Skip to main content

Advertisement

SpringerLink
Log in

Planar single plane area determination is a viable substitute for total volumetry of CSF and brain in childhood hydrocephalus

  • Original Article - Pediatric Neurosurgery
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

In the treatment of childhood hydrocephalus, 3D volumetry seems to have many advantages over classical planar index measurements for dedicated monitoring of changes in cerebrospinal fluid and brain volume. Nevertheless, this method requires extensive technical effort and access to the complete three-dimensional data set. Against this background, we evaluated the possibility of planar area determination in a single plane and the correlation to volumetry.

Methods

138 routinely performed true FISP MRI sequences (1 mm isovoxel) were analyzed retrospectively in 68 patients with pediatric hydrocephalus. After preprocessing, the 3D-data sets were skull stripped to estimate the inner skull volume. A 2-class segmentation into different tissue types (brain matter and CSF) was performed, and the volumes of CSF (VCSF) and brain matter (VBrain) were calculated. A plane at the level of the foramina of Monro was manually identified in the ac-pc oriented data. In this plane, the areas of brain (ABrain) and CSF (ACSF) in cm2 were calculated and used for further correlation analysis.

Results

Mean VCSF was 340 ± 145 cm3 and VBrain 1173 ± 254 cm3. In the selected plane, ACSF was 26 ± 14 cm2, and ABrain was 107 ± 25 cm2. There was a very strong positive correlation between both ACSF and VCSF (r = 0.895) and between ABrain and VBrain (r = 0.846). The prediction equations for VBrain and VCSF were highly significant.

Conclusion

Planar area determination of brain and CSF correlates excellently with both VCSF and VBrain. Thus, areas can serve as a surrogate marker for total brain and CSF volumes for a quantitated objective tracking of changes during treatment of childhood hydrocephalus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

CSF:

Cerebrospinal fluid

VP shunt:

Ventriculoperitoneal shunt

ETV:

Endoscopic third ventriculostomie

MRI:

Magnet resonance imaging

VBrain:

Brain volume in cm3

VCSF:

CSF volume in cm3

ABrain:

Planar area of brain in cm2

ACSF:

Planar area of CSF in cm2

ICV:

Intracranial volume in cm3

FSL:

Functional magnetic resonance imaging of the brain software library

BET:

Brain extraction tool

FAST:

FMRIB’s automated segmentation tool

True FISP:

True fast imaging with steady state precession

SD:

Standard deviation

FOHR:

Frontal occipital horn ratio

References

  1. Grimm F, Edl F, Gugel I, Kerscher SR, Bender B, Schuhmann MU (2019) Automatic volumetry of cerebrospinal fluid and brain volume in severe paediatric hydrocephalus, implementation and clinical course after intervention. Acta Neurochir (Wien) accepted. https://doi.org/10.1007/s00701-019-04143-5

  2. Jenkinson M, Beckmann CF, Behrens TE, Woolrich MW, Smith SM (2012) Fsl. NeuroImage 62:782–790. https://doi.org/10.1016/j.neuroimage.2011.09.015

    Article  Google Scholar 

  3. Limbrick DD Jr, Baird LC, Klimo P Jr, Riva-Cambrin J, Flannery AM, Pediatric Hydrocephalus Systematic R, Evidence-Based Guidelines Task F (2014) Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 4: Cerebrospinal fluid shunt or endoscopic third ventriculostomy for the treatment of hydrocephalus in children. J Neurosurg Pediatr 14(Suppl 1):30–34. https://doi.org/10.3171/2014.7.PEDS14324

    Article  PubMed  Google Scholar 

  4. Mandell JG, Kulkarni AV, Warf BC, Schiff SJ (2015) Volumetric brain analysis in neurosurgery: part 2. Brain and CSF volumes discriminate neurocognitive outcomes in hydrocephalus. J Neurosurg Pediatr 15:125–132. https://doi.org/10.3171/2014.9.PEDS12427

    Article  PubMed  Google Scholar 

  5. Mandell JG, Langelaan JW, Webb AG, Schiff SJ (2015) Volumetric brain analysis in neurosurgery: part 1. Particle filter segmentation of brain and cerebrospinal fluid growth dynamics from MRI and CT images. J Neurosurg Pediatr 15:113–124. https://doi.org/10.3171/2014.9.PEDS12426

