Ces radiol. 2009, 63(3):225-231

The assessment of the presence of the intracranial hypertension by means of the compression Doppler-ultrasound in posthaemorhagic newborns' hydrocephalusOriginal article

Pavel Rejtar¹, Pavel Eliáš¹, Oldřich Pozler³, Josef Jakubec², Jana Dědková¹, Jan Kopřiva¹, Zdeněk Kokštein³, Jan Malý³, Eva Tichá³, Eva Čermáková⁴

¹ Radiologická klinika LF a FN, Hradec Králové

² Neurochirurgická klinika LF a FN, Hradec Králové

³ JIRP pro novorozence Dětské kliniky LF a FN, Hradec Králové

⁴ Oddělení výpočetní techniky LF a FN, Hradec Králové

Aim: We wanted to try and verify the method of "pressure provocation test". The primary objective was to verify, if the basic and compressive resistive index correlates with the presence and eventually with the severity of intracranial hypertension. The secondary objective was to find relationship between the degree of intracranial hypertension and the diameter of cerebral ventricles, to asses the rapidity of PHH developement and to find out, in which period is PHH the most common.

Method: In years 1999-2008, 52 children with diagnosis of posthemorrhagic hydrocephalus were examined in our department. The average birth weight in children with PHH was 1436 g (550-4090 g, median 1150 g). The average age was 29,6 weeks (24-41 weeks, median 28 weeks). Totally, 73% of children had very low birth weight (VLBW). From the total count of 445 examinations, 162 values were chosen for the next statistic processing. The criterium for choice was simultaneous measurement of ventricle diameters, basic resistive index (IR), compressive resistive index (IRc) and direct intracranial pressure measurement (ICPm).

Results: Posthemorrhagic hydrocephalus developed on average in 16 days after the childbirth, till day 19 after the birth intracranial hypertension was proved in 95% of children. From the total count of measurements (n = 162), IRc were negative (7) and positive (5), in ICPm > 11 cm there was one negative outcome. The IR values in children with proved intracranial hypertension were in 71.3% (107 measurements) negative and didn't correlate to the value of ICP (p < 0.5). There was no correlation found between the ventricle diameter and the measured value of ICPm. The total accuracy of the method achieved 93.2% with high sensitivity (95.5%) and low specificity (36.4%).

Conclusion: Compressive doppler ultrasonography is able with high accuracy to determine the presence of intracranial hypertension even before development of clinical signs.

Keywords: hydrocephalus, intracranial hypertension, compression ultrasonography, resistive index

Accepted: June 15, 2009; Published: September 1, 2009  Show citation