The significance of ONSD, ONSD/ETD ratio, and other neuroimaging parameters in idiopathic intracranial hypertension

Önder, Halil; Goksungur, Gurol; Eliaçık, Sinan; Ulusoy, Ersin Kasım; Arslan, Guven

doi:10.1080/01616412.2021.1949688

Cited by 4 publications

(6 citation statements)

References 27 publications

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“…Two studies compared the accuracy of ONSD‐ETD ratio to ONSD alone in the detection of elevated ICP. One study ICP showed insufficient discriminative accuracy in detecting elevated ICP between the two measurements 66 . The study appears to measure the ON diameter in the “normal ICP” and ONSD in the “elevated ICP” sample MRI images, which puts the study findings into question.…”

Section: Discussionmentioning

confidence: 96%

“…One study ICP showed insufficient discriminative accuracy in detecting elevated ICP between the two measurements. 66 The study appears to measure the ON diameter in the "normal ICP" and ONSD in the "elevated ICP" sample MRI images, which puts the study findings into question. Another study evaluated ONSDint, ONSDext, and ONSD-ETD ratio in patients with brain injury and an ICP monitor.…”

Section: Other Identified Parametersmentioning

confidence: 99%

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Quality assessment of optic nerve sheath diameter ultrasonography: Scoping literature review and Delphi protocol

Hirzallah

Lochner

Hafeez

et al. 2022

Journal of Neuroimaging

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Background and Purpose:The optic nerve is surrounded by the extension of meningeal coverings of the brain. When the pressure in the cerebrospinal fluid increases, it causes a distention of the optic nerve sheath diameter (ONSD), which allows the use of this measurement by ultrasonography (US) as a noninvasive surrogate of elevated intracranial pressure. However, ONSD measurements in the literature have exhibited significant heterogeneity, suggesting a need for consensus on ONSD image acquisition and measurement. We aim to establish a consensus for an ONSD US Quality Criteria Checklist (ONSD US QCC).Methods: A scoping systematic review of published ultrasound ONSD imaging and measurement criteria was performed to guide the development of a preliminary ONSD US QCC that will undergo a modified Delphi study to reach expert consensus on ONSD quality criteria. The protocol of this modified Delphi study is presented in this manuscript.Results: A total of 357 ultrasound studies were included in the review. Quality criteria were evaluated under five categories: probe selection, safety, positioning, image acquisition, and measurement.

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Section: Discussionmentioning

confidence: 96%

Section: Other Identified Parametersmentioning

confidence: 99%

Quality assessment of optic nerve sheath diameter ultrasonography: Scoping literature review and Delphi protocol

Hirzallah

Lochner

Hafeez

et al. 2022

Journal of Neuroimaging

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“…These findings are consistent with prior reports of increased OSD in pediatric patients with increased ICP. 12,13,18 Though, these differences were not as significant in patients under anesthesia. In the anesthesia group, the mean peri-optic CSF rim in patients with papilledema was not significantly increased compared to patients without papilledema, and no significant correlation was found between the CSF rim and clinical papilledema.…”

Section: Discussionmentioning

confidence: 76%

“…Measurements of the OND and OSD were performed in transverse diameter perpendicular to the optic nerve at 3 mm behind the globe (Fig. 1), as previously described, 6,18 as the dura bulged the most at this area in an increased ICP state. 5 Measurements were obtained from both right and left orbits.…”

Section: Image Analysismentioning

confidence: 99%

Effect of General Anesthesia on MR Optic Nerve Sheath Diameter in the Pediatric Population

