Optic nerve sheath diameter threshold by ocular ultrasonography for detection of increased intracranial pressure in Korean adult patients with brain lesions

Abstract

Optic nerve sheath diameter (ONSD) seen on ocular US has been associated with increased intracranial pressure (IICP). However, most studies have analyzed normal range of ONSD and its optimal cut-off point for IICP in Caucasian populations. Considering ONSD differences according to ethnicity, previous results may not accurately reflect the association between IICP and ONSD in Koreans. Therefore, we conducted this study to investigate normal range of ONSD and its optimal threshold for detecting IICP in Korean patients.This prospective multicenter study was performed for patients with suspected IICP. ONSD was measured 3 mm behind the globe using a 13-MHz US probe. IICP was defined as significant brain edema, midline shift, compression of ventricle or basal cistern, effacement of sulci, insufficient gray/white differentiation, and transfalcine herniation by radiologic tests. The results of the ONSD are described as the median (25th–75th percentile). The differences of ONSD according to disease entity were analyzed. A receiver operator characteristic (ROC) curve was generated to determine the optimal cut-off point for identifying IICP.A total of 134 patients were enrolled. The patients were divided into 3 groups as follows: patients with IICP, n = 81 (60.5%); patients without IICP, n = 27 (20.1%); and control group, n = 26 (19.4%). ONSD in patients with IICP (5.9 mm [5.8–6.2]) is significantly higher than those without IICP (5.2 mm [4.8–5.4]) (P < 0.01) and normal control group (4.9 mm [4.6–5.2]) (P < 0.001). Between patients without IICP and normal control group, the difference of ONSD did not reach statistical significance (P = 0.31). ONSD >5.5 mm yielded a sensitivity of 98.77% (95% CI: 93.3%–100%) and a specificity of 85.19% (95% CI: 66.3%–95.8%).In conclusion, the optimal cut-off point of ONSD for identifying IICP was 5.5 mm. ONSD seen on ocular US can be a feasible method for detection and serial monitoring of ICP in Korean adult patients.

Ultrasonographic measurement of the optic nerve sheath diameter and its association with eyeball transverse diameter in 585 healthy volunteers

“…In addition, the upper normal ONSD limit (5.2 mm) and the upper bound of the 95% CI (4.14 mm) for the mean ONSD value corroborated with the optimal cut-off value for the identification of elevated ICP suggested by previous studies where the lowest bound of ONSD values was ≥5.2 mm in patients with elevated ICP 30 – 36 . Although some authors insist that ONSD is influenced by ethnicity, we could not find obvious differences between Korea and other countries 13 , 14 , 16 , 35 , 37 .…”

Ultrasonography Monitoring of Optic Nerve Sheath Diameter and Retinal Vessels in Patients with Cerebral Hemorrhage

“…These discrepancies may depend on various factors, including the execution technique, the subject selection, the underlying pathology and ethnicity, limiting the validation of the method for a more extensive use. Our optimal cut‐off point for the detection of raised ICP was 5.6 mm, being in‐line with cited previous reports and more recent findings …”

“…Our optimal cut-off point for the detection of raised ICP was 5.6 mm, being in-line with cited previous reports and more recent findings. 30,31 This study presents some limitations like the small study population and that we presumed that ICP was normal in control subjects without performing a CSF opening pressure evalua-tion. Additionally, we are aware of the limited predictive value of abnormal CT findings in the assessment of ICP.…”

Correlation of optic nerve sheath diameter with directly measured intracranial pressure in Korean adults using bedside ultrasonography

“…Regarding the East Asian population, a recent study conducted on healthy Chinese volunteers reported a mean ONSD of 5.1 mm (range, 4.7–5.4 mm) and a study performed on a Korean population found a mean ONSD of 4.9 mm (range, 4.6–5.2 mm) in the normal control group, similar to that of the healthy Chinese population, and a mean ONSD of 5.9 mm (range, 5.8–6.2 mm) in the IICP group diagnosed using brain CT scans, with a cut-off value of 5.5 mm [ 7 , 8 ]. However, these studies did not correlate ONSD with directly measured ICP.…”