Ultrasound and Photoacoustic Imaging of Hydrocephalus in Pediatric Patients

The goal of this research study is to understand the capabilities of the photoacoustic ultrasound (PAUS) imaging device for hydrocephalus detection. For each subject, the PAUS imaging of CSF fluid will be performed. From the obtained imaging data, such as patency of CSF outflow, function of CSF diversion devices, and resolution of symptomatic hydrocephalus will be quantified to serve as potential hydrocephalus diagnostic biomarkers. For this purpose, each of these biomarkers will be compared with available standard test results such as MRA, XRA and ultrasound blood flow measurements. In addition, the imaging data will be used to study the changes in imaging depth, spatial resolution and contrast across different patients.

A total of 250 hydrocephalus patients will be recruited and imaged at the Penn State Children's Hospital Hershey campus.

The clinical staff at Hershey will use the available hydrocephalus medical records of patients admitted to Penn State Children's Hospital to confirm their eligibility. Before imaging, the parent/guardian of the patient will be informed through consent process that the clinical staff will have access to their medical records.

All subjects will be imaged at rest using the PAUS system that provides multiparametric photoacoustic imaging metrics. This will be done once prior to each surgery/hydrocephalus treatment and once afterwards provided it does not interfere with patient care. Each measurement will be obtained no more than 7 days from the time of treatment. Patients undergoing repetitive, temporizing procedures (serial lumbar punctures, reservoir taps) at the bedside will have the opportunity to participate in real time measurement of the effect of the procedure while it is happening. This will be a secondary component of the study that will be specifically consented for in patients that this is the case. Refusal of this portion of the study will not prevent involvement in the other parts. These results will be quantitatively evaluated and tabulated for each recruited patient, along with the standard test results such as fontanelle fullness and occipito-frontal circumference as well as any other non-imaging and imaging results available for the patient's neurologic health.

These initial pilot studies on 250 hydrocephalus patients at Penn State will help provide preliminary data for ultimately demonstrating clinical effectiveness of this technology.

Inclusion criteria

• Diagnosis of hydrocephalus by a neurosurgeon
• Age ≤ 3 years
• Admitted to Penn State Health Children's Hospital with plans for definitive hydrocephalus treatment while inpatient, including shunt placement surgery, endoscopic third ventriculostomy, shunt revision, external ventricular drain placement.

Exclusion criteria

• Age > 3 years
• No open anterior fontanelle or fontanelle is obstructed for clinical purposes
• Too unstable to undergo diagnostic testing equivalents (i.e. standard ultrasonography)