Phase-contrast MRI and 3D-CISS versus contrast-enhanced MR cisternography on the evaluation of the aqueductal stenosis (original) (raw)
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Phase-Contrast MR Imaging Support for the Diagnosis of Aqueductal Stenosis
American Journal of Neuroradiology, 2008
BACKGROUND AND PURPOSE: Patients with aqueductal stenosis (AS) present with various clinical and radiologic features. Conventional MR imaging provides useful information in AS but depends on a subjective evaluation by the neuroradiologist. The purpose of this study was to evaluate the support of the phase-contrast MR imaging (PC-MR imaging) technique (sensitive to CSF flows) for the diagnosis of AS.
Data Revues 01509861 V38i2 S0150986110000854, 2011
Introduction In the current study, we aimed to compare the diagnostic efficacies of phase-contrast magnetic resonance imaging (PC-MRI) and three-dimensional constructive interference in steady-state (3D-CISS) sequence over detection of aqueductal stenosis (AS) on the basis of contrast-enhanced magnetic resonance cisternography (MRC). Methods Twenty-five patients with clinically and radiologically suspected AS were examined by PC-MRI, 3D-CISS, and MRC. Axial-sagittal PC-MRI and sagittal 3D-CISS were applied to view the cerebral aqueduct. Following injection of 0.5-1 ml intrathecal gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) injection, postcontrast MRC images were obtained in three planes in early and late phases. Aqueductal patency was scored as follows: grade 0, normal; grade 1, partial narrowing; and grade 2, complete obstruction. Results of PC-MRI and 3D-CISS were compared with the findings of MRC. Results In PC-MRI, seven cases were assessed as grade 0, 16 cases grade 1, and two cases grade 2. As a result of 3D-CISS sequence, eight cases were evaluated as grade 0, 12 cases grade 1, and five cases grade 2. Based on MRC, nine cases were assessed as grade 0, whereas nine and seven cases were evaluated to be grades 1 and 2, respectively. Five cases that demonstrated partial patency in PC-MRI or 3D-CISS showed complete obstruction by MRC. Conclusion PC-MRI is helpful in confirming the AS. However, positive flow does not necessarily exclude the existence of AS. 3D-CISS sequence provides excellent cerebrospinal fluid-to-aqueduct contrast, allowing detailed study of the anatomic features of the aqueduct. MRC should be performed on patients who demonstrate suspected AS findings on PC-MRI and/or 3D-CISS sequences.
2009
M agnetic resonance imaging (MRI) depicts cerebral tissue without need for contrast media in cerebral pathologies and gives detailed information on cerebrospinal fluid (CSF) and CSF flow pathways. In addition, physiopathologic evaluations including studies on CSF flow dynamics can be carried out by using cine-phase contrast techniques without need for invasive procedures such as contrast media injection or catheterization (1, 2). Evaluation of CSF flow physiology and pathologies with cine-phase contrast MRI evaluation has gained momentum in the last 15 years. Studies using this technique, which is very sensitive even to slow flow, have focused on the ventricular system, subarachnoid spaces, spinal canal, and the cerebral aqueduct (3-5). Following expression of flow through aqueduct quantitatively, an understanding of normal flow patterns was initially achieved, and flow changes in various pathologies were scrutinized. Communicating and obstructive hydrocephalus, Chiari malformation, and arachnoid cysts were the initial pathologies studied (6-9). Postsurgical clinical applications, such as evaluation of third ventriculostomy patency and aqueductal CSF flow evaluation following endoscopic aqueductoplasty came into use afterwards (10, 11). The characterization of normal CSF flow dynamics can provide pathophysiological information on diseases affecting CSF circulation by contributing to normal reference values. In this study, aqueductal CSF flow parameters in different age groups were investigated using cine-phase contrast MRI technique, with the aim of measuring differences in flow parameters among age groups and sexes. Materials and methods In this six-month prospective study, 60 subjects who underwent imaging for other indications but were found to have no abnormalities were included. Written consent was obtained from all subjects or legal representatives of subjects before the procedures. Of the cases, 25 (41.6%) were female and 35 (58.3%) were males, with ages ranging from 6 years to 70 years (mean, 31.2). The individuals were divided into five age groups: ≤14 years, 15-24 years, 25-34 years, 35-44 years, and ≥45 years. The mean ages in groups were as follows respectively: 9.1 years, 20.1 years, 30.1 years, 40.3 years, and 57.7 years. MRI examinations were performed with 1.5 T MR unit (Siemens Symphony, Erlangen, Germany). Imaging was carried out using standard head coils, in neutral supine position and without any case preparation. Subjects were asked to avoid deep breathing during the examination. Routine cranial axial and sagittal fast spin echo (FSE) T2-weighted images were acquired
