Related Experiment Video
Updated: Jun 12, 2026
State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Noninvasive detection of the distinction between progressive and compensated hydrocephalus in infants: is it
Paul H Leliefeld1, Rob H J M Gooskens, Cees A F Tulleken
1Department of Neurosurgery, University Medical Center Utrecht, G 03.124, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. p.h.leliefeld@umcutrecht.nl
Insights
In infants with compensated hydrocephalus, normal cerebral blood flow (CBF) and low apparent diffusion coefficients (ADCs) detected via MR imaging suggest a conservative approach, avoiding unnecessary shunt placement.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Medical Imaging
Background:
- Hydrocephalus in infants presents diagnostic challenges due to variable clinical signs.
- Distinguishing compensated from progressive hydrocephalus is crucial for appropriate intervention.
- Noninvasive methods are needed to guide decisions on shunt placement in infants.
Purpose of the Study:
- To investigate the utility of MR imaging-based cerebral blood flow (CBF) and apparent diffusion coefficients (ADCs) in infants with compensated hydrocephalus.
- To establish noninvasive biomarkers for differentiating compensated hydrocephalus from other conditions.
- To support conservative management strategies when appropriate.
Main Methods:
- Diagnosis of compensated hydrocephalus based on clinical criteria, normal intracranial pressure (ICP), and MR imaging.
- Total CBF measured via internal carotid and basilar arteries.
- ADC values assessed in five brain parenchyma regions using diffusion-weighted imaging.
- Noninvasive ICP measurement using the Rotterdam Teletransducer.
Main Results:
- Eighteen infants with compensated hydrocephalus were studied.
- Mean CBF values were within the normal age-related range.
- Mean ADC values were within the normal range for respective brain regions.
Conclusions:
- Normal CBF and low ADC values in infants with hydrocephalus are associated with compensated hydrocephalus.
- MR imaging findings of normal CBF and low ADC may support a conservative management approach.
- These noninvasive markers can aid in the decision-making process regarding shunt placement.
Object:
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.
Methods:
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(3) 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.
Results:
Eighteen infants with clinically compensated hydrocephalus were included. The mean CBF was 53.5 ml/100 cm(3) 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 x10(-6) mm(2)/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.
Conclusions:
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.
