探讨应用剪切波弹性成像（SWE）测量的视乳头平均杨氏模量（Emean）联合二维超声测量的视神经鞘直径（ONSD），对脑出血所致颅内压升高的诊断价值，并分析上述参数与视盘水肿严重程度的相关性。

前瞻性纳入2022年2月至2024年12月南昌大学第二附属医院脑出血致颅内高压患者及健康志愿者各36例。对患者行眼底检查，并依据Frisén量表对视盘水肿进行分级，根据最终分级结果，将颅内高压组患者进一步分为无/轻度水肿亚组与中/重度水肿亚组。采用二维超声测量ONSD，应用SWE技术测量视乳头Emean。采用独立样本t检验比较组间ONSD与Emean的差异；通过受试者操作特征（ROC）曲线评估各参数及联合参数模型（由二元Logistic回归构建）的诊断效能；采用Spearman等级相关分析评估颅内高压组内各参数与视盘水肿分级的相关性。

颅内高压组ONSD与Emean均显著高于健康对照组[（5.42±0.72）mm vs（4.53±0.25）mm；（25.38±2.72）kPa vs（17.65±1.48）kPa]，差异具有统计学意义（t=6.881、14.786，P均＜0.001）。诊断颅内高压的ONSD、Emean临界值分别为5.10 mm和21.2 kPa，其曲线下面积（AUC）分别为0.83和0.93，而两者联合诊断的AUC达0.95。亚组分析显示，中/重度水肿亚组ONSD与Emean均显著高于无/轻度水肿亚组[15例 vs 21例；（5.86±0.65）mm vs（5.12±0.61）mm；（28.02±1.98）kPa vs（23.45±2.01）kPa]，差异具有统计学意义（t=3.452，P=0.002；t=6.577，P＜0.001）。相关性分析进一步表明，Emean及ONSD均与视盘水肿分级呈正相关（r=0.782、0.621，P均＜0.001）。

由ONSD与Emean构成的超声多模态参数，对脑出血所致颅内压升高具有良好的诊断价值，且其参数变化与视盘水肿严重程度相关。联合应用两项参数可进一步提高诊断效能，为颅内高压的无创评估提供了新的影像学方法。

To investigate the diagnostic value of combined shear wave elastography (SWE)-derived mean Young's modulus (Emean) of the optic disc and optic nerve sheath diameter (ONSD) for detecting increased intracranial pressure (ICP) due to intracerebral hemorrhage, and to explore the correlation of these parameters with the severity of optic disc edema.

This prospective study enrolled 36 patients with intracranial hypertension secondary to intracerebral hemorrhage and 36 healthy volunteers at the Second Affiliated Hospital of Nanchang University between February 2022 and December 2024. All patients underwent funduscopic examination, and optic disc edema was graded using the Frisén scale. Based on the grading results, the intracranial hypertension group was further subdivided into a no/mild edema subgroup and a moderate/severe edema subgroup. ONSD was measured using two-dimensional ultrasound, while Emean of the optic nerve head was assessed via SWE. Intergroup differences in ONSD and Emean were compared using independent-samples t-tests. The diagnostic performance of each individual parameter and the combined model (constructed by binary logistic regression) was evaluated using receiver operating characteristic (ROC) curves. Spearman rank correlation analysis was applied to assess the relationship between each parameter and the optic disc edema grade within the intracranial hypertension group.

Both ONSD and Emean were significantly higher in the intracranial hypertension group than in the control group [(5.42±0.72) mm vs (4.53±0.25) mm, t=6.881; (25.38±2.72) kPa vs (17.65±1.48) kPa, t=14.786; both P＜0.001]. The optimal cutoff values of ONSD and Emean for diagnosing intracranial hypertension were 5.10 mm and 21.2 kPa, yielding areas under the curve (AUC) of 0.83 and 0.93, respectively. The combined model achieved an AUC of 0.95, surpassing that of either parameter alone. Subgroup analysis revealed that both ONSD and Emean were significantly higher in the moderate/severe edema subgroup than in the no/mild edema subgroup [15 vs 21 cases; (5.86±0.65) mm vs (5.12±0.61) mm, t=3.452, P=0.002; (28.02±1.98) kPa vs (23.45±2.01) kPa, t=6.577, P＜0.001]. Furthermore, Spearman correlation analysis demonstrated that both Emean and ONSD were positively correlated with the grade of optic disc edema (r=0.782 and 0.621, respectively; both P＜0.001).

The multimodal ultrasound parameters comprising ONSD and SWE-derived Emean demonstrate good diagnostic value for intracranial hypertension caused by intracerebral hemorrhage, and their changes correlate with the severity of optic disc edema. The combination of these two parameters further enhances diagnostic performance, providing a novel non-invasive imaging approach for the assessment of elevated intracranial pressure.