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MR ventriculography for the study of CSF flow
Vivek B Joseph1, Lakshminarayan Raghuram, Ipeson P Korah
1Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India.
Background And Purpose:
Various MR techniques have been used to assess CSF flow and to image the subarachnoid spaces and ventricles. Anecdotal reports describe the use of intrathecal and intraventricular gadolinium-based contrast agents in humans and animals. We sought to determine the clinical usefulness of gadolinium-enhanced MR ventriculography for assessing CSF flow in patients with various neurologic conditions.
Methods:
Five patients (three female and two male patients aged 6 months to 65 years) were included in the study. After performing sagittal, coronal, and axial T1-weighted MR imaging of the brain, 0.02-0.04 mmol of gadodiamide was injected into the lateral ventricle. Sagittal, coronal, and axial T1-weighted imaging was repeated soon after the injection. We were specifically looking for the site of obstruction to CSF flow in those patients with hydrocephalus, communication between cysts and ventricles, elucidation of suspicious intraventricular lesions, and patency of third ventriculostomies.
Results:
MR ventriculography showed good delineation of the ventricular system in all patients. In one patient with carcinomatosis and hydrocephalus, a block to contrast material flow was detected at the right foramen of Luschka. In another patient with hydrocephalus, partial block to the flow of contrast material was demonstrated at the right foramen of Monro. In a patient with hydrocephalus and a posterior fossa cyst, flow of contrast material was blocked between the third ventricle and the cyst, with a thin streak of contrast material in the aqueduct. As an assessment of the patency of a third ventriculostomy, MR ventriculography showed flow of contrast material into the suprasellar cisterns from the third ventricle in one patient and absence of flow in another.
Conclusion:
MR ventriculography is a safe technique for assessing CSF flow, with application in determining the site of obstruction in hydrocephalus, in assessing communication between cysts and the ventricle, and in determining the functioning status of endoscopic third ventriculostomies.
Insights
Gadolinium-enhanced MR ventriculography safely assesses cerebrospinal fluid (CSF) flow, identifying blockages in hydrocephalus and evaluating cyst communication and third ventriculostomy patency.
Area of Science:
- Neuroradiology
- Medical Imaging
- Neurology
Background:
- Magnetic Resonance (MR) techniques are utilized for assessing cerebrospinal fluid (CSF) flow and imaging brain structures.
- Gadolinium-based contrast agents have been anecdotally reported for intrathecal and intraventricular use in humans and animals.
Purpose of the Study:
- To determine the clinical usefulness of gadolinium-enhanced MR ventriculography for assessing CSF flow in patients with various neurologic conditions.
Main Methods:
- Five patients underwent T1-weighted MR imaging before and after intraventricular injection of gadodiamide.
- Imaging focused on identifying CSF flow obstructions, cyst-ventricle communication, intraventricular lesions, and third ventriculostomy patency.
Main Results:
- MR ventriculography clearly delineated the ventricular system in all patients.
- Obstructions to CSF flow were identified at the foramen of Luschka and foramen of Monro in hydrocephalus patients.
- Communication between cysts and ventricles was assessed, and third ventriculostomy patency was evaluated, showing both flow and absence of flow.
Conclusions:
- MR ventriculography is a safe and effective technique for evaluating CSF flow.
- It aids in pinpointing obstruction sites in hydrocephalus.
- The technique is valuable for assessing cyst-ventricle communication and the functional status of endoscopic third ventriculostomies.
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