Cohen

Kraus

Greenberg

et al. 2023

Magnetic Resonance Imaging

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BackgroundPapilledema is thought to be the hallmark sign of increased intracranial pressure (ICP). Distension of the subarachnoid space within the optic nerve sheath is also commonly reported in MR studies as an indirect sign of increased ICP.HypothesisGeneral anesthesia and positive pressure ventilation might result in changes in optic sheath diameter (OSD) observed on clinical brain MRI.Study TypeRetrospective.PopulationOne hundred forty‐five patients (154 MRI scans, 7.3 years ± 5.1); 97 studies in the anesthesia group (4.4 years ± 3.4) of which 22 had papilledema, and 57 in the non‐anesthesia group (12.3 years ± 3.2), of which 28 had papilledema.Field Strength/Sequence1.5T or 3.0T volumetric T2 images. T2 images were obtained from different vendors.AssessmentOSD, optic nerve diameter (OND), and peri‐optic cerebrospinal fluid (CSF) were measured manually on T2‐weighted MR images for various population subgroups (with and without anesthesia; with or without papilledema). The correlation between these measurements and the clinical diagnosis of papilledema was evaluated via receiver operating characteristic (ROC) analysis.Statistical TestsChi‐square test; Mann–Whitney Test; Spearman's test and ROCs; Interclass correlation coefficient, P = 0.05.ResultsGeneral anesthesia resulted in significantly larger mean OSD in patients with or without papilledema (7.3 ± 1.0 mm vs. 6.1 ± 1.1 mm and 6.7 ± 1.0 mm vs. 5.4 ± 0.9 mm, respectively). In the non‐anesthesia group, the average OSD values (6.1 ± 1.1 mm) were significantly higher in papilledema patients compared to non‐papilledema patients (5.4 ± 0.9 mm), with larger peri‐optic CSF rim (1.6 ± 0.4 mm vs. 1.3 ± 0.3 mm). In the anesthesia group, OND was significantly larger in papilledema patients (3.4 ± 0.4 mm vs. 3.1 ± 0.5 mm), though the average peri‐optic CSF rim did not reach a significance in papilledema compared with non‐papilledema patients (2.0 ± 0.3 mm vs. 1.8 ± 0.4 mm, P = 0.06). In patients with general anesthesia, peri‐optic CSF rim had a limited correlation with increased ICP.Data ConclusionIn the pediatric population, imaging findings of increased OSD on brain MRI might be related to general anesthesia rather than increased ICP. The interpretation of optic nerve sheath distention should be reported cautiously in conjunction with anesthesia status, especially in the pediatric population.Evidence Level: 4Technical Efficacy: 5

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“…The ONSD is a reliable, non-invasive radiological marker of ICP, whether measured by magnetic resonance imaging (MRI), ultrasound or CT scan ( 11 , 14 , 18 ). Liu et al ( 11 ) suggest that ONSD can reliably predict the requirement for surgery in patients with traumatic brain injury following admission to the emergency department (AUC = 0.920, 95% CI, 0.877–0.962).…”

Section: Discussionmentioning

confidence: 99%

Optic nerve sheath diameter and optic nerve sheath diameter/eyeball transverse diameter ratio in prediction of malignant progression in ischemic stroke

et al. 2022

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BackgroundThe optic nerve sheath diameter (ONSD)/eyeball transverse diameter (ETD) ratio has been suggested in the evaluation of intracranial pressure (ICP). The aim of this study was to evaluate the predictive value of ONSD and ONSD/ETD in relation to risk for secondary malignant middle cerebral artery infarction (MMI).MethodsA total of 91 patients with MCA occlusion were included in this study. Data were divided into two groups based on development of MMI or not. ONSD and ETD were measured by unenhanced computed tomography (CT). The differences in ONSD and the ONSD/ETD ratios between the MMI and non-MMI groups were compared. Receiver operating characteristic curve analyses were used to test the diagnostic value of ONSD and ONSD/ETD independently, to predict MMI.ResultsThe ONSD in the MMI group and non-MMI group were 5.744 ± 0.140 mm and 5.443 ± 0.315 mm, respectively (P = 0.001). In addition, the ONSD/ETD ratios in the MMI group and non-MMI group were 0.258 ± 0.008 and 0.245 ± 0.006, respectively (P = 0.001). The receiver operating characteristic (ROC) curve demonstrated an area under the curve (AUC) for ONSD of 0.812 [95% confidence interval (CI): 0.718–0.906, P = 0.001], with a sensitivity of 97.4% and a specificity of 66.0% at the cut-off value of 5.520 mm. The AUC for ONSD/ETD ratio in predicting occurrence of MMI was 0.895 (95% CI: 0.823–0.968, P = 0.001), with a sensitivity of 84.2% and a specificity of 92.5% at a cut-off value of 0.250.ConclusionIn acute stroke patients with massive cerebral infarction, an increased ONSD or ONSD/ETD ratio increases the odds of malignant progression and may be used as an indicator for emergent therapeutic interventions. In addition, the ONSD/ETD ratio may be more valuable than ONSD in predicting the malignant progression of acute stroke patients.

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The significance of ONSD, ONSD/ETD ratio, and other neuroimaging parameters in idiopathic intracranial hypertension

Cited by 4 publications

References 27 publications

Quality assessment of optic nerve sheath diameter ultrasonography: Scoping literature review and Delphi protocol

Quality assessment of optic nerve sheath diameter ultrasonography: Scoping literature review and Delphi protocol

Effect of General Anesthesia on MR Optic Nerve Sheath Diameter in the Pediatric Population

Optic nerve sheath diameter and optic nerve sheath diameter/eyeball transverse diameter ratio in prediction of malignant progression in ischemic stroke

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