The Value of MRA Versus MRI Brain DWI (ADC) in the Management of Ventriculomegaly in Pediatric Age Group

Abstract
Background: Neurosurgeons may find difficulties in differentiation between progressive and compensated hydro-cephalus since signs and symptoms of raised intracranial pressure can be subtle or completely absent in children with progressive hydrocephalus. The CBF and ADC values can help to differentiate between compensated and progressive hydrocephalus thus facilitating the decision to withhold CSF diversion in an infant with a compensated hydrocephalus.
Material and Methods: This prospective study included (40 participants) 10 control (5 males and 5 females) and 30 patients (18 males and 12 females). Patients were divided according to their clinical presentation into two groups, suspected to have Progressive Pressure Hydro cephalous (PPH) and Compensated Pressure hydro cephalous (CPH). All the patients underwent routine MRI brain, DWI (ADC) and MRA examinations.
Results: In our study, we found that each patient has his own CBF as base line for follow-up in hydrocephalic children with mean ADC value (1,018) as a cut off value below which compensated pressure hydrocephalus is diagnosed and above which progressive pressure hydrocephalus is diagnosed.
Conclusion: MRA is helpful as a complementary non invasive tool and each patient has his own CBF as base line for follow-up in hydrocephalic children due to great variations in the measured CBF with clear mean ADC cut off value for differentiation between compensated from progressive pressure and follow-up.