Imaging diagnosis of ventriculomegaly: fetal, neonatal, and pediatric
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Imaging diagnosis of ventriculomegaly: fetal, neonatal, and pediatric Usha D. Nagaraj 1,2
&
Beth M. Kline-Fath 1,2
Received: 31 July 2019 / Accepted: 2 September 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Ventriculomegaly is the term used to describe abnormal enlargement of ventricles in the brain. Neuroimaging, whether it is by ultrasound, computed tomography, or magnetic resonance imaging, is the key to its identification and can help to diagnose its cause and guide management in many cases. The implementation of the imaging modalities and potential differential considerations varies from the fetus, infant, and pediatric patient. Here we discuss how the imaging modalities can be used in these patient populations and review some of the differential considerations. Keywords Ventriculomegaly . Neuroimaging . Diagnosis . Fetal MRI . Fetal ultrasound
Introduction Ventriculomegaly (VMG) is a descriptive term used in neuroimaging to describe abnormal enlargement of the ventricles within the brain. In its simplest form, ventriculomegaly can be separated into 2 major categories: hydrocephalus or decreased cerebral volume. Hydrocephalus denotes increased intracranial pressure from increased cerebrospinal fluid (CSF) and can be obstructive, meaning the point of obstruction to CSF flow is within the ventricular system, or communicating, meaning the point of obstruction is within the CSF resorption pathways [1]. Decreased cerebral volume may be congenital or acquired (atrophy) (Fig. 1). Obstructive hydrocephalus, communicating hydrocephalus, and decreased cerebral volume are not mutually exclusive conditions and can co-exist in a given patient. Furthermore, VMG can be seen in isolation; however, it is frequently associated with other abnormalities in the brain. Neuroimaging by ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI) is essential in the diagnosis of VMG. Each of these imaging modalities has strengths and weaknesses depending on the age of the patient and can assist in determining the cause of VMG in a given patient. The causes of VMG in the fetal, neonatal, and pediatric * Usha D. Nagaraj [email protected] 1
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
2
University of Cincinnati College of Medicine, Cincinnati, OH, USA
brain are vast and varied. Enlarged ventricles can be the result of almost any category of abnormality in the brain which makes the compiling of a comprehensive list of diagnostic considerations not practical. What is more is that VMG in isolation, particularly when mild, can be an incidental finding. That being said, there are a group of conditions that are commonly encountered in the fetal and pediatric populations which are important to keep in mind. While the focus of this review will be on the utility and implementation of the various imaging modalities in the diagnosis of VMG in the fetus, infant, and pediatric patient, a relatively short list of potential causes will also be revi
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