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01.01.2012 | Neuro | Ausgabe 1/2012

European Radiology 1/2012

Magnetic resonance velocity mapping of 3D cerebrospinal fluid flow dynamics in hydrocephalus: preliminary results

Zeitschrift:
European Radiology > Ausgabe 1/2012
Autoren:
Andreas Stadlbauer, Erich Salomonowitz, Christian Brenneis, Karl Ungersböck, Wilma van der Riet, Michael Buchfelder, Oliver Ganslandt
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00330-011-2247-7) contains supplementary material, which is available to authorized users.

Abstract

Objectives

To investigate the detectability of CSF flow alterations in the ventricular system of patients with hydrocephalus using time-resolved 3D MR velocity mapping.

Methods

MR velocity mapping was performed in 21 consecutive hydrocephalus patients and 21 age-matched volunteers using a 3D phase-contrast (PC) sequence. Velocity vectors and particle path lines were calculated for visualisation of flow dynamics. CSF flow was classified as “hypomotile flow” if it showed attenuated dynamics and as “hypermotile flow” if it showed increased dynamics compared with volunteers. Diagnostic efficacy was compared with routine 2D cine PC-MRI.

Results

Seven patients showed hypomotile CSF flow: six had non-communicating hydrocephalus due to aqueductal stenosis. One showed oscillating flow between the lateral ventricles after craniotomy for intracranial haemorrhage. Seven patients showed normal flow: six had hydrocephalus ex vacuo due to brain atrophy. One patient who underwent ventriculostomy 10 years ago showed a flow path through the opening. Seven patients showed hypermotile flow: three had normal pressure hydrocephalus, three had dementia, and in one the diagnosis remained unclear. The diagnostic efficacy of velocity mapping was significantly higher except for that of aqueductal stenosis.

Conclusions

Our approach may be useful for diagnosis, therapy planning, and follow-up of different kinds of hydrocephalus.

Key Points

Velocity-mapping provides additional information about CSF flow compared to 2D phase-contrast MRI
Ventricular CSF flow of hydrocephalus patients and volunteers shows complex 3D dynamics
This technique may be useful for the management of patients with hydrocephalus
The pathophysiological basis of CSF flow dysfunction may be better understood

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Zusatzmaterial
Supplementary Movie 1
Velocity mapping of CSF flow dynamics in the ventricular system of a 69-year-old male patient with hypomotile CSF flow due to a stenosis of the aqueduct of Sylvius in sagittal direction (same patient as in Fig.  1a) (MP4 1262 kb)
Supplementary Movie 2
Velocity mapping of CSF flow dynamics in the ventricular system of a 67-year-old male volunteer (same volunteer as in Fig.  1c) (MP4 1489 kb)
Supplementary Movie 3
Velocity mapping of CSF flow dynamics in the ventricular system of a 39-year-old male patient who had brain injury and intracranial hemorrhage and craniotomy (temporal, right) 3 years ago (same patient as in Fig.  2a and d) (MP4 1175 kb)
Supplementary Movie 4
Velocity mapping of CSF flow dynamics in the ventricular system of a 45-year-old male volunteer (same volunteer as in Fig.  2c and e) (MP4 1632 kb)
Supplementary Movie 5
Velocity mapping in coronal orientation of CSF flow dynamics in the ventricular system of a 39-year-old male patient who had brain injury and intracranial hemorrhage and craniotomy (temporal, right) three years ago (same patient as in Fig.  2a and d) (MP4 1564 kb)
Supplementary Movie 6
Velocity mapping in coronal orientation of CSF flow dynamics in the ventricular system of a 45-year-old male volunteer (same volunteer as in Fig.  2c and e) (MP4 1702 kb)
Supplementary Movie 7
Velocity mapping of CSF flow dynamics in the ventricular system of a 78-year-old male patient with hydrocephalus ex vacuo due to brain atrophy and with normal CSF flow (same patient as in Fig.  3a) (MP4 1270 kb)
Supplementary Movie 8
Velocity mapping of CSF flow dynamics in the ventricular system of an 80-year-old female volunteer (same volunteer as in Fig.  3c) (MP4 1181 kb)
Supplementary Movie 9
Velocity mapping of CSF flow dynamics in the ventricular system of a 50-year-old male patient who has underwent a ventriculostomy 10 years ago because of non-communicating hydrocephalus (same patient as in Fig.  4a) (MP4 1009 kb)
Supplementary Movie 10
Velocity mapping of CSF flow in the ventricular system dynamics of a 60-year-old female patient with normal pressure hydrocephalus (same patient as in Fig.  5a) (MP4 1412 kb)
Supplementary Movie 11
Velocity mapping of CSF flow in the ventricular system dynamics of a 60-year-old male volunteer (same volunteer as in Fig.  5c) (MP4 1395 kb)
Literatur
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