To Study the Role of Limited Sequence Magnetic Resonance Imaging in Assessment of Children With Hydrocephalus.

Abstract

Aim: To evaluate the role of limited sequence MRI (LS MRI) in diagnosing obstructive from nonobstructive hydrocephalus for treatment planning correlating with surgical findings and in follow up cases of shunt treated hydrocephalus to predict the candidate requires revision surgery correlating with final treatment. Materials and Methods: A total of 235 cases were included in the study underwent limited sequence MRI, 121 cases were evaluated for diagnosing obstructive from nonobstructive hydrocephalus out of which 106 cases underwent surgery were correlated with surgical findings and 114 were symptomatic follow up cases evaluated for need of revision surgery. Diagnostic measures such as sensitivity, specificity, PPV, NPV and accuracy were calculated. A p value of <0.05 was considered to be statistically significant. Results: Obstruction was seen in 81 out of the 106 cases who underwent surgery. MRI showed obstruction in 72(88.9%) and no obstruction in 9(11.1%) cases. Out of the 25 cases with no obstruction in surgery, MRI correctly excluded obstruction in 20(80%) cases. MRI misdiagnosed obstruction in 5(20%) cases. No statistically significant difference between the limited sequence MRI and surgery (p value of 0.424 Sensitivity 88.89%, Specificity 80% PPV 93.51%, NPV 68.97% and Accuracy 86.79%). Out of the total 114 follow up cases of hydrocephalus,47 underwent surgery and 67 cases were managed conservatively. MRI criteria predicted surgical candidate in 43(91.5%) and no surgery in 4(8.5%) patients. MRI criteria predicted nonsurgical management in 64 (95.5%) out of the 67 cases and the rest of 3 (4.5%) cases MRI over rated need for surgery. (Sensitivity:91.49% Specificity:95.52% PPV: 93.5% NPV 94.1% Accuracy :93.9%.) Conclusion: LS MRI has good accuracy in detecting an obstruction in paediatric hydrocephalus. In predicting revision surgery for follow-up cases of shunt-treated hydrocephalus, LS MRI has good accuracy.