What is the role of imaging studies in the diagnosis of hydrocephalus?

Updated: Jun 04, 2018
  • Author: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP; Chief Editor: Jasvinder Chawla, MD, MBA  more...
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Answer

The following imaging studies may be used to evaluate patients with suspected hydrocephalus:

  • Computed tomography (CT) scanning: To assess size of ventricles and other structures

  • Magnetic resonance imaging (MRI): To assess for Chiari malformation or cerebellar or periaqueductal tumors

  • Ultrasonography through anterior fontanelle in infants: To assess for subependymal and intraventricular hemorrhage; to follow infants for possible progressive hydrocephalus

  • Skull radiography: To detect erosion of sella turcica, or "beaten copper cranium" (or "beaten silver cranium")—the latter can also be seen in craniosynostosis; (after shunt insertion) to confirm correct positioning of installed hardware

  • MRI cine: To measure CSF stroke volume (SV) in the cerebral aqueduct; however, such measurements don’t appear to be useful in predicting response to shunting [2]

  • Diffusion tensor imaging (DTI): To detect differences in fractional anisotropy and mean diffusivity of the brain parenchyma surrounding the ventricles; allows recognition of microstructural changes in periventricular white matter region that may be too subtle on conventional MRI [3]

  • Radionuclide cisternography (in NPH): To assess the prognosis with regard to possible shunting—however, due to its poor sensitivity in predicting shunt response when the ventricular to total intracranial activity (V/T) ratio is less than 32%, this test is no longer commonly used

See Workup for more detail.


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