3D Imaging and Measurement of Optic Nerve Sheath Diameter

The subarachnoid space between the dura and the pia mater is filled with cerebrospinal fluid, and, with elevated intracranial pressure, optic nerve sheath diameter (ONSD) will consequently increase. ONSD measurement thus serves as a non-invasive means for detecting intracranial hypertension. B-scans, however, only measure ONSD in a plane, and axial symmetry is assumed. In this study, we evaluated a novel ultrasound system for three-dimensional (3D) imaging and measurement of ONSD.

We imaged both eyes of 18 subjects using 15-MHz B-scans and a prototype 3D system. In this system, a focused single-element transducer was moved in a spiral pattern to sweep out a volume in approximately 5 seconds. We compared transverse B-scan ONSD measurements with values derived from cross-sections of 3D scans.

Mean ONSD was 5.32 ± 0.79 mm by B-scan and 5.57 ± 0.61 mm by 3D. The larger measurement by 3D was borderline statistically significant (P = 0.05). The within-eye variability between repeated measurements was comparable. Bland-Altman analysis showed no trend associated with increasing or decreasing ONSD. Eccentricity of 3D ONSD best-fit ellipses to nerve coronal sections averaged 0.51 ± 0.098.

The 3D prototype 5-second acquisition was faster than prior mechanical systems based on single element probes but still somewhat vulnerable to motion artifacts. The ability to assess the ONSD in three dimensions rather than as a transverse cross-section offers an avenue toward improved assessment of nerve anatomy and detection of intracranial hypertension.

3D imaging of the optic nerve offers improved assessment of changes associated with elevated intracranial pressure.