Noninvasive Transorbital Assessment of the Optic Nerve Sheath in Children: Relationship Between Optic Nerve Sheath Diameter, Deformability Index, and Intracranial Pressure

Oper Neurosurg (Hagerstown). 2019 Jun 1;16(6):726-733. doi: 10.1093/ons/opy231.


Background: Measurement of optic nerve sheath diameter (ONSD) is a promising technique for noninvasive assessment of intracranial pressure (ICP), but has certain limitations. A recent study showed that the deformability index (DI), a dynamic parameter quantifying the pulsatile nature of the optic nerve sheath, could differentiate between patients with high vs normal ICP.

Objective: To further evaluate the diagnostic accuracy of the DI, when interpreted together with ONSD.

Methods: This prospective study included children undergoing invasive ICP measurement as part of their clinical management. Ultrasound images of the optic nerve sheath were acquired prior to measuring ICP, the images were further processed to obtain the DI. Patients were dichotomized into high (≥20 mm Hg) or normal ICP groups and compared using the Mann-Whitney U-test. Diagnostic accuracy was described using area under the receiver operating characteristic curve (AUC), sensitivity and specificity, correlation between DI, ONSD, and ICP was investigated using linear regression.

Results: A total of 28 patients were included (19 high ICP). The DI was lower in the high ICP group (0.105 vs 0.28, P = .001). AUC was 0.87, and a cut-off value of DI ≤ 0.185 demonstrated sensitivity of 89.5% and specificity of 88.9%. Diagnostic accuracy improved when combining DI with ONSD (AUC 0.98, sensitivity 94.7%, specificity 88.9%) and correlation with ICP improved when combined analysis of DI and ONSD was performed (Pearson correlation coefficient: 0.82 vs 0.42, respectively, P = .012).

Conclusion: The DI was significantly lower for patients with high vs normal ICP. This relationship improved further when the DI and ONSD were interpreted together.

Keywords: Deformability index; Noninvasive ICP; Optic nerve sheath; Ultrasound.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain Injuries, Traumatic / complications
  • Cerebral Ventricle Neoplasms / complications
  • Child
  • Child, Preschool
  • Craniosynostoses / complications
  • Female
  • Humans
  • Hydrocephalus / complications
  • Infant
  • Intracranial Hypertension / diagnostic imaging*
  • Intracranial Hypertension / etiology
  • Intracranial Hypertension / pathology
  • Intracranial Pressure*
  • Male
  • Monitoring, Physiologic
  • Myelin Sheath / pathology*
  • Myelin Sheath / physiology
  • Optic Nerve / diagnostic imaging*
  • Optic Nerve / pathology
  • Optic Nerve / physiopathology
  • Orbit
  • Organ Size
  • Prospective Studies
  • Ultrasonography / methods*