American Journal of Neuroradiology, 2011
BACKGROUND AND PURPOSE: Diagnosis of AS and periaqueductal abnormalities by routine MR imaging sequences is challenging for neuroradiologists. The aim of our study was to evaluate the utility of the 3D-SPACE sequence with VFAM in patients with suspected AS. MATERIALS AND METHODS: PC-MRI and 3D-SPACE images were obtained in 21 patients who had hydrocephalus on routine MR imaging scans and had clinical suspicion of AS, as well as in 12 control subjects. Aqueductal patency was visually scored (grade 0, normal; grade 1, partial obstruction; grade 2, complete stenosis) by 2 experienced radiologists on PC-MRI (plus routine T1-weighted and T2weighted images) and 3D-SPACE images. Two separate scores were statistically compared with each other as well as with the consensus scores obtained from general agreement of both radiologists. RESULTS: There was an excellent correlation between 3D-SPACE and PC-MRI scores (ϭ 0.828). The correlation between 3D-SPACE scorings and consensus-based scorings was higher compared with the correlation between PC-MRI and consensus-based scorings (r ϭ 1, P Ͻ .001 and r ϭ 0.966, P Ͻ .001, respectively). CONCLUSIONS: 3D-SPACE sequence with VFAM alone can be used for adequate and successful evaluation of the aqueductal patency without the need for additional sequences and examinations. Noninvasive evaluation of the whole cranium is possible in a short time with high resolution by using 3D-SPACE. ABBREVIATIONS: 3D-CISS ϭ 3D constructive interference in steady state; 3D-SPACE ϭ 3D sampling perfection with application-optimized contrasts using different flip angle evolutions; AS ϭ aqueductal stenosis; CE-MRC ϭ contrast-enhanced MR cisternography; GRAPPA ϭ generalized autocalibrating partially parallel acquisition; MPRAGE ϭ magnetization-prepared rapid acquisition of gradient echo; PC ϭ phase-contrast cine; VFAM ϭ variant flip angle mode
Journal of Neurosurgery, 2000
INE phase-contrast MR imaging has been increasingly used during the last decade for evaluating cranial and spinal CSF flow. The phasecontrast technique is extremely sensitive, even to slow flow, and provides the potential for noninvasive flow quantification. The results of these measurements have yielded considerable information on the physiology of the normal CSF circulation. In addition, pathological CSF flow dynamics in communicating and obstructive hydrocephalus, Chiari malformation, 8 cystic lesion, 15 and cervical spondylosis 60 have been analyzed. With the increasing frequency of neuroendoscopic procedures, cine MR imaging has been recommended for evaluating the patency of third ventriculostomies. Aqueductal CSF flow after endoscopic aqueductoplasty, however, has not yet been investigated. We performed a prospective study to compare the aqueductal CSF flow in healthy volunteers and patients who had undergone endoscopic restoration of aqueductal patency.
European review for medical and pharmacological sciences, 2015
OBJECTIVE We aimed to evaluate dynamic cerebrospinal fluid (CSF) flow in idiopathic intracranial hypertension (IIH) patients with new MRI technology phase contrast cine (PCC) MRI. PATIENTS AND METHODS Nineteen patients diagnosed with idiopathic intracranial hypertension and 11 healthy volunteers were included in this study. Nine of the IIH cases had been previously diagnosed and had been on drug treatment and 10 cases were diagnosed with IIH recently and had not been put on drug treatment yet. All CSF flow datas were evaluated by phase contrast-MRI using a 1,5 T MRI. The CSF flow was calculated in the equidistant MRI sequence which was taken through a cardiac cycle. RESULTS Mean aqueduct area in the IIH group was 3.04 ± 1.14 mm², mean peak rate was 3.29 ± 1.77 cm/sec, mean average rate was 0.35 ± 0.33 cm/sec and mean flow was 0.67 ± 0.95 ml/min. In the control group mean aqueduct area was 2.87 ± 1.01 mm², mean peak rate was 4.20 ± 1.40 cm/sec, mean average rate was 0.37 ± 0.18 cm/se...
