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eISSN 2951-0805
    J Korean Soc Radiol. 2015 Jul;73(1):26-35. Korean.
    Published online Jun 24, 2015.
    https://doi.org/10.3348/jksr.2015.73.1.26
    Copyright © 2015 The Korean Society of Radiology
    Original Article

    Utility of Two Types of MR Cisternography for Patency Evaluation of Aqueduct and Third Ventriculostomy Site: Three Dimensional Sagittal Fast Spin Echo Sequence and Steady-State Coherent Fast Gradient Echo Sequence

    Jung Hyun Park, MD,1 Eunhee Kim, MD,1 Jong Bin Park, BS,1 Jae Hyoung Kim, MD,1 Byung Se Choi, MD,1 Cheolkyu Jung, MD,1 Yun Jung Bae, MD,1 and Kyung Mi Lee, MD1,2
      • 1Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
      • 2Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea.
    • Corresponding author: Eunhee Kim, MD. Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 463-707, Korea. Tel. 82-31-787-7629, Fax. 82-31-787-4011, Email: xmida@hanmail.net
    Received January 12, 2015; Accepted March 22, 2015.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    We aimed to evaluate the utility of two types of MR cisternography [fast spin echo sequence and steady-state coherent gradient echo (GRE) sequence] in addition to phase contrast-cine imaging (PC-cine), for assessing patency at the aqueduct and third ventriculostomy site.

    Materials and Methods

    43 patients (35 patients with suspected aqueductal stenosis and 8 patients with third ventriculostomy) were retrospectively analyzed. PC-cine, 3 dimensional sagittal fast spin echo sequence [driven-equilibrium imaging (DRIVE) or volumetric isotrophic T2-weighted acquisition (T2 VISTA)] and steady-state coherent fast GRE sequence (balanced turbo field echo; bTFE) imaging were performed in all patients. The patency of the aqueduct or third ventriculostomy site was scored. Some pitfalls of each sequence were also analyzed in individual cases.

    Results

    93% of all cases showed consistent scores in PC-cine, DRIVE/T2 VISTA, and bTFE imaging. DRIVE/T2 VISTA imaging provided functional information of cerebrospinal fluid flow with flow-related artifacts, while bTFE imaging allowed direct visualization of the aqueduct or ventriculostomy site. However, evaluation of anatomical structures was difficult in three cases with strong flow-related artifacts on DRIVE/T2 VISTA and in 2 cases with susceptibility artifacts on bTFE.

    Conclusion

    Both DRIVE/T2 VISTA and bTFE imaging have complementary roles in evaluating the patency of the aqueduct and 3rd ventriculostomy site.

    Keywords
    Aqueductal Stenosis; Third Ventriculostomy; Volumetric Isotrophic T2-Weighted Acquisition; Driven-Equilibrium Imaging; Balanced Turbo Field Echo

    Figures

    Fig. 1
    A 47-year-old man with Chiari malformation.
    A. Phase-contrast cine image shows active cerebrospinal fluid pulsation through the aqueduct (arrows).

    B. Volumetric isotrophic T2-weighted acquisition image shows patent aqueduct and flow-related artifact within the patent aqueduct (arrows).

    C. Balanced turbo field echo image shows patent aqueduct without flow-related artifact (arrow).

    Fig. 2
    A 54-year-old man with aqueductal stenosis.
    A. Phase-contrast cine image shows faint cerebrospinal fluid pulsation through the aqueduct (arrows).

    B, C. Both volumetric isotrophic T2-weighted acquisition (T2 VISTA) (B) and balanced turbo field echo (C) images show web-like lesion at the superior medullary velum of the 4th ventricle causing aqueductal stenosis (arrow). Also there is no flow-related artifact through the aqueduct on T2 VISTA image (B).

    Fig. 3
    A 65-year-old woman with a coil-embolized aneurysm at the top of the basilar artery. Phase-contrast cine image (A) shows coil-embolized giant aneurysm at the basilar tip (arrowheads) and no active cerebrospinal fluid pulsation through the aqueduct (arrow). Volumetric isotrophic T2-weighted acquisition image (B) also shows coil-embolized aneurysm causing aqueductal stenosis (arrow). However, the lumen of the aqueduct is obscured by coil-induced susceptibility artifact on balanced turbo field echo image (C).

    Fig. 4
    A 3-year-old boy with Dandy-Walker variant. Phase-contrast cine image (A) shows active cerebrospinal fluid (CSF) pulsation through the aqueduct (arrow). Volumetric isotrophic T2-weighted acquisition image (B) shows severe flow-related artifact through the aqueduct due to large amount of CSF flow, which obscures the normal contour of the aqueduct (arrow). Balanced turbo field echo image (C) shows slightly widened aqueduct and minimal flow-related artifact within the aqueduct (arrow).

    Fig. 5
    A 23-year-old man underwent the endoscopic third ventriculostomy for the aqueductal stenosis. Phase-contrast cine image (A) shows active cerebrospinal fluid pulsation through the ventriculostomy site in the 3rd ventricle floor (arrows). Volumetric isotrophic T2-weighted acquisition image (B) directly demonstrates the ventriculostomy site (arrows) and flow-related artifact through the ventriculostomy site. The ventriculostomy site is directly identified without flow-related artifact on balanced turbo field echo image (arrows) (C).

    Fig. 6
    A 10-month-old girl with endoscopic third ventriculostomy for the aqueductal stenosis. Phase-contrast cine image (A) shows active cerebrospinal fluid pulsation through the ventriculostomy site (arrow). Driven-equilibrium image (B) shows severe flow-related artifact in the 3rd ventricle and prepontine cistern area (arrows), which obscures the exact ventriculostomy site at the 3rd ventricle floor, whereas 3rd ventriculostomy site is localized with minimal linear flow-related artifact on balanced turbo field echo image (arrows) (C).

    Tables

    Table 1
    Comparison of PC-Cine, T2 VISTA/DRIVE and bTFE Imaging Scores for Evaluation of Aqueductal Patency

    Table 2
    Comparison of PC-Cine, T2 VISTA/DRIVE and bTFE Imaging Scores for Evaluation of Patency at Ventriculostomy Site after Endoscopic Third Ventriculostomy

    Notes

    This work was supported by grant number 02-2013-061 from the SNUBH Research Fund.

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    MeSH Terms
    Artifacts
    Cerebrospinal Fluid
    Humans
    Hydrocephalus
    Retrospective Studies
    Ventriculostomy*
    Metrics
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