Cine MR CSF Flow Study in Hydrocephalus: What are the Valuable Parameters?
To evaluate the changes of intracranial cerebrospinal fluid (CSF) dynamics in hydrocephalus, we studied the various parameters of cine phase contrast (PC) magnetic resonance (MR) CSF flow images in cases of acutely progressive hydrocephalus, comparing the
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Cine MR CSF Flow Study in Hydrocephalus: What are the Valuable Parameters? M.-H. Kim, K.-M. Shin, and J.-H. Song Department of Neurosurgery, Ewha Womans University College of Medicine, Seoul, South Korea
Summary To evaluate the changes of intracranial cerebrospinal fluid (CSF) dynamics in hydrocephalus, we studied the various parameters of cine phase contrast (PC) magnetic resonance (MR) CSF flow images in cases of acutely progressive hydrocephalus, comparing them with those in normal CSF circulation. The MR images were obtained with 1.5 T unit using the 2 dimensional cine PC sequence with cardiac gating in 10 non-obstructive hydrocephalus (NOH), 3 obstructive hydrocephalus (OH), and 10 controls. The temporal velocity information from the anterior and posterior cervical pericord spaces, third and fourth ventricles, and aqueduct were plotted as wave form. The wave forms were analyzed for configurations, amplitude parameters (Smax, Smin, Sdif), and temporal parameters (R-S, R-SMV, R-D. R-DMV). The statistical significance of each parameter was examined with paired t-test. All patients with OH underwent endoscopic thrid ventriculostomy, whereas all NOH underwent shunting procedures. In 5 ROIs, distinct reproducible configuration features were obtained at aqueductal and cervical pericord spaces. Statistically significant differences between control and hydrocephalus only in temporal parameters were determined. In NOH, the graph showed R-DMV shortening (p < 0.01) at anterior cervical pericord space. In OH, there were R-DMV shortening (p < 0.05) at anterior cervical pericord space, R-SMV shortening (p < 0.02) at posterior cervical pericord space. Also the level of obstructions could be determined in all OHs. The analysis of MR CSF flow images may give us valuable information on the site of obstruction, explaining the cause of hydrocephalus, thus deciding the necessity of shunting procedures using in vivo images. Keywords: Cine MR CSF flow; hydrocephalus: phase contrast.
Introduction Evaluation of CSF flow was accomplished by the use of cardiac gated gradient echo MR technique [3,7,8,12,13]. The qualitative cine MR allows a rapid and dramatic evaluation of both normal and abnormal patients in a visual form. Quantitative evaluation via phase reconstruction permits a more precise map-
ping of the flow patterns and is more senSItive in detecting fluid motion and allows calculation of CSF velocity [12]. Our investigation was undertaken to characterize and quantify CSF flow at key locations in the neuraxis of normal and abnormal situations by means of PC cine MR.
Methods We studied 10 patients (mean 47.6 years) with NOH, and 3 patients (mean 35.3 years) with OH. All NOHs underwent shunting procedures, and all OHs underwent endoscopic third ventriculostomy. All patients fulfilled the following criteria: a history of progressive dementia, gait disturbance, and/or urinary incontinence; hydrocephalus on CT and MRI (Table 1). Mean Evans index was about 0.32 in NOH and 0.40 in OH. We also examined 10 healthy volunteers (mean 30.4
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