Transcranial Shear Wave Elastography of Neonatal and Infant Brains for Quantitative Evaluation of Increased Intracranial Pressure

Abstract

Objectives: Increased intracranial pressure (ICP) in neonates and infants is a severe disease state that requires adequate diagnosis and, depending on the clinical situation and whether it is increasing, a rapid and efficient therapy. Clinical evaluation, B-mode ultrasound, and Doppler ultrasound give rise to a basic noninvasive diagnosis of increased ICP. The purpose of this prospective study was 2-fold: first, to analyze the technical feasibility of obtaining shear wave elastography (SWE) measurements of an infant's brain, and second, to compare the values of healthy neonates to those who have hydrocephalus and are either suspected of having or invasively shown to have increased ICP. Materials and Methods: This was a prospective, institutional review boardapproved study of 184 neonates and infants with a mean age of 12 weeks (ranging from 1 day to 12 months). The final, technical evaluable cohort consisted of 166 infants, of whom 110 were healthy asymptomatic infants and 56 were diagnosed with hydrocephalus. Of the latter, 38 showed clinically increased ICP and 18 did not. Invasive ICP measurements were available from 47 of the children. All infants underwent systematic examination using B-mode ultrasound, Doppler ultrasound, and SWE using a high-resolution linear 15-MHz probe (Aixplorer; Supersonic), by 1 of 2 radiologists, each of whom had at least 5 years' experience examining children's brains and applying SWE. Semiquantitative and quantitative SWE measurements were performed.We compared the SWE values to each participant's clinical symptoms and to their invasive ICP measurement results. Correlations were calculated using Pearson and Spearman correlation coefficients. We used Student t test to compare the mean SWE values in healthy children to those of children with increased ICP. Results: Shear wave elastography in the brain was technically feasible, giving reliable SWE measurements in 110 (88.7%) of 124 of healthy children and in 56 (93.3%) of 60 children with hydrocephalus. Shear wave elastography values and, thus, rigidity in the brain's parenchyma were significantly higher in children with hydrocephalus (n = 56) than in healthy children (n = 110; mean, 21.8 kPa vs 14.1 kPa; P = 0.0083). A thorough correlation between invasive ICP measurements and SWE values in a subgroup of patients with hydrocephalus revealed a direct correlation between increased ICP and increased SWE values (r = 0.69, P < 0.001). Mean SWE values were 30.8 kPa (range, 23.9-62.3 kPa) in patients with confirmed increased ICP (n = 35) versus 16.2 kPa (range, 10.2-41.9 kPa) in patients with nonincreased ICP (n = 12). Conclusions: Shear wave elastography is feasible in neonates with increased ICP and could be a useful additional diagnostic imaging and monitoring method for children verified or suspected to have increased ICP. However, more evidence is necessary to further evaluate the usefulness of SWE measurements in neonates with hydrocephalus. Clinical Relevance: Shear wave elastography can be used as a surrogate marker for ICP in neon...

Quantitative Evaluation of Neonatal Brain Elasticity Using Shear Wave Elastography

“…However, our results differed from those presented by other authors 32–35 . Differences in the elasticity method (1‐ versus 2‐dimensional SWE) and the protocol used (different transducers, acquisition planes, ROI areas, and placements) might justify some of the observed differences (Table 3).…”

“…Studies on cerebral ultrasound elastography are scarce and mainly experimental 27–30 . There are few studies concerning the evaluation of the human neonatal brain, including strain elastography 31 and acoustic radiation force impulse elastography 32–35 . Although differences in normal values between authors exist, in term neonates, the thalamus has been reported to have higher elasticity values than the white matter.…”

“…Clinical conditions in which brain elastography may have a substantial role can include leukomalacia, ischemia, hydrocephalus, and trauma 30,34,36,37 . In adults, brain elastography has been almost exclusively focused on the magnetic resonance (MR) approach, 38–50 since ultrasound is strongly limited by the ossified skull, limiting the usefulness of ultrasound in the intraoperative field 51,52 or the limited transtemporal approach 53 .…”

Differentiation Between Ischemic and Hemorrhagic Strokes – A Pilot Study with Transtemporal Investigation of Brain Parenchyma Elasticity Using Ultrasound Shear Wave Elastography

“…This is an expected observation as normal brain tissue on the contralateral side is compressed by the lesion (and its surrounding edema). A similar observation was made by Dirrichs et al, who detected significantly elevated values in children with hydrocephalus in comparison to a healthy control group [20].…”

The Value of Shear Wave Elastography in Predicting the Risk of Endometrial Cancer and Atypical Endometrial Hyperplasia

“…Shear wave elastography (SWE) technology, as a newly developed elastic imaging technology, 12,13 can directly reflect the hardness of the tissue, by quantitatively analyzing the tissue hardness from the calculated absolute value of Young's modulus. By constructing a logistic regression model, this study aims to analyze the clinical variables of EC and AEH, transvaginal conventional ultrasonography and Young's modulus values, and assess the diagnostic value of SWE technology in perimenopausal and postmenopausal EC and AEH, in order to improve the accuracy for the diagnosis of EC and AEH.…”