Hydrocephalus Imaging : Ultrasound,USG,Hydrocephalus Severity

4th Pediatric Infectious Diseases Conference

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ROLE OF IMAGING IN HYDROCEPHALUS

Related topics

What is Hydrocephalus

Causes Of Hydrocephalus

Normal Pressure Hydrocephalus and Post Shunt Complications

Dr Priya Chudgar.
Lecturer in Radiology,
Department of Radiology,
KEM Hospital,
Mumbai.

Q: What is the role of ultrasound in imaging hydrocephalus?

A: Ultrasound being a safe, quick, non-invasive & repeatable modality, has a definite role in diagnosis of hydrocephalus. However, the ultrasound waves cannot penetrate the bony skull. It is still used in neonatal brain imaging where the open anterior fontanelle is the acoustic window. Hence, its use is limited between age group 6 months-2 years.

When hydrocephalus is diagnosed in intrauterine life, associated CNS / extracranial anomalies should be looked for such as - meningomyelocele, other neural tube defects like spina bifida or chiari malformation. Often hydrocephalus can be diagnosed in utero by 15 weeks gestation. In utero, an upper limit of 10mm for the ventricular atrium is considered significant and hydrocephalus can be suspected.

Neonatal hydrocephalus is easy to recognize by routine coronal & sagittal imaging. Thus, diagnosis & progression can be evaluated. Care must be taken so that changes in ultrasound sector depth do not result in apparent enlargment or decompression of ventricles related to magnification difference when different depth scales are used. Failure to do so may result in a false impression of changing hydrocephalus.

Ventricular/Hemispheric Ratio - V/H ratio is a standard method for grading Hydrocephalus. It is ideally taken at level of foramen of Monroe/ third ventricle in coronal section. Distance of the lateral wall of lateral ventricle from midline to the hemispheric width, if more than 0.35, is suggestion of ventricular enlargement.

Normal USG :

USG Hydrocephalus :

Q: How will you grade severity of Hydrocephalus?

A: Though degree of ventricular dilatation is estimated on imaging, clinical implications are unpredictable. Even with mild hydrocephalus there may be more neurological damage than expected.

On CT scan, prominent temporal horns are amongst the first indicators. Transverse diameter of third ventricle > 5mm is considered as abnormal. Ballooning of frontal horn with periventricular hypodensity is seen in obstructive hydrocephalus. In addition, ventricular SRC index may be used.

Distance between Anterior tips of frontal horn
_______________________________________________ = 30%
Bifrontal diameter at same level (from inner table of skull)

Ultrasound uses the same principle. However, grading as mild, moderate, severe is subjective.

Next : Normal Pressure Hydrocephalus and Post Shunt Complications

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