Frontal Occipital and Frontal Temporal Horn Ratios: Comparison and Validation of Head Ultrasound-Derived Indexes With MRI and Ventricular Volumes in Infantile Ventriculomegaly
Rupa Radhakrishnan1,2, Brandon Patrick Brown1,2, Stephen F. Kralik3, Danielle Bain2, Scott Persohn2, Paul R. Territo2, Andrew Jea4, Boaz Karmazyn1,2, Show less
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Citation: American Journal of Roentgenology: 1-7. 10.2214/AJR.19.21261
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ABSTRACT :
OBJECTIVE. The purpose of our study was to assess whether linear ventricular dimensions—specifically, the frontal occipital horn ratio (FOHR) and frontal temporal horn ratio (FTHR) obtained from ultrasound (US)—are reliable measures of ventriculomegaly in infants. Our hypothesis was that these US measures would show good correlation with linear ventricular indexes and ventricular volumes obtained from MRI.
MATERIALS AND METHODS. We retrospectively identified 90 infants (age ≤ 6 months corrected gestational age) with ventriculomegaly from 2014 to 2017 who had a total of 100 sets of US and MRI studies performed in a 3-day period. FOHR and FTHR were independently measured on US and MRI by two pediatric radiologists and two pediatric neuroradiologists, respectively. Ventricular and brain volumes were segmented from the MR images, and the ventricle-to-intracranial volume ratio was calculated. MRI served as the reference standard. Intraclass correlation coefficients and Bland-Altman analyses were generated to evaluate interobserver and US-MRI concordance. We assessed correlation of the FOHR and FTHR with the ventricle-to-intracranial volume ratio.
RESULTS. Bland-Altman plots of the FOHR and FTHR between US and MRI showed excellent concordance with a bias of 0.05 (95% CI, −0.04 to 0.14) and 0.03 (95% CI, −0.06 to 0.13), respectively. There was good-to-excellent interobserver concordance for FOHR and FTHR on head US or MRI (r = 0.86–0.96). There was good correlation between ventricle-to-intracranial volume ratios and US- and MRI-derived FOHRs and FTHRs (r = 0.79–0.87).
CONCLUSION. FOHR and FTHR obtained from US in infants with ventriculomegaly have excellent interobserver concordance, are concordant with MRI-derived linear ratios, and correlate with MRI-derived ventricular volumes. Therefore, US-derived FOHR and FTHR are reliable indexes for clinical follow-up of infantile ventriculomegaly.
Keywords: hydrocephalus, interobserver concordance, posthemorrhagic hydrocephalus, preterm brain imaging, ventriculomegaly
Acknowledgment
Previous sectionNext section
We thank Samuel G. Jennings for assistance in the preparation of this manuscript.
References
Previous section
1. Sondhi V, Gupta G, Gupta PK, Patnaik SK, Tshering K. Establishment of nomograms and reference ranges for intra-cranial ventricular dimensions and ventriculo-hemispheric ratio in newborns by ultrasonography. Acta Paediatr 2008; 97:738–744 [Crossref] [Medline] [Google Scholar]
2. Davies MW, Swaminathan M, Chuang SL, Beth-eras FR. Reference ranges for the linear dimensions of the intracranial ventricles in preterm neonates. Arch Dis Child Fetal Neonatal Ed 2000; 82:F218–F223 [Crossref] [Medline] [Google Scholar]
3. Brouwer MJ, de Vries LS, Groenendaal F, et al. New reference values for the neonatal cerebral ventricles. Radiology 2012; 262:224–233 [Crossref] [Medline] [Google Scholar]
4. Grasby DC, Esterman A, Marshall P. Ultrasound grading of cerebral ventricular dilatation in pre-term neonates. J Paediatr Child Health 2003; 39:186–190 [Crossref] [Medline] [Google Scholar]
5. Antes S, Welsch M, Kiefer M, Gläser M, Körner H, Eymann R. The frontal and temporal horn ratio to assess dimension of paediatric hydrocephalus: a comparative volumetric study. Acta Neurochir Suppl (Wien) 2013; 118:211–214 [Google Scholar]
6. Antes S, Kiefer M, Schmitt M, Lechtenfeld M, Geipel M, Eymann R. Frontal and temporal horn ratio: a valid and reliable index to determine ventricular size in paediatric hydrocephalus patients? Acta Neurochir Suppl (Wien) 2012; 114:227–230 [Crossref] [Google Scholar]
7. Jamous M, Sood S, Kumar R, Ham S. Frontal and occipital horn width ratio for the evaluation of small and asymmetrical ventricles. Pediatr Neurosurg 2003; 39:17–21 [Crossref] [Medline] [Google Scholar]
8. Wellons JC 3rd, Shannon CN, Holubkov R, et al.; Hydrocephalus Clinical Research Network. Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study. J Neurosurg Pediatr 2017; 20:19–29 [Crossref] [Medline] [Google Scholar]
9. Handa RK, Territo PR, Blomgren PM, et al. Development of a novel magnetic resonance imaging acquisition and analysis workflow for the q uantification of shock wave lithotripsy-induced renal hemorrhagic injury. Urolithiasis 2017; 45:507–513 [Crossref] [Medline] [Google Scholar]
10. Tirkes T, Lin C, Cui E, et al. Quantitative MR evaluation of chronic pancreatitis: extracellular volume fraction and MR relaxometry. AJR 2018; 210:533–542 [Abstract] [Google Scholar]
11. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42:377–381 [Crossref] [Medline] [Google Scholar]
12. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016; 15:155–163 [Crossref] [Medline] [Google Scholar]
13. Mukaka MM. Statistics corner: a guide to appropriate use of correlation coefficient in medical research. Malawi Med J 2012; 24:69–71 [Medline] [Google Scholar]
14. Boyle TP, Nigrovic LE. Radiographic evaluation of pediatric cerebrospinal fluid shunt malfunction in the emergency setting. Pediatr Emerg Care 2015; 31:435–440; quiz, 441–443 [Crossref] [Medline] [Google Scholar]
15. Yue EL, Meckler GD, Fleischman RJ, et al. Test characteristics of quick brain MRI for shunt evaluation in children: an alternative modality to avoid radiation. J Neurosurg Pediatr 2015; 15:420–426 [Crossref] [Medline] [Google Scholar]
16. Boyle TP, Paldino MJ, Kimia AA, et al. Comparison of rapid cranial MRI to CT for ventricular shunt malfunction. Pediatrics 2014; 134:e47–e54 [Crossref] [Medline] [Google Scholar]
17. O'Hayon BB, Drake JM, Ossip MG, Tuli S, Clarke M. Frontal and occipital horn ratio: a linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus. Pediatr Neurosurg 1998; 29:245–249 [Crossref] [Medline] [Google Scholar]
18. Ragan DK, Cerqua J, Nash T, et al. The accuracy of linear indices of ventricular volume in pediatric hydrocephalus: technical note. J Neurosurg Pediatr 2015; 15:547–551 [Crossref] [Medline] [Google Scholar]
19. Oushy S, Parker JJ, Campbell K, et al. Frontal and occipital horn ratio is associated with multifocal intraparenchymal hemorrhages in neonatal shunted hydrocephalus. J Neurosurg Pediatr 2017; 20:432–438 [Crossref] [Medline] [Google Scholar]
20. [No authors listed]. Post-hemorrhagic hydrocephalus, pre-term infants, clinical pathway: ICU. Children's Hospital of Philadelphia website. www.chop.edu/clinical-pathway/post-hemorrhagic-hydrocephalus-ventricular-size. Accessed October 20, 2017 [Google Scholar]
Address correspondence to R. Radhakrishnan (rradhak@iu.edu).
R. Radhakrishnan is a 2018 ARRS Scholar and B. P. Brown is a 2018 Leonard Berlin Scholar.
R. Radhakrishnan received a grant from the Department of Radiology at Indiana University, a research and career development grant from ARRS, and a research grant from Philips Healthcare and the Radiological Society of North America.
Read More: https://www.ajronline.org/doi/abs/10.2214/AJR.19.21261
Rupa Radhakrishnan1,2, Brandon Patrick Brown1,2, Stephen F. Kralik3, Danielle Bain2, Scott Persohn2, Paul R. Territo2, Andrew Jea4, Boaz Karmazyn1,2, Show less
Share Share
+ Affiliations:
Citation: American Journal of Roentgenology: 1-7. 10.2214/AJR.19.21261
AbstractFull TextReferencesPDFPDF PlusAdd to FavoritesPermissionsDownload Citation
ABSTRACT :
OBJECTIVE. The purpose of our study was to assess whether linear ventricular dimensions—specifically, the frontal occipital horn ratio (FOHR) and frontal temporal horn ratio (FTHR) obtained from ultrasound (US)—are reliable measures of ventriculomegaly in infants. Our hypothesis was that these US measures would show good correlation with linear ventricular indexes and ventricular volumes obtained from MRI.
MATERIALS AND METHODS. We retrospectively identified 90 infants (age ≤ 6 months corrected gestational age) with ventriculomegaly from 2014 to 2017 who had a total of 100 sets of US and MRI studies performed in a 3-day period. FOHR and FTHR were independently measured on US and MRI by two pediatric radiologists and two pediatric neuroradiologists, respectively. Ventricular and brain volumes were segmented from the MR images, and the ventricle-to-intracranial volume ratio was calculated. MRI served as the reference standard. Intraclass correlation coefficients and Bland-Altman analyses were generated to evaluate interobserver and US-MRI concordance. We assessed correlation of the FOHR and FTHR with the ventricle-to-intracranial volume ratio.
RESULTS. Bland-Altman plots of the FOHR and FTHR between US and MRI showed excellent concordance with a bias of 0.05 (95% CI, −0.04 to 0.14) and 0.03 (95% CI, −0.06 to 0.13), respectively. There was good-to-excellent interobserver concordance for FOHR and FTHR on head US or MRI (r = 0.86–0.96). There was good correlation between ventricle-to-intracranial volume ratios and US- and MRI-derived FOHRs and FTHRs (r = 0.79–0.87).
CONCLUSION. FOHR and FTHR obtained from US in infants with ventriculomegaly have excellent interobserver concordance, are concordant with MRI-derived linear ratios, and correlate with MRI-derived ventricular volumes. Therefore, US-derived FOHR and FTHR are reliable indexes for clinical follow-up of infantile ventriculomegaly.
Keywords: hydrocephalus, interobserver concordance, posthemorrhagic hydrocephalus, preterm brain imaging, ventriculomegaly
Acknowledgment
Previous sectionNext section
We thank Samuel G. Jennings for assistance in the preparation of this manuscript.
References
Previous section
1. Sondhi V, Gupta G, Gupta PK, Patnaik SK, Tshering K. Establishment of nomograms and reference ranges for intra-cranial ventricular dimensions and ventriculo-hemispheric ratio in newborns by ultrasonography. Acta Paediatr 2008; 97:738–744 [Crossref] [Medline] [Google Scholar]
2. Davies MW, Swaminathan M, Chuang SL, Beth-eras FR. Reference ranges for the linear dimensions of the intracranial ventricles in preterm neonates. Arch Dis Child Fetal Neonatal Ed 2000; 82:F218–F223 [Crossref] [Medline] [Google Scholar]
3. Brouwer MJ, de Vries LS, Groenendaal F, et al. New reference values for the neonatal cerebral ventricles. Radiology 2012; 262:224–233 [Crossref] [Medline] [Google Scholar]
4. Grasby DC, Esterman A, Marshall P. Ultrasound grading of cerebral ventricular dilatation in pre-term neonates. J Paediatr Child Health 2003; 39:186–190 [Crossref] [Medline] [Google Scholar]
5. Antes S, Welsch M, Kiefer M, Gläser M, Körner H, Eymann R. The frontal and temporal horn ratio to assess dimension of paediatric hydrocephalus: a comparative volumetric study. Acta Neurochir Suppl (Wien) 2013; 118:211–214 [Google Scholar]
