2024年视神经鞘直径超声成像和测量国际共识解读

doi:10.3969/j.issn.1673-5765.2025.04.011

摘要/Abstract

摘要： 视神经鞘直径（optic nerve sheath diameter，ONSD）的超声成像和测量一直是备受临床和影像医师关注的话题。2024年，来自多个国家的ONSD超声领域专家共同制定了ONSD超声成像和测量国际共识，并将其发表在Critical Care Medicine上。该共识中的ONSD即时超声质量标准检查表给出了ONSD超声成像、测量的标准化建议，并对后续相关研究中ONSD测量的技术细节、培训建议进行了说明。本文对该专家共识进行解读。

关键词: 视神经鞘直径; 专家共识; 超声; 颅内压

Abstract: Ultrasound imaging and measurement of the optic nerve sheath diameter (ONSD) have long been a topic of significant interest among clinicians and radiologists. In 2024, experts in ONSD ultrasound from multiple countries jointly established an international consensus on ONSD ultrasound imaging and measurement, published in Critical Care Medicine. This consensus introduced the ONSD point-of-care ultrasonography quality criteria checklist, providing standardized recommendations for ONSD ultrasound imaging and measurement. It also provided explanations on the technical details and training suggestions for ONSD measurement in subsequent related research. This article interprets this expert consensus.

Key words: Optic nerve sheath diameter; Expert consensus; Ultrasound; Intracranial pressure

中图分类号:

田兵, 周福波, 王丽娟, 邢英琦. 2024年视神经鞘直径超声成像和测量国际共识解读[J]. 中国卒中杂志, 2025, 20(4): 470-478.

TIAN Bing, ZHOU Fubo, WANG Lijuan, XING Yingqi. Interpretation of the 2024 International Consensus on Optic Nerve Sheath Diameter Ultrasound Imaging and Measurement[J]. Chinese Journal of Stroke, 2025, 20(4): 470-478.

