A Fully Automatic Framework for Intracranial Pressure Grading: Integrating Keyframe Identification, ONSD Measurement and Clinical Data

Intracranial pressure (ICP) elevation poses severe threats to cerebral function, thus necessitating monitoring for timely intervention. While lumbar puncture is the gold standard for ICP measurement, its invasiveness and associated risks drive the need for non-invasive alternatives. Optic nerve sheath diameter (ONSD) has emerged as a promising biomarker, as elevated ICP directly correlates with increased ONSD. However, current clinical practices for ONSD measurement suffer from inconsistency in manual operation, subjectivity in optimal view selection, and variability in thresholding, limiting their reliability. To address these challenges, we introduce a fully automatic two-stage framework for ICP grading, integrating keyframe identification, ONSD measurement and clinical data. Specifically, the fundus ultrasound video processing stage performs frame-level anatomical segmentation, rule-based keyframe identification guided by an international consensus statement, and precise ONSD measurement. The intracranial pressure grading stage then fuses ONSD metrics with clinical features to enable the prediction of ICP grades, thereby demonstrating an innovative blend of interpretable ultrasound analysis and multi-source data integration for objective clinical evaluation. Experimental results demonstrate that our method achieves a validation accuracy of $0.845 \pm 0.071$ (with standard deviation from five-fold cross-validation) and an independent test accuracy of 0.786, significantly outperforming conventional threshold-based method ($0.637 \pm 0.111$ validation accuracy, $0.429$ test accuracy). Through effectively reducing operator variability and integrating multi-source information, our framework establishes a reliable non-invasive approach for clinical ICP evaluation, holding promise for improving patient management in acute neurological conditions.