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Byug Chul Yu 1 Article
Correlation between Optic Nerve Sheath Diameter Measured by Computed Tomography and Elevated Intracranial Pressure in Patients with Traumatic Brain Injury
Tae Kyoo Lim, Byug Chul Yu, Dae Sung Ma, Gil Jae Lee, Min A Lee, Sung Yeol Hyun, Yang Bin Jeon, Kang Kook Choi
J Trauma Inj. 2017;30(4):140-144.   Published online December 30, 2017
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AbstractAbstract PDF

The optic nerve sheath diameter (ONSD) measured by ultrasonography is among the indicators of intracranial pressure (ICP) elevation. However, whether ONSD measurement is useful for initial treatment remains controversial. Thus, this study aimed to investigate the relationship between ONSD measured by computed tomography (CT) and ICP in patients with traumatic brain injury (TBI).


A total of 246 patients with severe trauma from January 1, 2015 until December 31, 2015 were included in the study. A total of 179 patients with brain damage with potential for ICP elevation were included in the TBI group. The remaining 67 patients comprised the non-TBI group. A comparison was made between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to determine the accuracy of ONSD when used as a screening test for the TBI group including those with TBI with midline shift (with elevated ICP).


The mean injury severity score (ISS) and glasgow coma scale (GCS) of all patients were 24.2±6.1 and 5.4±0.8, respectively. The mean ONSD of the TBI group (5.5±1.0 mm) was higher than that of the non-TBI group (4.7±0.6 mm). Some significant differences in age (55.3±18.1 vs. 49.0±14.8, p<0.001), GCS (11.7±4.1 versus 13.3±3.0, p<0.001), and ONSD (5.5±1.0 vs. 4.7±0.6, p<0.001) were observed between the TBI and the non-TBI group. An ROC analysis was used to assess the correlation between TBI and ONSD. Results showed an area under the ROC curve (AUC) value of 0.752. The same analysis was used in the TBI with midline shift group, which showed an AUC of 0.912.


An ONSD of >5.5 mm, measured on CT, is a good indicator of ICP elevation. However, since an ONSD is not sensitive enough to detect an increased ICP, it should only be used as one of the parameters in detecting ICP along with other screening tests.



Citations to this article as recorded by  
  • Correlation Between Optic Nerve Sheath Diameter at Initial Head CT and the Rotterdam CT Score
    Aletor O Amakhian, Elohor B Obi-Egbedi-Ejakpovi, Eghosa Morgan, Ademola A Adeyekun, Munir M Abubakar
    Cureus.2023;[Epub]     CrossRef
  • Sono-clinical decision rule for repeat head computed tomography scan in traumatic brain injury in emergency settings
    Priyanka Modi, Sanjeev Bhoi, Savan Pandey
    WFUMB Ultrasound Open.2023; 1(2): 100026.     CrossRef
  • Sonographic Measurement of the Optic Nerve Sheath Diameter to Improve Detection of Elevated Intracranial Pressure
    Faten Farid Awdallah, Islam Hassan Abulnaga, Suzy Fawzy Michael, Hassan Khaled Nagi, Mohamed Hosny Abdallah
    Biomedical and Pharmacology Journal.2022; 15(3): 1677.     CrossRef
  • Serial Optic Nerve Sheath Diameter via Radiographic Imaging
    Diane McLaughlin, Lisa Anderson, Jinhong Guo, Molly McNett
    Neurology Clinical Practice.2021;[Epub]     CrossRef
  • The association between intracranial pressure and optic nerve sheath diameter on patients with head trauma
    Kaan Çelik, Bekir Enes Demiryurek
    Arquivos de Neuro-Psiquiatria.2021; 79(10): 879.     CrossRef
  • MRI measurement of optic nerve sheath diameter using 3D driven equilibrium sequence as a non-invasive tool for the diagnosis of idiopathic intracranial hypertension
    Ahmed S. Abdelrahman, Mai M. K. Barakat
    Egyptian Journal of Radiology and Nuclear Medicine.2020;[Epub]     CrossRef

J Trauma Inj : Journal of Trauma and Injury