参考文献

[1] LIU D，KAHN M. Measurement and relationship of subarachnoid pressure of the optic nerve to intracranial pressures in fresh cadavers[J]. Am J Ophthalmol，1993，116（5）：548-556.
[2] GEERAERTS T，LAUNEY Y，MARTIN L，et al. Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury[J]. Intensive Care Med，2007，33（10）：1704-1711.
[3] SOLIMAN I，JOHNSON G G R J，GILLMAN L M，et al. New optic nerve sonography quality criteria in the diagnostic evaluation of traumatic brain injury[J/OL]. Crit Care Res Pract，2018，2018：3589762[2025-01-10]. https://doi.org/10.1155/2018/3589762.
[4] BHARGAVA V，TAWFIK D，TAN Y J，et al. Ultrasonographic optic nerve sheath diameter measurement to detect intracranial hypertension in children with neurological injury：a systematic review[J/OL]. Pediatr Crit Care Med，2020，21（9）：e858-e868[2025-01-10]. https://doi.org/10.1097/PCC.0000000000002453.
[5] FERNANDO S M，TRAN A，CHENG W，et al. Diagnosis of elevated intracranial pressure in critically ill adults：systematic review and meta-analysis[J/OL]. BMJ，2019，366：l4225[2025-01-10]. https://doi.org/10.1136/bmj.l4225.
[6] ALETREBY W，ALHARTHY A，BRINDLEY P G，et al. Optic nerve sheath diameter ultrasound for raised intracranial pressure：a literature review and meta-analysis of its diagnostic accuracy[J]. J Ultrasound Med，2022，41（3）：585-595.
[7] MONTORFANO L，YU Q，BORDES S J，et al. Mean value of B-mode optic nerve sheath diameter as an indicator of increased intracranial pressure：a systematic review and meta-analysis[J/OL]. Ultrasound J，2021，13（1）：35[2025-01-10]. https://doi.org/10.1186/s13089-021-00235-5.
[8] HIRZALLAH M I，LOCHNER P，HAFEEZ M U，et al. Quality assessment of optic nerve sheath diameter ultrasonography：scoping literature review and Delphi protocol[J]. J Neuroimaging，2022，32（5）：808-824.
[9] HIRZALLAH M I，LOCHNER P，HAFEEZ M U，et al. Optic nerve sheath diameter point-of-care ultrasonography quality criteria checklist：an international consensus statement on optic nerve sheath diameter imaging and measurement[J]. Crit Care Med，2024，52（10）：1543-1556.
[10] LOCHNER P，BEHNKE S，FASSBENDER K，et al. Simulation and experimental characterization of lateral imaging resolution of ultrasound systems and assessment of system suitability for acoustic optic nerve sheath diameter measurement[J]. J Neuroimaging，2019，29（1）：34-41.
[11] American Institute of Ultrasound in Medicine：as low as reasonably achievable（ALARA）principle[EB/OL].（2020-05-19）[2025-01-24]. https://www.aium.org/resources/guidelines.aspx.
[12] U. S. Department of Health and Human Services Food and Drug Administration Center for Devices and Radiological Health：marketing clearance of diagnostic ultrasound systems and transducers guidance for Industry and Food and Drug Administration staff[EB/OL].（2019-06-27）[2025-01-24]. https://www.fda.gov/media/71100/download.
[13] ABRAMOWICZ J S，ADHIKARI S，DICKMAN E，et al. Ocular ultrasound：review of bioeffects and safety，including fetal and point of care perspective：review of bioeffects and safety，including fetal and point-of-care perspective[J]. J Ultrasound Med，2022，41（7）：1609-1622.
[14] BORA V，SOOD G，DUNVILLE L M，et al. Oculocardiac reflex[EB/OL].（2024-05-07）[2025-01-24]. https://pubmed.ncbi.nlm.nih.gov/29763007/.
[15] MARKS A，PATEL D，CHOTTINER M，et al. Covered or uncovered：a randomized control trial of Tegaderm versus no Tegaderm for ocular ultrasound[J/OL]. Am J Emerg Med，2022，61：87-89[2025-01-10].
https://doi.org/10.1016/j.ajem.2022.08.044.
[16] FICHTNER J，ULRICH C T，FUNG C，et al. Management of spontaneous intracranial hypotension—transorbital ultrasound as discriminator[J]. J Neurol Neurosurg Psychiatry，2016，87（6）：650-655.
[17] CHIN J H，SEO H，LEE E H，et al. Sonographic optic nerve sheath diameter as a surrogate measure for intracranial pressure in anesthetized patients in the Trendelenburg position[J/OL]. BMC Anesthesiol，2015，15：43[2025-01-10]. https://doi.org/10.1186/s12871-015-0025-9.
[18] USTICK J J，PARDON L P，CHETTRY P，et al. Effects of head-down tilt on optic nerve sheath diameter in healthy subjects[J]. Ophthalmic Physiol Opt，2023，43（6）：1531-1539.
[19] KERMORGANT M，LABRUNÉE M，DESPAS F，et al. How does head position induced intracranial pressure changes impact sympathetic activity and cerebral blood flow？[J/OL]. Auton Neurosci，2022，243：103036[2025-01-10]. https://doi.org/10.1016/j.autneu.2022.103036.
[20] MARSHALL-GOEBEL K，TERLEVIĆ R，GERLACH D A，et al. Lower body negative pressure reduces optic nerve sheath diameter during head-down tilt[J]. J Appl Physiol（1985），2017，123（5）：1139-1144.
[21] BLECHA S，HARTH M，SCHLACHETZKI F，et al. Changes in intraocular pressure and optic nerve sheath diameter in patients undergoing robotic-assisted laparoscopic prostatectomy in steep 45° Trendelenburg position[J/OL]. BMC Anesthesiol，2017，17（1）：40[2025-01-10]. https://doi.org/10.1186/s12871-017-0333-3.
[22] ERTL M，AIGNER R，KROST M，et al. Measuring changes in the optic nerve sheath diameter in patients with idiopathic normal-pressure hydrocephalus：a useful diagnostic supplement to spinal tap tests[J]. Eur J Neurol，2017，24（3）：461-467.
[23] DEMER J L. Optic nerve sheath as a novel mechanical load on the globe in ocular duction[J]. Invest Ophthalmol Vis Sci，2016，57（4）：1826-1838.
[24] SAENZ R，CHENG H，PRAGER T C，et al. Use of A-scan ultrasound and optical coherence tomography to differentiate papilledema from pseudopapilledema[J]. Optom Vis Sci，2017，94（12）：1081-1089.
[25] RAVAL R，SHEN J，LAU D，et al. Comparison of three point-of-care ultrasound views and MRI measurements for optic nerve sheath diameter：a prospective validity study[J]. Neurocrit Care，2020，33（1）：173-181.
[26] HEDRICK W，PETERSON C. Image artifacts in real-time ultrasound[J]. J Diagn Med Sonogr，1995，11（6）：300-308.
[27] COPETTI R，CATTAROSSI L. Optic nerve ultrasound：artifacts and real images[J]. Intensive Care Med，2009，35（8）：1488-1491.
[28] ASPIDE R，BERTOLINI G，ALBINI R L，et al. A proposal for a new protocol for sonographic assessment of the optic nerve sheath diameter：the CLOSED protocol[J]. Neurocrit Care，2020，32（1）：327-332.
[29] PANSELL J，BELL M，RUDBERG P，et al. Optic nerve sheath diameter measurement by ultrasound：evaluation of a standardized protocol[J]. J Neuroimaging，2022，32（1）：104-110.
[30] WANG X F，FISHER L K，MILEA D，et al. Predictions of optic nerve traction forces and peripapillary tissue stresses following horizontal eye movements[J]. Invest Ophthalmol Vis Sci，2017，58（4）：2044-2053.
[31] PANSELL J，BELL M，RUDBERG P，et al. Optic nerve sheath diameter in intracranial hypertension：measurement external or internal of the dura mater？[J]. J Neuroimaging，2023，33（1）：58-66.
[32] STEVENS R R F，HUBERTS W，GOMMER E D，et al. An automated algorithm for optic nerve sheath diameter assessment from B-mode ultrasound images[J]. J Neuroimaging，2021，31（4）：724-732.
[33] BÄUERLE J，SCHUCHARDT F，SCHROEDER L，et al. Reproducibility and accuracy of optic nerve sheath diameter assessment using ultrasound compared to magnetic resonance imaging[J/OL]. BMC Neurol，2013，13：187[2025-01-10]. https://doi.org/10.1186/1471-2377-13-187.
[34] STEINBORN M，FIEGLER J，KRAUS V，et al. High resolution ultrasound and magnetic resonance imaging of the optic nerve and the optic nerve sheath：anatomic correlation and clinical importance[J]. Ultraschall Med，2011，32（6）：608-613.
[35] BÄUERLE J，NEDELMANN M. Sonographic assessment of the optic nerve sheath in idiopathic intracranial hypertension[J]. J Neurol，2011，258（11）：2014-2019.
[36] STEAD G A，CRESSWELL F V，JJUNJU S，et al. The role of optic nerve sheath diameter ultrasound in brain infection[J/OL]. eNeurologicalSci，2021，23：100330[2025-01-10]. https://doi.org/10.1016/j.ensci.2021.100330.