Evaluation of the Optic Nerve in Children with Attention Deficit Hyperactivity Disorder Using Shear Wave Elastography
DOI:
https://doi.org/10.58600/eurjther3233Keywords:
attention-deficit/hyperactivity disorder,, optic nerve, shear wave elastography, ultrasonographyAbstract
Objective: Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder associated with structural and microfunctional alterations of the central nervous system. As the optic nerve is an extension of the CNS, this study evaluated optic nerve stiffness in children with ADHD using shear wave elastography (SWE) and investigated its potential as a non-invasive imaging biomarker.
Methods: This prospective case-control study included 74 children aged 6–15 years: 37 diagnosed with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria and 37 age- and sex-matched healthy controls. Bilateral optic nerve sheath diameter (ONSD) and SWE measurements were performed using a high-resolution ultrasound system with a 9-MHz linear transducer. A region of interest was positioned approximately 5 mm posterior to the optic disc. Three consecutive stiffness measurements were obtained from each optic nerve, and the mean value (kPa) was used for analysis. Group comparisons and receiver operating characteristic (ROC) curve analyses were performed.
Results: Age, sex distribution, and ONSD measurements did not differ significantly between the groups (all p > 0.050). In contrast, optic nerve stiffness was significantly higher in the ADHD group than in controls for both eyes (all p < 0.001). Mean right optic nerve stiffness was 25.31 ± 13.37 kPa versus 5.70 ± 3.02 kPa, and mean left optic nerve stiffness was 24.84 ± 13.79 kPa versus 5.63 ± 2.73 kPa in the ADHD and control groups, respectively. Mean bilateral stiffness was also significantly higher in the ADHD group (25.27 ± 12.80 vs. 5.55 ± 2.54 kPa, p < 0.001). ROC analysis demonstrated excellent diagnostic performance, with AUC values of 0.978, 0.971, and 0.975 for the right, left, and mean bilateral stiffness measurements, respectively.
Conclusion: Children with ADHD demonstrated significantly increased optic nerve stiffness despite having normal optic nerve sheath diameters. These findings suggest that ADHD may be associated with microstructural and biomechanical alterations of the optic nerve. SWE appears to be a promising, non-invasive, and reproducible imaging modality that may contribute to the development of novel imaging biomarkers in ADHD and other neurodevelopmental disorders.
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