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Abstract

Background: Hydrocephalus in infants necessitates accurate diagnosis to prevent neurodevelopmental complications. While computed tomography (CT) remains the gold standard, its ionizing radiation poses significant pediatric risks. Ultrasonography (USG) offers a radiation-free alternative, but its diagnostic performance requires rigorous validation.
Objective: To determine the diagnostic accuracy of cranial ultrasonography for infant hydrocephalus using CT as the reference standard.
Methods: In this cross-sectional study, 164 infants (aged 0–12 months) with clinical suspicion of hydrocephalus underwent cranial USG followed by CT at a tertiary care hospital. Diagnostic accuracy was calculated via 2×2 contingency tables, with stratified analyses for age, gender, and clinical risk factors.
Results: CT confirmed hydrocephalus in 48.8% (80/164) of infants. USG demonstrated sensitivity of 88.8% (95% CI: 80.1–94.0), specificity of 52.4% (95% CI: 41.6–62.9), positive predictive value of 64.0%, negative predictive value of 83.0%, and overall accuracy of 70.1%. Infants aged <6 months showed higher sensitivity (91.7% vs. 85.7%) but lower specificity (41.7% vs. 65.0%) compared to older infants. Prematurity significantly reduced specificity (38.1% vs. 68.8%, p<0.001).
Conclusion: Ultrasonography exhibits excellent sensitivity for hydrocephalus screening but suffers from low specificity, particularly in preterm and young infants. CT remains essential for confirmation of positive USG results to avoid unnecessary interventions