ArticleJournal of neuroimaging : official journal of the American Society of Neuroimaging
Optic Nerve Sheath Diameter: Which Axis Should Be Measured?
Article in Journal of neuroimaging : official journal of the American Society of Neuroimaging. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- 3D Imaging and Measurement of Optic Nerve Sheath Diameter.Translational vision science & technology · 2026Article
- Systematic review of the diagnostic accuracy of noninvasive intracranial pressure monitoring using optic nerve sheath diameter and the Brain4Care system.Brain & spine · 2026Review
- Measuring optic nerve sheath diameter in children: a simple ultrasound protocol for ICP assessment.Frontiers in pediatrics · 2025Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
background and purposeOptic nerve sheath diameter (ONSD) measured by point-of-care ultrasound (POCUS) is a commonly used non-invasive estimate of intracranial pressure (ICP). However, methodological variations limit standardization of this promising technique. Different imaging axes are identified as one such source of ONSD POCUS methodological variation. This study aimed to evaluate the agreement and diagnostic accuracy for elevated ICP between transverse and sagittal ONSD measurements.
methodsWe conducted a post-hoc analysis of 213 intensive care patients from three prior studies. ONSD was measured in both transverse and sagittal planes, externally (ONSDext) and internally (ONSDint) of the dura mater. Agreement was assessed using Lin's concordance correlation coefficient (CCC). Diagnostic accuracy for detecting ICP ≥20 mmHg was evaluated using area under the receiver operator characteristics curve (AUROC) analyses in a subset of 139 patients.
resultsSagittal ONSD was significantly larger than transverse ONSD (median difference 0.2 mm, p<0.001). Agreement between transverse and sagittal ONSD was poor (CCC: 0.65 and 0.70 for right and left side ONSDext, and 0.43 and 0.51 for right and left side ONSDint). No significant differences in AUROC were found between transverse, sagittal, or averaged measurements.
conclusionsTransverse and sagittal ONSD measurements are not interchangeable due to significant differences and poor agreement. Diagnostic accuracy was similar across methods. These findings support continued use of transverse measurement as the standard approach for ONSD POCUS in clinical practice.
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