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Endoscopic third ventriculostomy: predicting outcome with phase-contrast MR imaging
Stavros M Stivaros1, Deborah Sinclair, Paul A Bromiley
1Department of Imaging Science, Wolfson Molecular Imaging Centre, University of Manchester, 27 Palatine Rd, Withington, Manchester M20 3LJ, England. stavros.stivaros@postgrad.manchester.ac.uk
Purpose:
To determine whether phase-contrast magnetic resonance (MR) imaging measurements of preoperative cerebral blood and cerebrospinal fluid (CSF) hydrodynamics can be used as a biomarker of response to endoscopic third ventriculostomy (ETV).
Materials And Methods:
Approval from the local research ethics committee and written informed consent were obtained for this prospective study. Thirteen patients (six female patients, seven male patients; median age, 43 years) with chronic obstructive hydrocephalus, 12 of whom went on to undergo ETV, were imaged with phase-contrast MR imaging at 1.5 T to determine rates of total cerebral blood flow (CBF) and ventriculostomy defect, foramen magnum (FM), and cerebral aqueduct CSF flow. Ten control subjects (10 men; median age, 37 years) were similarly imaged. Correlations between measured values were assessed by means of Pearson correlation coefficients. Measurements were compared between groups with a Mann-Whitney test, and measurements before and after surgical intervention were compared with a Wilcoxon test for paired samples.
Results:
Rates of CBF (356 mL . min(-1) +/- 73 [standard deviation] vs 518 mL . min(-1) +/- 79, P < .001) and CSF flow in the FM (17.62 mL . min(-1) +/- 13.12 vs 36.35 mL . min(-1) +/- 8, P < .05) were significantly lower in patients than in control subjects.
Conclusion:
ETV induces changes in brain volume and CBF that can be predicted by using simple metrics. These pilot results support a formal trial of these techniques in a larger prospective study.