The most effective imaging modalities for confirming a diagnosis of hydrocephalus are magnetic resonance imaging (MRI) and computed tomography (CT) scans. MRI is preferred for its superior ability to visualize ventricular enlargement, periventricular changes, and to differentiate hydrocephalus from other causes of ventricular dilation, such as brain atrophy. It also allows assessment of cerebrospinal fluid flow dynamics, which is particularly useful in normal pressure hydrocephalus (NPH) cases. CT scanning is widely used as an initial imaging modality due to its rapid availability and effectiveness in detecting ventricular enlargement and acute complications such as hemorrhage or mass effect. Both modalities are complementary, with MRI providing more detailed anatomical and functional information, while CT is valuable for urgent assessment and in settings where MRI is contraindicated or unavailable.
In neonatal hydrocephalus, cranial ultrasound is also an effective initial imaging tool due to its safety, accessibility, and ability to visualize ventricular size through the open fontanelles. However, MRI remains the gold standard for detailed evaluation and surgical planning in all age groups.
Therefore, the diagnostic approach typically involves initial CT or ultrasound (in neonates), followed by MRI for comprehensive assessment and confirmation of hydrocephalus.
NICE NG232 Keong et al. 2016 Langner et al. 2017 Pindrik et al. 2022
Key References
- NG232 - Head injury: assessment and early management
- NG228 - Subarachnoid haemorrhage caused by a ruptured aneurysm: diagnosis and management
- NG99 - Brain tumours (primary) and brain metastases in over 16s
- (Keong et al., 2016): Imaging normal pressure hydrocephalus: theories, techniques, and challenges.
- (Langner et al., 2017): Diagnosis and Differential Diagnosis of Hydrocephalus in Adults.
- (Pindrik et al., 2022): Diagnosis and Surgical Management of Neonatal Hydrocephalus.