{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:16:30Z","timestamp":1768569390794,"version":"3.49.0"},"posted":{"date-parts":[[2025,10,2]]},"group-title":"Neurology","reference-count":45,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T00:00:00Z","timestamp":1759363200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,10,2]]},"abstract":"<jats:title>Structured Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Accurate cerebrospinal fluid (CSF) and brain volume estimation are important components for evaluating hydrocephalus treatments, including shunts and endoscopic third ventriculostomy (ETV) procedures. While MRI-based segmentation typically provides precise measurements, metallic artifacts from implanted shunts in hydrocephalus patients can impede accurate volume determination. This study introduces a method for assessing brain growth in hydrocephalus patients using artifact-affected MRI scans and presents an efficient, automated artificial intelligence (AI)-based pipeline for hemi-brain segmentation and subsequent volume assessment.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The study consists of 75 patients participating in the Endoscopic versus Shunt Treatment of Hydrocephalus in Infants (ESTHI) trial. Pre- and post-operative T2 MRI scans were collected. Hemi-brain growth curves for the artifact-free hemisphere are proposed to assess postoperative brain growth from MRI with metallic shunt artifacts. An AI-based hemi-brain volume estimation pipeline was developed, consisting of a brain\/CSF segmentation model and a hemi-brain mask generator. Segmentation labels, including left\/right hemi-brain masks and brain\/CSF segmentation maps were created. The AI pipeline was trained and validated using a manually segmented data subset. The volumes of left and right brain hemispheres after surgeries were calculated and analyzed.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Postoperative hemisphere volume ratios approach the normal ratio and remained constant over time, confirming the feasibility for use of hemi-brain measurements as proxies for whole-brain volume assessment in the presence of metallic artifacts. Additionally, the AI-based pipeline demonstrated high accuracy in generating hemi-brain masks and segmenting brain\/CSF, effectively automating the process of hemi-brain volume estimation.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The hemi-brain volume estimation of the unaffected hemisphere offers a feasible method for assessing brain growth over time. This process can be automated using a highly accurate AI pipeline, providing a valuable tool for monitoring brain growth in pediatric hydrocephalus patients with shunts.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.09.28.25336850","type":"posted-content","created":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T19:50:15Z","timestamp":1759434615000},"source":"Crossref","is-referenced-by-count":0,"title":["Hemi-brain growth as a biomarker for whole brain growth"],"prefix":"10.64898","author":[{"given":"Utkarsh S.","family":"Bajaj","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingzhao","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelsey","family":"Tempelton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Srijit","family":"Mukherjee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nichol","family":"Nunn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhaya V.","family":"Kulkarni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Kestle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vishal","family":"Monga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2623-3614","authenticated-orcid":false,"given":"Steven J.","family":"Schiff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2025100408400660000_2025.09.28.25336850v1.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-024-00519-9"},{"key":"2025100408400660000_2025.09.28.25336850v1.2","doi-asserted-by":"publisher","DOI":"10.3171\/2019.2.PEDS18325"},{"key":"2025100408400660000_2025.09.28.25336850v1.3","doi-asserted-by":"publisher","DOI":"10.1136\/adc.37.194.345"},{"key":"2025100408400660000_2025.09.28.25336850v1.4","doi-asserted-by":"publisher","DOI":"10.3171\/foc.2001.11.2.2"},{"key":"2025100408400660000_2025.09.28.25336850v1.5","doi-asserted-by":"publisher","DOI":"10.1007\/s101430050035"},{"key":"2025100408400660000_2025.09.28.25336850v1.6","first-page":"1","volume-title":"History of the treatment of hydrocephalus, in Scott MR (ed): Hydrocephalus","volume":"3","year":"1990"},{"key":"2025100408400660000_2025.09.28.25336850v1.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197010152831608"},{"key":"2025100408400660000_2025.09.28.25336850v1.8","doi-asserted-by":"publisher","DOI":"10.1542\/neo.19-8-e467"},{"key":"2025100408400660000_2025.09.28.25336850v1.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60694-8"},{"key":"2025100408400660000_2025.09.28.25336850v1.10","first-page":"1065","article-title":"Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis","volume":"130","year":"2018","journal-title":"J Neurosurg"},{"key":"2025100408400660000_2025.09.28.25336850v1.11","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-021-05209-5"},{"key":"2025100408400660000_2025.09.28.25336850v1.12","doi-asserted-by":"publisher","DOI":"10.3171\/ped.2005.103.6.0475"},{"key":"2025100408400660000_2025.09.28.25336850v1.13","unstructured":"Drake JM , Sainte-Rose C : The Shunt Book. 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