Fast Quantitative Magnetic Resonance Imaging Evaluation of Hydrocephalus Using 3-Dimensional Fluid-Attenuated Inversion Recovery: Initial Experience

Abstract

Objective This study aimed to demonstrate the initial experience of using fast quantitative magnetic resonance imaging (MRI) to evaluate hydrocephalus. Methods A total of 109 brain MRI volumetry examinations (acquisition time, 7 minutes 30 seconds) were performed in 72 patients with hydrocephalus. From the measured ventricular system and brain volumes, ventricle-brain volume percentage was calculated to standardize hydrocephalus severity (processing time, <5 minutes). The obtained values were categorized into no, mild, and severe based on the fronto-occipital horn ratio (FOHR) and the ventricle-brain volume percentages reported in the literature. The measured volumes and percentages were compared between patients with mild hydrocephalus and those with severe hydrocephalus. The diagnostic performance of brain hydrocephalus MRI volumetry was evaluated using receiver operating characteristic curve analysis. Results Ventricular volumes and ventricle-brain volume percentages were significantly higher in in patients with severe hydrocephalus than in those with mild hydrocephalus (FOHR-based severity: 352.6 ± 165.6 cm3 vs 149.1 ± 78.5 cm3, P < 0.001, and 26.8% [20.8%–33.1%] vs 12.1% ± 6.0%, P < 0.001; percentage-based severity: 359.5 ± 143.3 cm3 vs 137.0 ± 62.9 cm3, P < 0.001, and 26.8% [21.8%–33.1%] vs 11.3% ± 4.2%, P < 0.001, respectively), whereas brain volumes were significantly lower in patients with severe hydrocephalus than in those with mild hydrocephalus (FOHR-based severity: 878.1 ± 363.5 cm3 vs 1130.1 cm3 [912.1–1244.2 cm3], P = 0.006; percentage-based severity: 896.2 ± 324.6 cm3 vs 1142.3 cm3 [944.2–1246.6 cm3], P = 0.005, respectively). The ventricle-brain volume percentage was a good diagnostic parameter for evaluating the degree of hydrocephalus (area under the curve, 0.855; 95% confidence interval, 0.719–0.990; P < 0.001). Conclusions Brain MRI volumetry can be used to evaluate hydrocephalus severity and may provide guide interpretation because of its rapid acquisition and postprocessing times.