Advanced Neuroimaging Techniques in Pediatric Hydrocephalus

From the early days of pneumoencephalography and ventriculography to the emerging technology of magnetic resonance diffusion tensor imaging (DTI) of the present day, neuroimaging has always been a critical tool in the diagnosis and treatment of pediatric hydrocephalus. There is accumulating evidence from both human and animal research suggesting that one of the major pathophysiological mechanisms underlying poor outcomes in these children is damage to vulnerable white matter (WM) structures in the brain as a result of ventricular enlargement and increased intracranial pressure. However, a clear understanding of these WM abnormalities and their implications on neurobehavioral outcomes in these patients is not well understood. To this end, DTI has recently been studied to allow noninvasive quantification of these abnormalities. Our review discusses the evolution of neuroimaging in pediatric hydrocephalus and focuses on the use of advanced imaging techniques, such as DTI, which is supported by a growing body of literature as a promising noninvasive imaging tool in the diagnosis and long-term management of this patient population. We conclude with a brief discussion on emerging techniques and experimental imaging.