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.