[Non-invasive estimation of intracranial pressure :  MR-based evaluation in children with hydrocephalus].
OBJECTIVE
The intracranial pressure (ICP) is a crucially important parameter for diagnostic and therapeutic decision-making in patients with hydrocephalus.


METHODS
So far there is no standard method to non-invasively assess the ICP. Various approaches to obtain the ICP semi-invasively or non-invasively are discussed and the clinical application of a magnetic resonance imaging (MRI)-based method to estimate ICP (MR-ICP) is demonstrated in a group of pediatric patients with hydrocephalus.


METHODS
Arterial inflow, venous drainage and craniospinal cerebrospinal fluid (CSF) flow were quantified using phase-contrast imaging to derive the MR-ICP.


METHODS
A total of 15 patients with hydrocephalus (n=9 treated with shunt placement or ventriculostomy) underwent MRI on a 3 T scanner applying retrospectively-gated cine phase contrast sequences. Of the patients six had clinical symptoms indicating increased ICP (age 2.5-14.61 years, mean 7.4 years) and nine patients had no clinical signs of elevated ICP (age 2.1-15.9 years; mean 9.8 years; all treated with shunt or ventriculostomy). Median MR-ICP in symptomatic patients was 24.5 mmHg (25th percentile 20.4 mmHg; 75th percentile 44.6 mmHg). Median MR-ICP in patients without acute signs of increased ICP was 9.8 mmHg (25th percentile 8.6 mmHg; 75th percentile 11.4 mmHg). Group differences were significant (p < 0.001; Mann-Whitney U-test).


RESULTS
The MR-ICP technique is a promising non-invasive tool for estimating ICP.


CONCLUSIONS
Further studies in larger patient cohorts are warranted to investigate its application in children with hydrocephalus.
Institut für Klinische Radiologie, Ludwig-Maximilians-Universität München, München, Deutschland.
M
M
Muehlmann
D
D
Steffinger
A
A
Peraud
M
M
Lehner
F
F
Heinen
N
N
Alperin
B
B
Ertl-Wagner
I K
IK
Koerte
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis* / Q000503:physiopathology*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007427:Intracranial Pressure; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008365:Manometry / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity