Correlation of Optic Nerve Sheath Diameter With Directly Measured Intracranial Pressure in Korean Adults Using Bedside Ultrasonography

PLoS One. 2017 Sep 13;12(9):e0183170. doi: 10.1371/journal.pone.0183170. eCollection 2017.


Objectives: The correlation of optic nerve sheath diameter (ONSD) as seen on ultrasonography (US) and directly measured intracranial pressure (ICP) has been well described. Nevertheless, differences in ethnicity and type of ICP monitor used are obstacles to the interpretation. Therefore, we investigated the direct correlation between ONSD and ventricular ICP and defined an optimal cut-off point for identifying increased ICP (IICP) in Korean adults with brain lesions.

Methods: This prospective study included patients who required an external ventricular drainage (EVD) catheter for ICP control. IICP was defined as an opening pressure over 20 mmHg. ONSD was measured using a 13 MHz US probe before the procedure. Linear regression analysis and receiver operator characteristic (ROC) curve were used to assess the association between ONSD and ICP. Optimal cut-off value for identifying IICP was defined.

Results: A total of 62 patients who underwent ONSD measurement with simultaneous EVD catheter placement were enrolled in this study. Thirty-two patients (51.6%) were found to have IICP. ONSD in patients with IICP (5.80 ± 0.45 mm) was significantly higher than in those without IICP (5.30 ± 0.61 mm) (P < 0.01). The IICP group showed more significant linear correlation with ONSD (r = 0.57, P < 0.01) compared to the non-IICP group (r = 0.42, P = 0.02). ONSD > 5.6 mm disclosed a sensitivity of 93.75% and a specificity of 86.67% for identifying IICP.

Conclusion: ONSD as seen on bedside US correlated well with directly measured ICP in Korean adults with brain lesions. The optimal cut-off point of ONSD for detecting IICP was 5.6 mm.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Intracranial Hypertension / diagnosis*
  • Intracranial Hypertension / pathology
  • Intracranial Pressure*
  • Male
  • Middle Aged
  • Monitoring, Physiologic / methods
  • Myelin Sheath / pathology*
  • Optic Nerve / diagnostic imaging*
  • Optic Nerve / pathology*
  • Organ Size
  • Point-of-Care Testing*
  • Republic of Korea
  • Ultrasonography*
  • Young Adult

Grant support

This study was supported by Hallym University Research Fund (HURF-2015-52) and National Research Foundation of Korea grant funded by the Ministry of Science, Information and Communication Technologies and Future Planning of the Korea Government (No. 2017M3A9E8033223).