Frontal and Temporal Horn Ratio: A Valid and Reliable Index to Determine Ventricular Size in Paediatric Hydrocephalus Patients?

Antes, Sebastian; Kiefer, M.; Schmitt, Mélanie; Lechtenfeld, Miriam; Geipel, Martina; Eymann, Regina

doi:10.1007/978-3-7091-0956-4_44

Cited by 13 publications

(10 citation statements)

References 15 publications

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“…Although volumetric techniques are probably most representative of true ventricular volume, linear measures are primarily used in current clinical practice; 2,15 nonetheless, image analysis techniques used in our study revealed patterns related to ventriculomegaly that may inform future investigations. For instance, enlargement of the subarachnoid space in pediatric patients has been cited as a potential confounder when determining true intracranial volume.…”

Section: Discussionmentioning

confidence: 76%

Correlations of atrial diameter and frontooccipital horn ratio with ventricle size in fetal ventriculomegaly

Pisapia

Rozycki

Akbari

et al. 2017

PED

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OBJECTIVE Fetal ventriculomegaly (FV), or enlarged cerebral ventricles in utero, is defined in fetal studies as an atrial diameter (AD) greater than 10 mm. In postnatal studies, the frontooccipital horn ratio (FOHR) is commonly used as a proxy for ventricle size (VS); however, its role in FV has not been assessed. Using image analysis techniques to quantify VS on fetal MR images, authors of the present study examined correlations between linear measures (AD and FOHR) and VS in patients with FV. METHODS The authors performed a cross-sectional study using fetal MR images to measure AD in the axial plane at the level of the atria of the lateral ventricles and to calculate FOHR as the average of the frontal and occipital horn diameters divided by the biparietal distance. Computer software was used to separately segment and measure the area of the ventricle and the ventricle plus the subarachnoid space in 2 dimensions. Segmentation was performed on axial slices 3 above and 3 below the slice used to measure AD, and measurements for each slice were combined to yield a volume, or 3D VS. The VS was expressed as the absolute number of voxels (non-normalized) and as the number of voxels divided by intracranial size (normalized). A Pearson correlation coefficient was used to measure the strength of the relationships between the linear measures and the size of segmented regions in 2 and 3 dimensions and over various gestational ages (GAs). Differences between correlations were compared using Steiger's z-test. RESULTS Fifty FV patients who had undergone fetal MRI between 2008 and 2014 were included in the study. The mean GA was 26.3 ± 5.4 weeks. The mean AD was 18.1 ± 8.3 mm, and the mean FOHR was 0.49 ± 0.11. When using absolute VS, the correlation between AD and 3D VS (r = 0.844, p < 0.0001) was significantly higher than that between FOHR and 3D VS (r = 0.668, p < 0.0001; p = 0.0004, Steiger's z-test). However, when VS was normalized, correlations were not significantly different between AD and 3D VS (r = 0.830, p < 0.0001) or FOHR and 3D VS (r = 0.842, p < 0.0001; p = 0.8, Steiger's z-test). For GAs of 24 weeks or earlier, AD correlated more strongly with normalized 3D VS (r = 0.902, p < 0.0001) than with FOHR (r = 0.674, p < 0.0001; p < 0.0001, Steiger's z-test). After 24 weeks, there was no difference in correlations between linear measures (AD or FOHR) and 3D VS (r > 0.9). Correlations of linear measures with VS in 2 and 3 dimensions were similar, and inclusion of the subarachnoid space did not significantly alter results. CONCLUSIONS Findings in the study support the use of AD as a measure of VS in fetal studies as it correlates highly with both absolute and relative VS, especially at early GAs, and captures the preferential dilation of the occipital horns in patients with FV. Compared with AD, FOHR similarly correlates with normalized VS and, after a GA of 24 weeks, can be reported in fetal studies to provide continuity with postnatal monitoring.

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Section: Discussionmentioning

confidence: 76%

Correlations of atrial diameter and frontooccipital horn ratio with ventricle size in fetal ventriculomegaly

Pisapia

Rozycki

Akbari

et al. 2017

PED

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“…The frontal and temporal horn ratio (the ratio of interventricular distance between the frontal and temporal horns of the lateral cerebral ventricles) is probably the new ultrasonographic index, which can be easily measured on the coronal sonographic section of the brain. The statistical comparison between new frontal and temporal horn ratio and commonly used frontal and occipital horn ratio shows strong linear correlation between both coefficients [300].…”

Section: Morphology Of the Cerebral Ventricles In Pediatric Hydrocephmentioning

confidence: 88%

The Role of Transcranial Doppler Sonography in the Management of Pediatric Hydrocephalus

