Noninvasive detection of the distinction between progressive and compensated hydrocephalus in infants: is it possible?

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Clinical signs and symptoms of hydrocephalus can be clear and specific, but also subtle, nonspecific, or even absent. It may be difficult to decide whether shunt placement is indicated, especially in infants. Therefore, there is a need for the development of better noninvasive detection methods to distinguish between compensated and (slowly) progressive hydrocephalus. Early interference can reverse the cerebral damage, whereas the detection of a nonpathological state in infants with compensated hydrocephalus avoids the complications of unnecessary shunt procedures. Using MR imaging, the authors investigated cerebral blood flow (CBF) and apparent diffusion coefficients (ADCs) measured in infants with clinically compensated hydrocephalus.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The diagnosis of compensated hydrocephalus was made on the basis of clinical criteria, consisting of no signs or symptoms of increased intracranial pressure (ICP), measurement of a normal ICP, and standard MR imaging showing enlarged ventricles. Flow measurements through both internal carotid arteries and the basilar artery were considered to represent the total CBF. In addition, ADC values were assessed in 5 different regions of interest in the brain parenchyma using diffusion weighted imaging. Brain volumetric measurement was performed to express CBF in ml/100 cm<jats:sup>3</jats:sup> brain/min, thus compensating for physiological CBF growth over time. Mean arterial blood pressure was manually measured to exclude this factor as a cause of a possible change in CBF. Intracranial pressure measurement was performed noninvasively using the Rotterdam Teletransducer.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Eighteen infants with clinically compensated hydrocephalus were included. The mean CBF was 53.5 ml/100 cm<jats:sup>3</jats:sup> of brain/min. The individual CBF values were graphically compared with age-related normal CBF values and fell in the normal range. Mean ADC value was 890.0 ×10<jats:sup>−6</jats:sup> mm<jats:sup>2</jats:sup>/sec. Apparent diffusion coefficient values per region of interest were graphically compared with normal ADC values per region of interest and fell within the normal range.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>In infants with hydrocephalus, normal CBF and low ADC values, as measured using MR imaging, are associated with compensated hydrocephalus and may support a conservative approach with respect to the decision on whether to place a shunt.</jats:p></jats:sec>

Diffusion Tensor Imaging Properties and Neurobehavioral Outcomes in Children with Hydrocephalus

“…Similar results have been found in some previous studies. 9, 11, 12, 23, 24 In DWI studies, hydrocephalus was often found to be associated with abnormally high ADC values in PVWM. 23-25 In DTI studies, lower FA values have been consistently found in the corpus callosum in hydrocephalus, while mixed FA changes have been reported in some other white matter structures, such as the internal capsule.…”

Preterm neuroimaging and neurodevelopmental outcome: a focus on intraventricular hemorrhage, post-hemorrhagic hydrocephalus, and associated brain injury

“…Studies have demonstrated both elevated intracranial RIs in infants with hydrocephalus, and subsequent decreases in RI after ventricular tap or shunt [56, 57]. …”

“…Increased frontal and occipital white matter ADCs have been described for infants with progressive, symptomatic hydrocephalus [57]. Increased white matter ADC values in infants with PHVD may reflect an increase of the extra­cellular water compartment due to impaired interstitial fluid absorption.…”

Arrested Hydrocephalus in Childhood: Case Series and Review of the Literature

“…Leliefeld et al proposed to use the apparent diffusion coefficient (ADC), and the cerebral blood flow (CBF) calculated through MRI to determine this difference. 20 Elevated periventricular ADC values secondary to interstitial edema, 21 and decreased CBF both might be suggestive of progressive hydrocephalus. 22 We retrospectively measured the periventricular ADC values for our patients.…”

“…27 The boost given by the hydrocephalus-related ICP abnormalities during this specific phase might induce an "overgrowth" of this adaptability, allowing for a strong development of the transependymal intraparenchymal pathway. 20,27,33 Open skull sutures might also be of some importance, allowing for milder ICP disturbances and no or only slight brain damages during the compensation phase. Unfortunately, many things associated with AH are not yet fully understood.…”