Purpose or Case Report: Pediatric hydrocephalus is a common disease in the United States, accounting for more than 39,000 annual admissions and a healthcare cost of $1.4-2.0 billion. Timely detection and intervention of intracranial hypertension (ICP), a complication of hydrocephalus, is associated with an improved neurologic outcome. This research aims to evaluate the feasibility of assessing the movement of the floor of the third ventricle and intracranial arterial pulsations on mid sagittal view of the grayscale brain ultrasound for predicting ICP in neonates and infants.
Methods & Materials: In this retrospective study, the sagittal midline, B-mode cine clips of neonates and infants with increased and normal ICP were evaluated for the presence or absence of intracranial arterial pulsation and movement of the floor of the third ventricle. Arterial pulsation was evaluated in two areas adjacent to: i) the genu and anterior part of the body of the corpus callosum for the anterior cerebral artery and ii) prepontine cistern for the basilar artery. To summarize the data, we used frequency and percentage for categorical data and median and interquartile range (IQR) for numerical data. Fisher’s exact test was used to measure association. A single radiologist read the studies two months apart, and intra-reader agreement was calculated with kappa scores. All statistical significance was declared at p-value <0.05.
Results: A total of 60 patients (22 [36.7%] with increased and 38 [63.3%] with normal ICP) were included; median age was 21.5 days (IQR 2-59.5), and 26 (44.8%) were female. Pulsation was absent in 86.3% of the abnormal and 15.8 % of the normal group; the difference was statistically significant (p<0.001). However, the presence of arterial pulsation in more than one site was not statistically significant (p=0.39). Movement of the floor of the third ventricle was a rare event in both groups, and there was no significant difference between them (p=0.55). There was a strong intra-rater agreement in the observation for pulsation (kappa=0.89, p<0.001).
Conclusions: The absence of intracranial arterial pulsation in the mid-sagittal plane B-mode scan could suggest increased ICP in neonates and infants with hydrocephalus. Given that the arterial pulsatility may be correlated to ICP, further work is warranted not only to validate this imaging biomarker but also advance qualitative approaches to assessing vascular pulsatility using commercially available flow detection tools such as the microvascular imaging technique.