Ultrasound Assessment of the Third Ventricle Diameter: Agreement With CT Results in the Pediatric Population.

OBJECTIVES

To evaluate the agreement between transcranial ultrasound (TUS) and CT measurements of third ventricle diameter in critically ill children.

DESIGN

Prospective observational cohort study.

SETTING

PICU of the Children's Hospital of Rabat, Morocco.

PATIENTS: Children 1 month to 15 years old admitted with acute neurologic distress who underwent brain CT.

INTERVENTIONS: TUS was performed within 1 hour of CT using a phased-array probe through bilateral transtemporal windows.

MEASUREMENTS AND MAIN

RESULTS

Of 150 screened patients, 148 were included (median age 5 yr; 68% male). Feasibility was high, with bilateral acoustic windows obtained in 98.6% of cases. The median third ventricle diameter was 3.6 mm by both CT and TUS. Bland-Altman analysis demonstrated good agreement between TUS and CT: mean bias 0.11 mm (limits of agreement, -0.78 to 1.01 mm) on the right side and 0.16 mm (-0.81 to 1.13 mm) on the left. Agreement was highest for smaller third ventricle diameters, which accounted for most measurements. No patients had a midline shift or had undergone decompressive craniectomy at the time of imaging.

CONCLUSIONS

TUS provides reproducible bedside measurements of third ventricle diameter in children, with good agreement compared with CT in patients without midline shift or major surgical alterations. While not a substitute for comprehensive neuroimaging, TUS may serve as a nonirradiating adjunct for serial ventricular monitoring, particularly for monitoring for the development of hydrocephalus and during external ventricular drain management. Further research should evaluate interoperator reproducibility, applicability in patients with mass effect, and integration into clinical workflows.