Ventricular shape evaluation on early ultrasound predicts post-hemorrhagic hydrocephalus

Novel insights into non-coding RNAs and their role in hydrocephalus

A large body of evidence has highlighted the role of non-coding RNAs in neurodevelopment and neuroinflammation. This evidence has led to increasing speculation that non-coding RNAs may be involved in the pathophysiological mechanisms underlying hydrocephalus, one of the most common neurological conditions worldwide. In this review, we first outline the basic concepts and incidence of hydrocephalus along with the limitations of existing treatments for this condition. Then, we outline the definition, classification, and biological role of non-coding RNAs. Subsequently, we analyze the roles of non-coding RNAs in the formation of hydrocephalus in detail. Specifically, we have focused on the potential significance of non-coding RNAs in the pathophysiology of hydrocephalus, including glymphatic pathways, neuroinflammatory processes, and neurological dysplasia, on the basis of the existing evidence. Lastly, we review the potential of non-coding RNAs as biomarkers of hydrocephalus and for the creation of innovative treatments.

High-level feature-guided attention optimized neural network for neonatal lateral ventricular dilatation prediction

BACKGROUND

Periventricular-intraventricular hemorrhage can lead to posthemorrhagic ventricular dilatation or even posthemorrhagic hydrocephalus if not detected promptly. Sequential cranial ultrasound scans are typically used for their diagnoses. Nonetheless, manual image audit has numerous disadvantages.

PURPOSE

This study aimed to develop a predictive model utilizing modified inception (MI) and high-level feature-guided attention (HFA) modules for predicting neonatal lateral ventricular dilation via ultrasound images.

METHODS

The MI modules reduced input data sizes and dimensions, while the HFA modules effectively delved into semantic information through supervision from high-level feature images to low-level feature images. The process facilitated the accurate identification of dilated lateral ventricles. A total of 710 neonates, corresponding to 1420 lateral ventricles, were recruited in this study. Each lateral ventricle was captured in two images, one on the parasagittal plane and the other on the coronal plane. The combination of anterior horn width, ventricular index, thalamo-occipital distance, and ventricular height served as the gold standard. A lateral ventricle would be considered dilatated if any of these four indices exceeded its upper reference value. These lateral ventricles were randomly split into training and testing sets at a 7:3 ratio. We evaluated the validity of our proposed approach and its competitors across the coronal plane, parasagittal plane, and overall performance. We also determined the impact of subjects' baseline characteristics on the overall performance of the proposed approach. Additionally, ablation analyses were conducted to ensure the efficacy of the proposed approach.

RESULTS

Our proposed approach achieved the largest Youden index (0.65, 95% CI: 0.58-0.72), DOR (27.11, 95% CI: 15.89-46.26), area under curves (AUC) of receiver operating characteristic curve (ROC) (0.84, 95% CI: 0.80-0.88), and AUC of precision-recall curve (PRC) (0.81, 95% CI: 0.74-0.86) in the overall performance assessment and ablation analyses. Moreover, it boasted the biggest Cramer's V values on the coronal (Cramer's V = 0.488, p < 0.001) and parasagittal (Cramer's V = 0.713, p < 0.001) planes individually. Factors such as left side, male sex, singleton birth, and vaginal delivery were positively correlated with higher performance regarding the proposed algorithm, except for the gestational age.

CONCLUSION

This work provides a novel attention optimized algorithm for rapid and accurate ventricular dilatation predictions. It surpasses the traditional algorithms in terms of validity whether concerning the coronal plane, parasagittal plane, or overall performance. The overall performance of algorithms will be influenced by the baseline characteristics of populations.

Prediction of persistent ventricular dilation by initial ventriculomegaly and clot volume in a porcine model

OBJECTIVE

While intraventricular hemorrhage (IVH) is associated with posthemorrhagic ventricular dilation (PHVD), not all infants affected by high-grade IVH develop PHVD. The authors aimed to determine clot-associated predictors of PHVD in a porcine model by varying the amount and rate of direct intraventricular injection of whole autologous blood.

METHODS

Seven 1-week-old piglets underwent craniectomy and injection of autologous blood into the right lateral ventricle. They survived for a maximum of 28 days. MRI was performed prior to injection, immediately postoperatively, and every 7 days thereafter. T1-weighted, T2-weighted, and susceptibility-weighted imaging (SWI) sequences were used to segment ventricular and clot volumes. Spearman correlations were used to determine the relationship between blood and clot volumes and ventricular volumes over time.

