ACR Appropriateness Criteria® Hydrocephalus-Child

Hydrocephalus is a disorder of cerebrospinal fluid circulation that leads to ventricular enlargement and increased intracranial pressure. Presentation and imaging choice vary with age: infants often develop progressive macrocephaly because of skull compliance, whereas older children more commonly present with headache, vomiting, and lethargy. In newly suspected hydrocephalus, imaging confirms ventricular dilation, helps assess acuity, may identify an underlying cause, and informs management. In patients with cerebrospinal fluid diversion, imaging primarily evaluates suspected shunt malfunction, with modality selection driven by clinical urgency, patient cooperation, and age. In infants with open fontanelles, cranial ultrasound provides rapid assessment of ventricular size. MRI is generally preferred to define ventricular caliber and sites of obstruction; abbreviated/rapid MRI can shorten examinations and may avoid sedation. Noncontrast CT is useful when rapid evaluation is required or MRI is not feasible. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.