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The utility of the fronto-temporal horn ratio on cranial ultrasound in premature newborns: a ventriculomegaly marker



The aims of this study were to find the normal value of fronto-temporal horn ratio (FTHR) as a marker of ventriculomegaly on cranial ultrasound (CUS) in premature newborns and the relation to white matter injury (WMI) and cerebral palsy (CP).


This is a retrospective study of newborns admitted between 2011 and 2014. Inclusion criteria were: (1) gestation <29 weeks, (2) birth weight ≤1500 g, (3) referred within 7 days of life, (4) at least two CUS preformed, (5) brain magnetic resonance imaging (MRI) at term age-equivalent. Intraventricular hemorrhage (IVH) grade was identified and FTHR was measured on all CUS. WMI on MRI was evaluated through (1) injury score (Kidokoro 2013) and (2) fractional anisotropy (FA) on the MRI diffusion tensor imaging. CP was estimated using the gross motor function classification system (GMFCS).


One hundred neonates met the inclusion criteria: 37 with no IVH, 36 with IVH grade 1–2, and 27 with IVH grade 3–4. The FTHR cut-point of 0.51 had the highest sensitivity and specificity for moderate-to-severe WMI. In the IVH grade 3–4 group, the elevated FTHR correlated with lower FA and higher GMFCS.


FTHR is a useful quantitative biomarker of ventriculomegaly in preterm newborns. It may help standardize ventricular measurement and direct intervention.


  • The fronto-temporal horn ratio has the potential to become a standardized tool that can provide an actionable measure to direct intervention for post-hemorrhagic ventricular dilation.

  • This current study will provide the basis of a future clinical trial to optimize intervention timing to decrease the risk of white matter injury in this vulnerable population.

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Fig. 1
Fig. 2: Diffusion Tensor (DTI) on Magnetic Resonance Imaging (MRI).
Fig. 3
Fig. 4
Fig. 5: Fronto-temporal horn ratio (FTHR) values on serical cranial ultrasounds (CUS) before (image to the left) and after (image to the right) the temporizing intervention in the grade 3–4 intraventricular hemorrhage group who received a temporizing intervention (n = 13).


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This work was funded by an Early Career Award through the Thrasher Foundation.

Author information




R.O. conceptualized and designed the study and acquired the data, including the chart review and the technical analysis of the cranial ultrasound and brain MRI images. He drafted the article and revised it multiple times. He approved the final version for publication. T.C. conceptualized and designed the study and helped drafting the manuscript and revising it for important intellectual content. She approved the final version for publication. E.B. helped in acquiring and managing the data in Redcap. She also helped in analyzing the data. She critically reviewed and approved the final version of the manuscript for publication. J.G.M. helped conceptualize and design the study. He contributed significantly to the data acquisition by reviewing the brain imaging (brain MRI). He also helped critically revising the final manuscript for important intellectual content and approved the final version to be published. D.B. conceptualized and designed the study, helped in reviewing the cranial ultrasound images, reviewed the manuscript critically for important intellectual content, and approved the final version to be published. A.B. contributed to the acquisition of the data, reviewed the cranial ultrasound images, helped in revising the article for important intellectual content, and approved the final version to be published. C.O. conceptualized and designed the study and reviewed the manuscript for important intellectual content. He reviewed the manuscript and approved the final version to be published. M.J. conceptualized and designed the study, performed the statistical analysis and helped in interpreting the data. She reviewed the manuscript and approved the final version for publication. A.N.M. conceptualized and designed the study, planned the statistical analysis, helped significantly in interpreting the data, reviewed the manuscript critically, and approved the final version to be published. A.A.P. conceptualized and designed the study, mentored the primary investigator, planned the statistical analysis, helped with data interpretation, critically reviewed the manuscript, and approved the final version to be published. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Rawad Obeid.

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Obeid, R., Jacobs, M., Chang, T. et al. The utility of the fronto-temporal horn ratio on cranial ultrasound in premature newborns: a ventriculomegaly marker. Pediatr Res (2021).

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