Net optic nerve sheath diameter as a factor for predicting intracranial hypertension

Q: What was the study’s main goal?

To evaluate correlations between MRI-derived optic nerve parameters and ICP, and to assess their diagnostic value for predicting intracranial hypertension.

Q: How were optic nerve parameters and ICP measured?

Optic nerve parameters (OND, ONSD, nONSD, and ONSD/EBTD) were measured on cranial MRI. ICP was determined by lumbar puncture, with elevated ICP defined as >250 mmH2O.

Sep 30, 2026

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Net optic nerve sheath diameter is evaluated as a non-invasive indicator for predicting intracranial hypertension. A retrospective cohort of 112 patients with clinically suspected intracranial infection underwent lumbar puncture and cranial MRI between October 2020 and September 2022. Optic nerve parameters including OND, ONSD, nONSD (ONSD − OND), and ONSD/EBTD were measured, with ICP defined by lumbar puncture as >250 mmH2O. Results show elevated ICP associated with higher ONSD, nONSD, and ONSD/EBTD, and nONSD provides notable predictive accuracy.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Background

Methods

Results

Conclusions

Keywords

Original Article Net optic nerve sheath diameter as a factor for predicting intracranial hypertension Chi Niu1\#, Yifan Wang1\#, Bin Xu1, Zheng Chen1, Thara Tunthanathip2, Jingming Liu1 1Department of Emergency, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; 2Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand Contributions: (I) Conception and design: C Niu, Y Wang; (II) Administrative support: J Liu, B Xu; (III) Provision of study materials or patients: C Niu, B Xu, Z Chen; (IV) Collection and assembly of data: Y Wang, Z Chen; (V) Data analysis and interpretation: C Niu, B Xu; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. \#These authors contributed equally to this work. Correspondence to: Jingming Liu, MD. Department of Emergency, Beijing Tiantan Hospital, Capital Medical University, No. 119 West Rd., Southern Fourth Ring Road, Beijing 100070, China. Email: [liujingming1977@163.com](liujingming1977@163.com). Background: The assessment of intracranial pressure (ICP) is crucial in the management of neurological emergencies. Although invasive ICP monitoring has been widely used for the early diagnosis of intracranial hypertension, its routine application remains controversial for various reasons. This study aimed to evaluate the correlations between optic nerve parameters measured using cranial magnetic resonance imaging (MRI) and ICP, and to assess their diagnostic value in predicting intracranial hypertension. Methods: The data of 112 patients with clinically suspected intracranial infections who underwent lumbar puncture (LP) and cranial MRI between October 2020 and September 2022 were retrospectively collected. Several optic nerve-related parameters were measured via cranial MRI, including optic nerve diameter (OND), optic nerve sheath diameter (ONSD), and eyeball transverse diameter (EBTD) . The net optic nervesheath diameter (nONSD; calculated as ONSD − OND) and the ONSD:EBTD ratio (ONSD/EBTD) were also calculated. ICP was determined via LP, with elevated ICP defined as >250 mmH2O. The correlation between ocular parameters and ICP, along with the predictive value of these parameters for intracranial hypertension, was determined. Results: Among the included patients, 41 were found to have elevated ICP. In comparison with patients with normal ICP, those with intracranial hypertension had a higher median ONSD {5.23 [interquartile range (IQR) 4.85–5.83] vs. 4.83 (IQR 3.54–5.17) mm; P<0.001}, nONSD [2.62 (IQR 2.60–3.07) vs. 2.22 (IQR 1.85–2.40) mm; P<0.001], and ONSD/EBTD [0.23 (IQR 0.21–0.24) vs. 0.20 (IQR 0.15–0.23); P<0.001] . Moderate significant linear correlations were found between ONSD and ICP (r=0.36; P<0.001), ONSD/ EBTD and ICP (r=0.36; P<0.001), and nONSD and ICP (r=0.61; P<0.001) . The nONSD showed relatively promising predictive accuracy among the whole patient group: at an nONSD threshold of 2.52 mm, the specificity was 88.7%, and the positive predictive value (PPV) was 80% . Conclusions: nONSD demonstrates strong potential as a non-invasive predictor of elevated ICP. Nonetheless, further prospective studies in varied populations are needed to establish the generalizability and clinical application of nONSD. Keywords: Intracranial hypertension (ICP); optic nerve sheath diameter (ONSD); emergency department Submitted Aug 02, 2025. Accepted for publication Nov 11, 2025. Published online Dec 11, 2025. doi: 10.21037/qims-2025-1671 View this article at: [https://dx.doi.org/10.21037/qims-2025-1671](https://dx.doi.org/10.21037/qims-2025-1671) © AME Publishing Company. Quant Imaging Med Surg 2026;16(1):70 | [https://dx.doi.org/10.21037/qims-2025-1671](https://dx.doi.org/10.21037/qims-2025-1671) Page 2 of 9 Niu et al. ONSD for ICP prediction Introduction The evaluation of intracranial pressure (ICP) is crucial for the management of neurologi

FAQs

What was the study’s main goal?

To evaluate correlations between MRI-derived optic nerve parameters and ICP, and to assess their diagnostic value for predicting intracranial hypertension.

How were optic nerve parameters and ICP measured?

Optic nerve parameters (OND, ONSD, nONSD, and ONSD/EBTD) were measured on cranial MRI. ICP was determined by lumbar puncture, with elevated ICP defined as >250 mmH2O.

Which parameter showed the best predictive performance?

The net optic nerve sheath diameter (nONSD) showed relatively promising predictive accuracy, with an nONSD threshold of 2.52 mm yielding specificity 88.7% and positive predictive value 80%.

Sep 30, 2026

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