The value of CSF flow studies in the management of CSF disorders in children: a pictorial review
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(2019) 10:3
Insights into Imaging
PICTORIAL REVIEW
Open Access
The value of CSF flow studies in the management of CSF disorders in children: a pictorial review Shaimaa Abdelsattar Mohammad* , Noha Mohamed Osman and Khaled A. Ahmed
Abstract CSF flow disorders are frequently encountered in children. The advent of MR technology with the emergence of new pulse sequences allowed better understanding of CSF flow dynamics. In this pictorial review, we aim to conduct a comprehensive review of the MR protocol used to study CSF flow disorders and to discuss the utility of each pulse sequence in the adopted protocol. We will focus on the key anatomical structures that should be examined to differentiate hydrocephalus form ventricular dilatation ex-vacuo. The MR features of obstructive and communicating hydrocephalus will be discussed, in addition to the manifestations of CSF disorders associated with posterior fossa malformations (Dandy-Walker malformation, Chiari, and Blake’s pouch cyst). Moreover, the value of MRI in the assessment of patients following interventional procedures (ventriculoperitoneal shunt and third ventriculostomy) will be addressed. Keywords: Pediatric hydrocephalus, Ventricular dilatation ex-vacuo, Phase contrast, Blake’s pouch and arachnoid cyst, Dandy-Walker malformation
Key points MRI is the ideal modality to investigate CSF flow
disorders in children. Our practical illustrated protocol based on 3D high-
resolution T2-WI and phase contrast along with conventional sequences helps to recognize different entities of CSF flow disorders in children. Most cases of hydrocephalus are related to obstruction with the aqueduct of Sylvius being the commonest site.
Introduction The advent in MRI technology has led to better understanding of CSF flow disorders which are frequently encountered in children [1, 2]. Flow-sensitive MRI techniques and three-dimensional highresolution sequences have been applied for functional and anatomical assessment of CSF flow dynamics,
respectively [3–5]. These studies can discriminate between communicating and non-communicating hydrocephalus with accurate localization of the site of obstruction [6]. Assessment of arachnoid cysts and determination of CSF movement alterations in cases with Chiari and Dandy-Walker malformations can be properly performed [3, 7]. Moreover, hydrocephalus and ventriculomegaly ex-vacuo can be differentiated. In addition to shunt surgeries, interventional procedures such as endoscopic third ventriculostomy and aqueductoplasty are among the treatment options. Accurate diagnosis of the site of obstruction and detection of a combination of pathologies are crucial for proper selection of the treatment strategy and improving the postoperative outcome [7, 8]. In this review, we will describe the MRI protocol adopted for the assessment of the ventricular system and CSF flow in children and the value of each imaging sequence in order to help reach the diagnosis. In addition, imaging features of various disorders are described.
* Correspondence: shai
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