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Reference Trajectories of Extra-Axial Cerebrospinal Fluid during Childhood and Adolescence Defined in a Clinically

Ayan S Mandal1,2,3, Lena Dorfschmidt2,3, Jenna M Schabdach2,3

  • 1Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104.

Radiology. Artificial Intelligence
|December 10, 2025
PubMed

Insights

New growth charts for extra-axial cerebrospinal fluid (eaCSF) help diagnose benign enlargement of the subarachnoid space (BESS). These charts provide age-related benchmarks for assessing atypical eaCSF development in children.

Area of Science:

  • Neuroradiology
  • Pediatric Imaging
  • Quantitative MRI

Background:

  • Benign enlargement of the subarachnoid space (BESS) requires accurate diagnostic criteria.
  • Extra-axial cerebrospinal fluid (eaCSF) volume changes dynamically with age.
  • Establishing normative data for eaCSF is crucial for identifying atypical development.

Purpose of the Study:

  • To develop normative growth charts for extra-axial cerebrospinal fluid (eaCSF) volume in children.
  • To define diagnostic criteria for benign enlargement of the subarachnoid space (BESS) using age-related eaCSF benchmarks.
  • To aid in the assessment of atypical cerebrospinal fluid development.

Main Methods:

  • Retrospective analysis of T1-weighted MRI scans from 1205 pediatric patients (0.19-19.6 years).
  • Segmentation of T1w scans to quantify eaCSF volume.
  • Modeling of eaCSF growth charts using Generalized Additive Models for Location, Scale and Shape (GAMLSS).

Main Results:

  • eaCSF volume demonstrated dynamic changes with age, decreasing from birth to 2 years and increasing thereafter.
  • Seven out of nine patients diagnosed with BESS had eaCSF measurements above the 97.5th percentile.
  • The developed percentile scores effectively distinguished BESS patients from controls (AUC > 0.95).

Conclusions:

  • MRI-derived eaCSF measurements exhibit dynamic age-related evolution in early life.
  • Computational measurements of eaCSF, when paired with normative modeling, can differentiate atypical CSF development from controls.
  • The developed eaCSF growth charts provide a valuable tool for diagnosing BESS.

Keywords:
Benign Enlargement of Subarachnoid SpaceBrain/Brain StemMRIPediatrics

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