Acta Radiologica, 1993
Reproducibility of the aqueductal CSF signal intensity on a gradient echo cine-MR sequence exploiting through plane inflow enhancement was tested in 11 patients with normal or dilated ventricles. Seven patients with normal pressure hydrocephalus (NPH) syndrome were investigated with the sequence before and after CSF shunting. Two patients exhibiting central flow void within a hyperintense aqueductal CSF improved after surgery and the flow void disappeared after shunting. One patient with increased maximum and minimum aqueductal CSF signal as compared to 18 healthy controls also improved and the aqueductal CSF signal was considerably decreased after shunting. Three patients with aqueductal CSF values similar to those in the controls did not improve, notwithstanding their maximum aqueductal CSF signals decreasing slightly after shunting. No appreciable aqueductal CSF flow related enhancement consistent with non-communicating hydrocephalus was found in the last NPH patient who improved after surgery. Cine-MR with inflow technique yields a reproducible evaluation of flow-related aqueductal CSF signal changes which might help in identifying shunt responsive NPH patients. These are likely to be those with hyperdynamic aqueductal CSF or aqueductal obstruction.
Neurosurgery, 2007
N ormal pressure hydrocephalus (NPH) is a clinical syndrome characterized by gait and memory disturbances, incontinence, and widening of the ventricular system, as first described by Hakim and Adams (14) in 1965. Although the pathophysiology remains poorly understood, the syndrome is potentially reversible because diversion of cerebrospinal fluid (CSF) by shunt surgery has been documented as an effective treatment (2, 16, 21). The results of surgery are, however, variable, and improvement rates ranging from as low as 10% to as high as 90% are reported (20, 23, 26-28, 30). In clinical practice, therefore, a careful selection of patients for surgery is the main challenge of this syndrome. Different ancillary tests to assess CSF dynamics have been used for selecting patients with suspected NPH for surgical treatment (2, 3, 10, 11, 15, 18, 31, 32). Most of these tests are invasive and are routinely performed only in specialized centers. Technical advancements in magnetic resonance imaging (MRI) have made it possible to estimate pulsatile CSF flow, and a hyperdynamic aqueductal CSF
Intrathecal Gadolinium-Enhanced MR Cisternography in the Evaluation of CSF Leakage
American Journal of Neuroradiology, 2010
CE-MRC has been in use for the past 15 years and was reported to be a useful method in the evaluation of CSF disorders and hydrocephalus. The use of CE-MRC in conjunction with other MR imaging techniques has been shown to be effective in selected cases for the evaluation of several disorders of cerebrospinal system. CE-MRC has certain advantages over other cisternographic studies with fewer side effects if performed properly. Although intrathecal Gd administration is not widely accepted yet, several recent studies have reported the safety of small-dose intrathecal gadolinium injection. In this review, we describe CE-MRC and review recent applications in several clinical conditions. ABBREVIATIONS AC ϭ arachnoid cyst; AS ϭ aqueductal stenosis; CE ϭ contrast-material enhanced; CISS ϭ constructive interference in steady state; CTC ϭ CT cisternography; CTM ϭ CT myelography; ETV ϭ endoscopic third ventriculostomy; Gd ϭ gadolinium; Gd-DTPA ϭ gadopentetate dimeglumine; IHS ϭ intracranial hypotension syndrome; ICP ϭ intracranial pressure; MRC ϭ MR cisternography; NCE ϭ noncontrast-material enhanced; MRM ϭ MR myelography; NPH ϭ normal pressure hydrocephalus; PC ϭ phase-contrast; RC ϭ radionuclide cisternography; STV ϭ spontaneous third ventriculostomy