BACKGROUND In childhood hydrocephalus, both the amount of cerebrospinal fluid and the brain volume are relevant for the prognosis of the development and for therapy monitoring. Since classical planar measurements of ventricular size are subject to strong limitations, imprecise and neglect brain volume, 3D volumetry is most desirable. We used and evaluated the robust segmentation algorithms of the freely available FSL-toolbox in paediatric hydrocephalus patients before and after specific therapy. METHODS Retrospectively 76 pre- and postoperative high-resolution T2-weighted MRI sequences (true FISP, 1 mm isovoxel) were analyzed in 38 patients with paediatric hydrocephalus (mean 4.4 ± 5.1 years) who underwent surgical treatment (ventriculo-peritoneal (VP) shunt n = 22, endoscopic third ventriculostomy (ETV) n = 16). After preprocessing, the 3D-datasets were skull stripped to estimate the inner skull surface. Following, a 2 class segmentation into different tissue types (brain matter and CSF) was performed. The volumes of CSF and brain were calculated. RESULTS The method could be implemented in an automated fashion in all 76 MRIs. In the VP shunt cohort, the amount of CSF (p < 0.001) decreased. Consecutively brain volume increased significantly (p < 0.001). Following ETV, CSF volume (p = 0.019) decreased significantly (p = 0.012) although the reduction was less pronounced than after shunt implantation. Brain volume expanded (p = 0.02). CONCLUSION A reliable automated segmentation of CSF and brain could be performed with the implemented algorithm. The method was able to track changes after therapy and detected significant differences in CSF and brain volumes after shunting and after ETV.

中文翻译：

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严重小儿脑积水的自动脑脊髓液容量测定和脑容量测定，实施及干预后的临床过程。

背景技术在儿童脑积水中，脑脊髓液的量和脑容量都与发育的预后和治疗监测有关。由于经典的心室平面测量受制于严格的限制，不精确和忽略的大脑体积，因此最需要3D体积测量。我们使用和评估了小儿脑积水患者在特定治疗前后免费使用的FSL工具箱的鲁棒分割算法。方法回顾性分析38例接受手术治疗（脑室-腹膜（VP）分流）的小儿脑积水（平均4.4±5.1岁）的患者的术前和术后高分辨率T2加权MRI序列（真实FISP，1毫米等体积） n = 22，内镜下第三脑室造口术（ETV）n = 16）。经过预处理 剥去3D数据集以估计头骨内部表面。接下来，将2类分割成不同的组织类型（脑组织和CSF）。计算脑脊液和大脑的体积。结果该方法可在所有76例MRI中以自动化方式实施。在VP分流队列中，CSF量减少（p <0.001）。连续脑容量显着增加（p <0.001）。ETV后，尽管与分流植入后相比，脑脊液体积（p = 0.019）显着下降（p = 0.012），但下降幅度不大。脑容量扩大（p = 0.02）。结论可以用所实现的算法对脑脊液和大脑进行可靠的自动分割。