RESULTS

The maximum ventricular volume was up to 12 times that of baseline. One animal developed acute hydrocephalus on day 4. All other animals survived until planned endpoints. The interaction between volume of blood injected and duration of injection was significantly associated with clot volume on the postoperative scan (p = 0.003) but not the amount of blood injected alone (p = 0.38). Initial postoperative and day 7 clot volumes, but not volume of blood injected, were correlated with maximum (p = 0.007 and 0.014) and terminal (p = 0.014 and 0.036) ventricular volumes. Initial postoperative ventricular volume was correlated with maximum and terminal ventricular volume (p = 0.007 and p = 0.014).

CONCLUSIONS

Initial postoperative, maximum, and terminal ventricular dilations were associated with the amount of clot formed, rather than the amount of blood injected. This supports the hypothesis that PHVD is determined by clot burden rather than the presence of blood products and allows further testing of early clot lysis to minimize PHVD risk.

Timing of Temporizing Neurosurgical Treatment in Relation to Shunting and Neurodevelopmental Outcomes in Posthemorrhagic Ventricular Dilatation of Prematurity: A Meta-analysis

OBJECTIVE

To determine the relationship between timing of initiation of temporizing neurosurgical treatment and rates of ventriculoperitoneal shunt (VPS) and neurodevelopmental impairment in premature infants with post-hemorrhagic ventricular dilatation (PHVD).

STUDY DESIGN

We searched MEDLINE, EMBASE, CINAHL, Web of Science, the Cochrane Database of Systematic Reviews, and the Cochrane Center Register of Controlled Trials for studies that reported on premature infants with PHVD who underwent a temporizing neurosurgical procedure. The timing of the temporizing neurosurgical procedure, gestational age, birth weight, outcomes of conversion to VPS, moderate-to-severe neurodevelopmental impairment, infection, temporizing neurosurgical procedure revision, and death at discharge were extracted.

RESULTS

Sixty-two full-length articles and 6 conference abstracts (n = 2533 patients) published through November 2020 were included. Pooled rate for conversion to VPS was 60.5% (95% CI, 54.9-65.8), moderate-severe neurodevelopmental impairment 34.8% (95% CI, 27.4-42.9), infection 8.2% (95% CI, 6.7-10.1), revision 14.6% (95% CI, 10.4-20.1), and death 12.9% (95% CI, 10.2-16.4). The average age at temporizing neurosurgical procedure was 24.2 ± 11.3 days. On meta-regression, older age at temporizing neurosurgical procedure was a predictor of conversion to VPS (P < .001) and neurodevelopmental impairment (P < .01). Later year of publication predicted increased survival (P < .01) and external ventricular drains were associated with more revisions (P = .001). Tests for heterogeneity reached significance for all outcomes and a qualitative review showed heterogeneity in the study inclusion and diagnosis criteria for PHVD and initiation of temporizing neurosurgical procedure.

CONCLUSIONS

Later timing of temporizing neurosurgical procedure predicted higher rates of conversion to VPS and moderate-severe neurodevelopmental impairment. Outcomes were often reported relative to the number of patients who underwent a temporizing neurosurgical procedure and the criteria for study inclusion and the initiation of temporizing neurosurgical procedure varied across institutions. There is need for more comprehensive outcome reporting that includes all infants with PHVD regardless of treatment.

Ultrasound-Based Phenotyping of Lateral Ventricles to Predict Hydrocephalus Outcome in Premature Neonates

OBJECTIVE

Prediction of post-hemorrhagic hydrocephalus (PHH) outcome-i.e., whether it requires intervention or not-in premature neonates using cranial ultrasound (CUS) images is challenging. In this paper, we present a novel fully-automatic method to perform phenotyping of the brain lateral ventricles and predict PHH outcome from CUS.

METHODS

Our method consists of two parts: ventricle quantification followed by prediction of PHH outcome. First, cranial bounding box and brain interhemispheric fissure are detected to determine the anatomical position of ventricles and correct the cranium rotation. Then, lateral ventricles are extracted using a new deep learning-based method by incorporating the convolutional neural network into a probabilistic atlas-based weighted loss function and an image-specific adaption. PHH outcome is predicted using a support vector machine classifier trained using ventricular morphological phenotypes and clinical information.

RESULTS

Experiments demonstrated that our method achieves accurate ventricle segmentation results with an average Dice similarity coefficient of 0.86, as well as very good PHH outcome prediction with accuracy of 0.91.

CONCLUSION

Automatic CUS-based ventricular phenotyping in premature newborns could objectively and accurately predict the progression to severe PHH.

SIGNIFICANCE

Early prediction of severe PHH development in premature newborns could potentially advance criteria for diagnosis and offer an opportunity for early interventions to improve outcome.