    Article  PubMed  Google Scholar 

  6. Mendrik AM, Vincken KL, Kuijf HJ, Breeuwer M, Bouvy WH, de Bresser J, Alansary A, de Bruijne M, Carass A, El-Baz A, Jog A, Katyal R, Khan AR, van der Lijn F, Mahmood Q, Mukherjee R, van Opbroek A, Paneri S, Pereira S, Persson M, Rajchl M, Sarikaya D, Smedby O, Silva CA, Vrooman HA, Vyas S, Wang C, Zhao L, Biessels GJ, Viergever MA (2015) MRBrainS challenge: online evaluation framework for brain image segmentation in 3T MRI scans. Comput Intell Neurosci 2015:813696. https://doi.org/10.1155/2015/813696

    Article  PubMed  PubMed Central  Google Scholar 

  7. Moeskops P, Benders MJ, Chit SM, Kersbergen KJ, Groenendaal F, de Vries LS, Viergever MA, Isgum I (2015) Automatic segmentation of MR brain images of preterm infants using supervised classification. Neuroimage 118:628–641. https://doi.org/10.1016/j.neuroimage.2015.06.007

    Article  PubMed  Google Scholar 

  8. O'Neill BR, Pruthi S, Bains H, Robison R, Weir K, Ojemann J, Ellenbogen R, Avellino A, Browd SR (2013) Rapid sequence magnetic resonance imaging in the assessment of children with hydrocephalus. World Neurosurg 80:e307–e312. https://doi.org/10.1016/j.wneu.2012.10.066

    Article  PubMed  Google Scholar 

  9. Ragan DK, Cerqua J, Nash T, McKinstry RC, Shimony JS, Jones BV, Mangano FT, Holland SK, Yuan W, Limbrick DD Jr (2015) The accuracy of linear indices of ventricular volume in pediatric hydrocephalus: technical note. J Neurosurg Pediatr 15:547–551. https://doi.org/10.3171/2014.10.PEDS14209

    Article  PubMed  PubMed Central  Google Scholar 

  10. Schmitz B, Hagen T, Reith W (2003) Three-dimensional true FISP for high-resolution imaging of the whole brain. Eur Radiol 13:1577–1582. https://doi.org/10.1007/s00330-003-1846-3

    Article  CAS  PubMed  Google Scholar 

  11. Smith SM (2002) Fast robust automated brain extraction. Hum Brain Mapp 17:143–155. https://doi.org/10.1002/hbm.10062

    Article  PubMed  Google Scholar 

  12. Toma AK, Holl E, Kitchen ND, Watkins LD (2011) Evans' index revisited: the need for an alternative in normal pressure hydrocephalus. Neurosurgery 68:939–944. https://doi.org/10.1227/NEU.0b013e318208f5e0

    Article  PubMed  Google Scholar 

  13. Toma AK, Tarnaris A, Grieve JP, Watkins LD, Kitchen ND (2010) Adjustable shunt valve-induced magnetic resonance imaging artifact: a comparative study. J Neurosurg 113:74–78. https://doi.org/10.3171/2009.9.JNS09171

    Article  PubMed  Google Scholar 

  14. Warf B, Ondoma S, Kulkarni A, Donnelly R, Ampeire M, Akona J, Kabachelor CR, Mulondo R, Nsubuga BK (2009) Neurocognitive outcome and ventricular volume in children with myelomeningocele treated for hydrocephalus in Uganda. J Neurosurg Pediatr 4:564–570. https://doi.org/10.3171/2009.7.PEDS09136

    Article  PubMed  Google Scholar 

  15. Yepes-Calderon F, Nelson MD, McComb JG (2018) Automatically measuring brain ventricular volume within PACS using artificial intelligence. PLoS One 13:e0193152. https://doi.org/10.1371/journal.pone.0193152

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Zhang Y, Brady M, Smith S (2001) Segmentation of brain MR images through a hidden Markov random field model and the expectation-maximization algorithm. IEEE Trans Med Imaging 20:45–57. https://doi.org/10.1109/42.906424

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

No funding was received for this research.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany

    Florian Grimm, Florian Edl, Isabel Gugel, Susanne R. Kerscher & Martin U. Schuhmann

  2. Division of Pediatric Neurosurgery, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany

    Susanne R. Kerscher & Martin U. Schuhmann

Authors
  1. Florian Grimm
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Florian Edl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Isabel Gugel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susanne R. Kerscher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Martin U. Schuhmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Florian Grimm.

Ethics declarations

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (University Hospital Tübingen, Germany) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent was not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Pediatric Neurosurgery

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Grimm, F., Edl, F., Gugel, I. et al. Planar single plane area determination is a viable substitute for total volumetry of CSF and brain in childhood hydrocephalus. Acta Neurochir 162, 993–1000 (2020). https://doi.org/10.1007/s00701-019-04160-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-019-04160-4

Keywords

Search

Navigation