Appearance of the Optic Nerve Sheath Diameter (ONSD) using Higher Frequency Linear Probes in Detection and Monitoring of Raised Intracranial Pressures-A Cadaveric Study

Pichamuthu, Kishore; Prithishkumar, Ivan James

doi:10.7860/jcdr/2019/36359.12973

Cited by 5 publications

(19 citation statements)

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“…dedicate the hyperechoic striped bands to the pia mater. Pichamuthu et al., 7 on the other hand, interpret the striped bands as being both the pia and dura mater, with the subarachnoid space only appearing in the middle of these bands in patients with elevated ICP. Others assume that these bands represent the subarachnoid space 14,15,18,21,22 that reflects ultrasound waves because of the complex structure of trabeculae and pillars 23 .…”

Section: Discussionmentioning

confidence: 99%

“…Because this sheath expansion is considered to be a surrogate parameter for noninvasive ICP estimation 1,2 the optic nerve sheath diameter (ONSD) is often measured in clinical practice. Although intra‐ and interobserver agreement of ONSD estimation is high within individual studies, 3,4 ONSD cutoff values for the diagnosis of elevated ICP (>15 mmHg) vary between studies 5–7 and thereby limit the application of ONSD assessment as a noninvasive surrogate marker for ICP monitoring. It is hence of utmost importance to identify and resolve sources of these variations in cutoff values.…”

Section: Introductionmentioning

confidence: 99%

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Optic nerve sheath diameter assessment by neurosonology: A review of methodologic discrepancies

Stevens

Gommer

Aries

et al. 2021

Journal of Neuroimaging

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Background and Purpose Reported cutoff values of the optic nerve sheath diameter (ONSD) for the diagnosis of elevated intracranial pressure (ICP) are inconsistent. This hampers ONSD as a possible noninvasive bedside monitoring tool for ICP. Because the influence of methodological differences on variations in cutoff values is unknown, we performed a narrative review to identify discrepancies in ONSD assessment methodologies and to investigate their effect on reported ONSD values. Methods We used a structured and quantitative approach in which each ONSD methodology found in the reviewed articles was categorized based on the characteristic appearance of the ultrasound images and ultrasound marker placement. Subsequently, we investigated the influence of the different methodologies on ONSD values by organizing the ONSDs with respect to these categories. Results In a total of 63 eligible articles, we could determine the applied ONSD assessment methodology. Reported ultrasound images either showed the optic nerve and its sheath as a dark region with hyperechoic striped band at its edges or as a single dark region surrounded by lighter retrobulbar fat. Four different ultrasound marker positions were used to delineate the optic nerve sheath, which resulted in different ONSD values and more importantly, different sensitivities to changes in ICP. Conclusions Based on our observations, we recommend to place ultrasound markers at the outer edges of the hyperechoic striped bands or at the transitions from the single dark region to the hyperechoic retrobulbar fat because these locations yielded the highest sensitivity of ONSD measurements for increased ICP.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optic nerve sheath diameter assessment by neurosonology: A review of methodologic discrepancies

Stevens

Gommer

Aries

et al. 2021

Journal of Neuroimaging

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“…7 Although intra-and interobserver variability in ONSD estimation can be low within individual studies, 8,9 ONSD cut-off values for the diagnosis of elevated ICP (>15 mmHg) vary between studies. [10][11][12][13] A possible explanation could be discrepancies in ONSD assessment methodologies between different centres [12][13][14] and discrepancies in the interpretation of the echoic behavior of the different layers of the optic nerve sheath. 12,15,16 Although ONSD assessment might be improved by standardization according to respective guidelines, ONSD values would still be dependent on the compliance of operators.…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12][13] A possible explanation could be discrepancies in ONSD assessment methodologies between different centres [12][13][14] and discrepancies in the interpretation of the echoic behavior of the different layers of the optic nerve sheath. 12,15,16 Although ONSD assessment might be improved by standardization according to respective guidelines, ONSD values would still be dependent on the compliance of operators. Differences in manual ONSD measurements might be overcome by constructing an automated framework for ONSD assessment.…”

Section: Introductionmentioning

confidence: 99%

An Automated Algorithm for Optic Nerve Sheath Diameter Assessment from B‐mode Ultrasound Images

Stevens

Huberts

Gommer

et al. 2021

Journal of Neuroimaging

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BACKGROUND AND PURPOSE:The optic nerve sheath diameter (ONSD) is a promising surrogate marker for the detection of raised intracranial pressure (ICP). However, inconsistencies in manual ONSD assessment are thought to affect ONSD and the corresponding ONSD cutoff values for the diagnosis of elevated ICP, hereby hampering the full potential of ONSD. In this study, we developed an image intensity-invariant algorithm to automatically estimate ONSD from B-mode ultrasound images at multiple depths. METHODS:The outcomes of the algorithm were validated against manual ONSD measurements by two human experts. Each expert analyzed the images twice (M1 and M2) in unknown order. RESULTS:The algorithm proved capable of segmenting the ONSD in 39 of 42 images, hereby showing mean differences of −.08 ± .45 and −.05 ± .41 mm compared to averaged ONSD values (M1 + M2/2) of Operator 1 and Operator 2, respectively, whereas the mean difference between the two experts was .03 ± .26 mm. Moreover, differences between algorithm-derived and expert-derived ONSD values were found to be much smaller than the 1 mm difference that is expected between patients with normal and elevated ICP, making it likely that our algorithm can distinguish between these patient groups. CONCLUSIONS:Our algorithm has the potential to improve the accuracy of ONSD as a surrogate marker for elevated ICP because it has no intrinsic variability. However, future research should be performed to validate if the algorithm does indeed result in more accurate noninvasive ICP predictions.

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“…Thus, the optic nerve sheath distends in response to an elevated CSF pressure only from its attachment to the sclera up to 6–8 mm behind the globe. 3 The point of maximum distension is about 3 mm posterior to the globe.…”

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confidence: 99%

Optic Nerve Sheath Ultrasound: Where do We Go from Here?

Pichamuthu¹

2021

Indian Journal of Critical Care Medicine

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Appearance of the Optic Nerve Sheath Diameter (ONSD) using Higher Frequency Linear Probes in Detection and Monitoring of Raised Intracranial Pressures-A Cadaveric Study

Cited by 5 publications

References 0 publications

Optic nerve sheath diameter assessment by neurosonology: A review of methodologic discrepancies

Optic nerve sheath diameter assessment by neurosonology: A review of methodologic discrepancies

An Automated Algorithm for Optic Nerve Sheath Diameter Assessment from B‐mode Ultrasound Images

Optic Nerve Sheath Ultrasound: Where do We Go from Here?

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