Kolarovszki¹

2019

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IV 5. Etiology of hydrocephalus 5.1 Congenital hydrocephalus 5.2 Acquired postnatal hydrocephalus 6. Pathophysiology of hydrocephalus 6.1 Pathophysiological mechanisms of onset and development of hydrocephalus 6.2 Pathologic changes in hydrocephalus 6.3 Vascular changes in hydrocephalus 6.4 Biochemical changes in hydrocephalus 6.5 Changes of cerebral metabolism in hydrocephalus 7. Clinical manifestations of pediatric hydrocephalus 8. Basic properties of ultrasound 9. Biological effects of ultrasound 9.1 Thermal effects 9.2 Cavitation 9.3 Other mechanic effects 10. Doppler sonography 10.1 The role of Doppler principle in ultrasonography 10.2 The Doppler systems with continuous wave (CW) 10.3 The pulsatility Doppler systems (the pulsed waves, PW) 10.4 The color flow Doppler tomography (CFD, real-time two-dimensional Doppler) 10.5 The technique of the color Doppler power mapping (color Doppler energy, CDE; color power angio, CPA; Doppler power mode; power mapping) 11. The transcranial color-coded Doppler ultrasonography 11.1 The transcranial color-coded Doppler ultrasonographic examination 12. The Doppler curve, measured and calculated parameters 12.1 The Doppler curve 12.2 Measured and assessed parameters of the Doppler curve 12.3 Development of Doppler parameters of cerebral circulation: physiological values 12.3.1 Neonates 12.3.2 Infancy V 12.4 The factors influencing the value of qualitative indices of the Doppler curve 12.4.1 The factors increasing the resistance index of cerebral arteries 12.4.2 Factors decreasing the resistance index of cerebral arteries 13. Morphology of the cerebral ventricles in pediatric hydrocephalus 14. Assessment of Doppler parameters of the cerebral arteries in children with hydrocephalus 15. Case reports 15.1 Assessment of intracranial dynamics in the preterm neonate with hydrocephalus before and after insertion of external ventricular drainage 15.2 Observation of intraindividual dynamics in the preterm neonate with asphyxia and development of progressive hydrocephalus regarding indication of drainage procedure 15.3 Impact of tachycardia on Doppler parameters of blood flow in ACA in the infant with active hydrocephalus 15.4 Assessment of intracranial dynamics of the infant with schizencephaly 15.5 Assessment of intracranial dynamics in the term neonate with congenital hydrocephalus, Arnold-Chiari malformation type II and lumbosacral myelomeningocele 15.6 Assessment of intracranial dynamics in the preterm neonate with posthemorrhagic hydrocephalus 15.7 Assessment of intracranial dynamics in the neonate with occipital encephalocele and congenital hydrocephalus 15.8 Assessment of intracranial dynamics in the term neonate with birth trauma, intracerebral hemorrhage and hemocephalus 15.9 Assessment of intracranial dynamics in the neonate with congenital hydrocephalus and VP shunt revision 15.10 Assessment of intracranial dynamics of congenital hydrocephalus in prenatal and postnatal period

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“…Additionally, MR is an expensive modality and CT could expose the patient to potential adverse effects of radiation. Therefore, US can serve as the best readily available imaging modality for evaluating infants with ventriculomegaly [9, 11].…”

Section: Discussionmentioning

confidence: 99%

“…Assessment of cross-sectional planes is important to neurosurgeons who rely on ventricular size measurements to determine the necessity and timing for surgical interventions. A fronto-temporal horn ratio (FTHR) has been established as a coronal plane analog to the axial FOR [11]. In addition, Radhakrishnan et al [9] found favorable results for interobserver reliability in US-FOR measurements modified for the coronal plane in children with ventriculomegaly; their study also showed a good correlation with MR-FOR measurements.…”

Section: Introductionmentioning

confidence: 99%

Validation of Sonographic Fronto-Occipital Ratio Based on Anatomical Landmarks Compared to MR/CT-Derived Indexes in Children with Chiari II and Ventriculomegaly

et al. 2021

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Introduction: Ultrasound (US) based indexes such as fronto-occipital ratio (FOR) can be used to obtain an acceptable estimation of ventricular volume. Patients with colpocephaly present a unique challenge due to the shape of their ventricles. In the present study, we aim to evaluate the validity and reproducibility of modified US-FOR index in children with Chiari II-related ventriculomegaly. Methods: In this retrospective study, we evaluated Chiari II patients younger than one year who underwent head US and MR or CT scans for ventriculomegaly evaluation. MR/CT based FOR was measured in the axial plane by identifying the widest diameter of frontal horns, occipital horns, and the interparietal diameter (IPD). US based FOR (US-FOR) was measured using the largest diameter based on the following landmarks: frontal horn and IPD in the coronal plane at the level of the foramen of Monro, IPD just superior to the Sylvian fissures, and occipital horn posterior to the thalami and inferior to the superior margins of the thalami. Interclass correlation coefficients (ICC) were used to evaluate inter-rater reliability and Pearson correlation coefficients and Bland-Altman plots were applied to assess agreement between US and other two modalities. Results: Ninety paired US and MR/CT exams were assessed for agreement between US-FOR and MR/CT-FOR measurements. ICC showed an excellent inter-rater reliability for US-FOR (ICC=0.99, p<0.001) and MR/CT-FOR measurements (ICC=0.99, p<0.001). The mean (range) values based on US-FOR showed a slight overestimation in comparison to MR/CT-FOR [0.51 (0.36-0.68) vs 0.46 (0.34-0.64)]. Pearson correlation coefficient showed high cross-modality agreement for the FOR index (r=0.83, p<0.001). Bland-Altman plot showed excellent concordance between US-FOR and MR/CT-FOR with a bias of 0.05 (95% CI, -0.03-0.13) Conclusion: US-FOR in the coronal plane is a comparable tool for evaluating ventriculomegaly in Chiari II patients when compared with MR/CT-FOR, even in the context of colpocephaly.

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Frontal and Temporal Horn Ratio: A Valid and Reliable Index to Determine Ventricular Size in Paediatric Hydrocephalus Patients?

Cited by 13 publications

References 15 publications

Correlations of atrial diameter and frontooccipital horn ratio with ventricle size in fetal ventriculomegaly

Correlations of atrial diameter and frontooccipital horn ratio with ventricle size in fetal ventriculomegaly

The Role of Transcranial Doppler Sonography in the Management of Pediatric Hydrocephalus

Validation of Sonographic Fronto-Occipital Ratio Based on Anatomical Landmarks Compared to MR/CT-Derived Indexes in Children with Chiari II and Ventriculomegaly

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