automatic Framework for Intracranial Pressure Grading: Integrating Keyframe Identification, ONSD Measurement and Clinical Data
- 自动识别关键帧并精准测量视神经鞘直径
- 融合多源信息实现颅内压分级,验证准确率达84.5%
- 减少人为差异,适合急诊神经科临床应用
颅内压(ICP)升高对脑功能构成严重威胁,需及时监测以指导干预。虽然腰椎穿刺是金标准,但其侵入性和风险促使非侵入性替代方法的发展。视神经鞘直径(ONSD)作为潜在生物标志物,其增大与颅内压升高直接相关。然而,当前临床中ONSD测量存在手动操作不一致、最佳视角选择主观及阈值设定变异等问题,影响可靠性。为此,我们提出一种全自动两阶段框架,整合关键帧识别、ONSD测量与临床数据,用于颅内压分级。第一阶段通过帧级解剖分割、基于国际共识的规则化关键帧识别与精确测量;第二阶段融合ONSD指标与临床特征,实现颅内压等级预测。实验显示,该方法在五折交叉验证中达到0.845±0.071的准确率,在独立测试集上达0.786,显著优于传统阈值法(验证准确率0.637±0.111,测试准确率0.429)。通过降低操作者差异并融合多源信息,本框架为临床提供了可靠的无创颅内压评估方案,有望改善急性神经系统疾病的患者管理。
原文摘要 · Abstract (English)
Intracranial pressure (ICP) elevation poses severe threats to cerebral function, thus necessitating monitoring for timely intervention. While lumbar puncture is the gold standard for ICP measurement, its invasiveness and associated risks drive the need for non-invasive alternatives. Optic nerve sheath diameter (ONSD) has emerged as a promising biomarker, as elevated ICP directly correlates with increased ONSD. However, current clinical practices for ONSD measurement suffer from inconsistency in manual operation, subjectivity in optimal view selection, and variability in thresholding, limiting their reliability. To address these challenges, we introduce a fully automatic two-stage framework for ICP grading, integrating keyframe identification, ONSD measurement and clinical data. Specifically, the fundus ultrasound video processing stage performs frame-level anatomical segmentation, rule-based keyframe identification guided by an international consensus statement, and precise ONSD measurement. The intracranial pressure grading stage then fuses ONSD metrics with clinical features to enable the prediction of ICP grades, thereby demonstrating an innovative blend of interpretable ultrasound analysis and multi-source data integration for objective clinical evaluation. Experimental results demonstrate that our method achieves a validation accuracy of $0.845 \pm 0.071$ (with standard deviation from five-fold cross-validation) and an independent test accuracy of 0.786, significantly outperforming conventional threshold-based method ($0.637 \pm 0.111$ validation accuracy, $0.429$ test accuracy). Through effectively reducing operator variability and integrating multi-source information, our framework establishes a reliable non-invasive approach for clinical ICP evaluation, holding promise for improving patient management in acute neurological conditions.
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