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Is all "communicating" hydrocephalus really communicating? Prospective study on the value of 3D-constructive
1Acibadem University, School of Medicine, Department of Radiology, Istanbul, Turkey. adincer@asg.com.tr
AJNR. American Journal of Neuroradiology
|August 1, 2009
Summary
Three-dimensional constructive interference in steady state (3D-CISS) MRI detects obstructive membranes in cerebrospinal fluid pathways missed by conventional sequences. This improved diagnosis of hydrocephalus can alter patient treatment and prognosis.
Area of Science:
- Neurosurgery
- Radiology
- Medical Imaging
Background:
- Hydrocephalus diagnosis relies on assessing cerebrospinal fluid (CSF) pathways.
- Conventional MRI sequences may fail to detect subtle obstructive membranes.
- Three-dimensional constructive interference in steady state (3D-CISS) is a specialized MRI technique.
Observation:
- A study compared 3D-CISS with conventional MRI sequences in 134 hydrocephalus patients.
- 3D-CISS identified obstructive membranes not visible on conventional imaging.
- These membranes were located in the fourth ventricle outlets and basal cisterns.
Findings:
- 3D-CISS revealed 26 new cases (19.4%) of noncommunicating hydrocephalus previously misdiagnosed.
- Obstructive membranes were found in the foramina of Luschka in 22 of these cases.
- 3D-CISS guided neuroendoscopy in 31 patients (23.1%), avoiding shunt surgery.
Implications:
- 3D-CISS significantly improves the detection of obstructive membranes in CSF pathways.
- Accurate diagnosis with 3D-CISS can lead to less invasive treatment selection.
- This technique has the potential to alter patient management and improve outcomes in hydrocephalus.
