| Summary: | Abstract Background To develop and validate a multimodal transorbital ultrasound model for noninvasive detection of increased intracranial pressure (IICP) by integrating anatomical and hemodynamic parameters. Methods In this prospective diagnostic study, 136 neurology patients scheduled for lumbar puncture underwent pre-procedural ultrasound measurement of optic nerve sheath diameter (ONSD), ONSD-to-eyeball transverse diameter ratio (ONSD/ETD), and central retinal artery hemodynamics (peak systolic velocity [PSV], resistance index [RI]). Patients were classified as IICP (CSF pressure > 200 mmH₂O) or normal ICP (NICP) groups. Parameter performance was analyzed via ROC curves; multivariate logistic regression constructed a predictive model. Results The IICP group (n = 52) showed significantly higher ONSD (5.06 ± 0.49 vs. 4.19 ± 0.82 mm), ONSD/ETD (0.24 ± 0.02 vs.0.19 ± 0.04), and RI (0.66 ± 0.07vs.0.56 ± 0.09) but lower PSV (9.45 ± 1.38 vs.10.86 ± 2.14 cm/s) versus NICP (n = 84) (all P < 0.001). The integrated model (ONSD + ONSD/ETD + PSV + RI) achieved superior diagnostic accuracy: AUC 0.95 (95% CI: 0.922–0.988), sensitivity 88.1%, specificity 98.0%, Youden’s index 0.86—significantly outperforming any single parameter (AUC 0.67–0.87, P < 0.001)—with the predictive equation: Logit(P) = 1.94×ONSD–84.6×ONSD/ETD + 0.79×PSV–3.8×RI + 11.05. Conclusion Transorbital multimodal ultrasound combining structural and vascular parameters enables highly accurate, rapid IICP screening, offering a clinically viable noninvasive alternative to conventional monitoring.
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