6. Antes S, Kiefer M, Schmitt M, Lechtenfeld M, Geipel M, Eymann R. Frontal and temporal horn ratio: a valid and reliable index to determine ventricular size in paediatric hydrocephalus patients? Acta Neurochir Suppl (Wien) 2012; 114:227–230 [Crossref] [Google Scholar]
7. Jamous M, Sood S, Kumar R, Ham S. Frontal and occipital horn width ratio for the evaluation of small and asymmetrical ventricles. Pediatr Neurosurg 2003; 39:17–21 [Crossref] [Medline] [Google Scholar]
8. Wellons JC 3rd, Shannon CN, Holubkov R, et al.; Hydrocephalus Clinical Research Network. Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study. J Neurosurg Pediatr 2017; 20:19–29 [Crossref] [Medline] [Google Scholar]
9. Handa RK, Territo PR, Blomgren PM, et al. Development of a novel magnetic resonance imaging acquisition and analysis workflow for the q uantification of shock wave lithotripsy-induced renal hemorrhagic injury. Urolithiasis 2017; 45:507–513 [Crossref] [Medline] [Google Scholar]
10. Tirkes T, Lin C, Cui E, et al. Quantitative MR evaluation of chronic pancreatitis: extracellular volume fraction and MR relaxometry. AJR 2018; 210:533–542 [Abstract] [Google Scholar]
11. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42:377–381 [Crossref] [Medline] [Google Scholar]
12. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016; 15:155–163 [Crossref] [Medline] [Google Scholar]
13. Mukaka MM. Statistics corner: a guide to appropriate use of correlation coefficient in medical research. Malawi Med J 2012; 24:69–71 [Medline] [Google Scholar]
14. Boyle TP, Nigrovic LE. Radiographic evaluation of pediatric cerebrospinal fluid shunt malfunction in the emergency setting. Pediatr Emerg Care 2015; 31:435–440; quiz, 441–443 [Crossref] [Medline] [Google Scholar]
15. Yue EL, Meckler GD, Fleischman RJ, et al. Test characteristics of quick brain MRI for shunt evaluation in children: an alternative modality to avoid radiation. J Neurosurg Pediatr 2015; 15:420–426 [Crossref] [Medline] [Google Scholar]
16. Boyle TP, Paldino MJ, Kimia AA, et al. Comparison of rapid cranial MRI to CT for ventricular shunt malfunction. Pediatrics 2014; 134:e47–e54 [Crossref] [Medline] [Google Scholar]
17. O'Hayon BB, Drake JM, Ossip MG, Tuli S, Clarke M. Frontal and occipital horn ratio: a linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus. Pediatr Neurosurg 1998; 29:245–249 [Crossref] [Medline] [Google Scholar]
18. Ragan DK, Cerqua J, Nash T, et al. The accuracy of linear indices of ventricular volume in pediatric hydrocephalus: technical note. J Neurosurg Pediatr 2015; 15:547–551 [Crossref] [Medline] [Google Scholar]
19. Oushy S, Parker JJ, Campbell K, et al. Frontal and occipital horn ratio is associated with multifocal intraparenchymal hemorrhages in neonatal shunted hydrocephalus. J Neurosurg Pediatr 2017; 20:432–438 [Crossref] [Medline] [Google Scholar]
20. [No authors listed]. Post-hemorrhagic hydrocephalus, pre-term infants, clinical pathway: ICU. Children's Hospital of Philadelphia website. www.chop.edu/clinical-pathway/post-hemorrhagic-hydrocephalus-ventricular-size. Accessed October 20, 2017 [Google Scholar]
Address correspondence to R. Radhakrishnan (rradhak@iu.edu).
R. Radhakrishnan is a 2018 ARRS Scholar and B. P. Brown is a 2018 Leonard Berlin Scholar.
R. Radhakrishnan received a grant from the Department of Radiology at Indiana University, a research and career development grant from ARRS, and a research grant from Philips Healthcare and the Radiological Society of North America.
Read More: https://www.ajronline.org/doi/abs/10.2214/AJR.19.21261
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