Which imaging modalities are most effective for confirming a diagnosis of hydrocephalus?

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.

¹ (Keong et al., 2016) (Langner et al., 2017) (Pindrik et al., 2022)