Project summary The identification of intracranial hypertension (ICH) is essential during pediatric neurological and neurosurgical evaluation. If untreated, it may lead to brain injury, developmental delay or even death. However, current non- invasive evaluation of ICH is based on clinical symptoms that have poor correlation with it, and imaging findings are highly variable and subjective. Hence, non-invasive evaluation of ICH is challenging and often inconclusive. Additionally, invasive intracranial pressure monitors can help identify ICH but they are usually avoided because they often offer inconclusive results and carry important risks of hemorrhage and infections. Consequently, ICH remains underdiagnosed in the population. In this project, we aim to create non-invasive methods to automatically identify the presence of ICH in pediatric patients using CT images of the head. The main hypothesis of this project is that an elevated intracranial pressure results into a decrease of bone mineralization, which can be quantified from CT images. This hypothesis is supported by clinical reports of patients with elevated pressure or brain growth constraints showing thinner and less dense cranial bones, and of patient with intracranial hypotension presenting an abnormally thick cranial bone. During this project, we will: (1) create a sex- and age-specific normative statistical model of cranial bone thickness and density between birth and 10 years using a large retrospective CT image dataset of subjects without cranial pathology; (2) quantify bone abnormalities in patients with ICH and create machine learning models to identify them using a retrospective dataset of patients who required surgical treatment for pressure release; and (3) perform a pilot study to identify and quantify local signs of elevated pressure in patients with cranial growth constraints caused by craniosynostosis. Upon completion of this project, we will have established normative references of cranial bone mineralization, identified and quantified bone mineralization changes associated with ICH, and created automatic tools to identify them. In addition, if our exploratory study in patients with craniosynostosis succeeds, it will prompt a larger clinical study of the presence of ICH in these patients that could translate in a substantial improvement of their clinical management through timely interventions, especially in older children and relapsing patients.