From the Departments of Diagnostic and Interventional Radiology.
Pediatrics, RWTH Aachen University Hospital, Aachen, Germany.
Invest Radiol. 2019 Nov;54(11):719-727. doi: 10.1097/RLI.0000000000000602.
Increased intracranial pressure (ICP) in neonates and infants is a severe disease state that requires adequate diagnosis and, depending on the clinical situation and whether it is increasing, a rapid and efficient therapy. Clinical evaluation, B-mode ultrasound, and Doppler ultrasound give rise to a basic noninvasive diagnosis of increased ICP. The purpose of this prospective study was 2-fold: first, to analyze the technical feasibility of obtaining shear wave elastography (SWE) measurements of an infant's brain, and second, to compare the values of healthy neonates to those who have hydrocephalus and are either suspected of having or invasively shown to have increased ICP.
This was a prospective, institutional review board-approved study of 184 neonates and infants with a mean age of 12 weeks (ranging from 1 day to 12 months). The final, technical evaluable cohort consisted of 166 infants, of whom 110 were healthy asymptomatic infants and 56 were diagnosed with hydrocephalus. Of the latter, 38 showed clinically increased ICP and 18 did not. Invasive ICP measurements were available from 47 of the children. All infants underwent systematic examination using B-mode ultrasound, Doppler ultrasound, and SWE using a high-resolution linear 15-MHz probe (Aixplorer; Supersonic), by 1 of 2 radiologists, each of whom had at least 5 years' experience examining children's brains and applying SWE. Semiquantitative and quantitative SWE measurements were performed.We compared the SWE values to each participant's clinical symptoms and to their invasive ICP measurement results. Correlations were calculated using Pearson and Spearman correlation coefficients. We used Student t test to compare the mean SWE values in healthy children to those of children with increased ICP.
Shear wave elastography in the brain was technically feasible, giving reliable SWE measurements in 110 (88.7%) of 124 of healthy children and in 56 (93.3%) of 60 children with hydrocephalus. Shear wave elastography values and, thus, rigidity in the brain's parenchyma were significantly higher in children with hydrocephalus (n = 56) than in healthy children (n = 110; mean, 21.8 kPa vs 14.1 kPa; P = 0.0083). A thorough correlation between invasive ICP measurements and SWE values in a subgroup of patients with hydrocephalus revealed a direct correlation between increased ICP and increased SWE values (r = 0.69, P < 0.001). Mean SWE values were 30.8 kPa (range, 23.9-62.3 kPa) in patients with confirmed increased ICP (n = 35) versus 16.2 kPa (range, 10.2-41.9 kPa) in patients with nonincreased ICP (n = 12).
Shear wave elastography is feasible in neonates with increased ICP and could be a useful additional diagnostic imaging and monitoring method for children verified or suspected to have increased ICP. However, more evidence is necessary to further evaluate the usefulness of SWE measurements in neonates with hydrocephalus.
Shear wave elastography can be used as a surrogate marker for ICP in neonates and infants.
新生儿和婴儿颅内压（ICP）升高是一种严重的疾病状态，需要进行充分的诊断，并根据临床情况以及 ICP 是否升高，快速有效地进行治疗。临床评估、B 型超声和多普勒超声对 ICP 升高进行基本的无创诊断。本前瞻性研究的目的有两个：首先，分析获得婴儿脑剪切波弹性成像（SWE）测量值的技术可行性；其次，将健康新生儿与患有脑积水且疑似或经证实 ICP 升高的婴儿的 SWE 值进行比较。
这是一项前瞻性的、经机构审查委员会批准的研究，纳入了 184 名平均年龄为 12 周（1 天至 12 个月）的新生儿和婴儿。最终的、可进行技术评估的队列由 166 名婴儿组成，其中 110 名是无症状的健康婴儿，56 名被诊断为脑积水。其中 38 名患儿存在临床 ICP 升高，18 名患儿 ICP 正常。47 名患儿可获得有创 ICP 测量值。所有婴儿均由 2 名放射科医生使用高分辨率线性 15MHz 探头（Aixplorer；Supersonic）通过 B 型超声、多普勒超声和 SWE 进行系统检查，每位医生都有至少 5 年检查儿童大脑和应用 SWE 的经验。进行了半定量和定量 SWE 测量。我们将 SWE 值与每位患者的临床症状和有创 ICP 测量结果进行比较。使用 Pearson 和 Spearman 相关系数计算相关性。我们使用 Student t 检验比较健康儿童和 ICP 升高儿童的平均 SWE 值。
大脑中的 SWE 技术可行，可在 124 名健康儿童中的 110 名（88.7%）和 60 名脑积水儿童中的 56 名（93.3%）中获得可靠的 SWE 测量值。脑实质的 SWE 值和硬度在脑积水儿童（n=56）中明显高于健康儿童（n=110；平均值 21.8kPa 比 14.1kPa；P=0.0083）。在脑积水患者亚组中，有创 ICP 测量值与 SWE 值之间进行了彻底的相关性分析，结果显示 ICP 升高与 SWE 值升高之间存在直接相关性（r=0.69，P<0.001）。在确认 ICP 升高的患者（n=35）中，平均 SWE 值为 30.8kPa（范围，23.9-62.3kPa），而在 ICP 未升高的患者（n=12）中，平均 SWE 值为 16.2kPa（范围，10.2-41.9kPa）。
SWE 对新生儿 ICP 升高是可行的，可能是一种有用的额外诊断成像和监测方法，适用于确诊或疑似 ICP 升高的儿童。但是，需要更多的证据来进一步评估 SWE 测量值在患有脑积水的新生儿中的有用性。
SWE 可作为新生儿和婴儿 ICP 的替代标志物。
