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Cine phase-contrast MR images failed to predict clinical outcome following ETV
Xiao Di1, M Ragab, Mark G Luciano
1Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Background:
To predict success of endoscopic third ventriculostomy (ETV) in patients with obstructive hydrocephalus, we evaluated pre- and post- operative phase-contrast cine magnetic resonance images (PC MRI) on cerebrospinal fluid (CSF), cine flow in basal cisterns around the brain stem, and cervical medullar junction (CMJ) retrospectively.
Methods:
The study involved 102 patients with mean age of 36.74+/-23.25, and F/M = 1.55. All patients had PC MRI taken both pre- and post-operatively. A dynamic MRI video of PC MRI was reviewed at sagittal, axial, and coronal sections to determine cistern flows around the brain stem and CMJ. For quantitative analysis, quadrants were divided around midbrain axially to evaluate interpeduncular, quadrageminal, and ambient cisterns of both sides using scores of 0 to 60. Pre- and post- pontine and CMJ flows were shown in sagittal view and scored 0 to 20, and lateral cerebellopontine cisterns of both sides were measured on coronal image and scored 0 to 20.
Results:
No significant difference in CSF flow was seen from three individual views and total cine score, or between ETV success and failure groups by multivariate analysis of variance. Kaplan-Meier Analysis and Spearman's Correlation Test produced no relationship between MRI cine flow scores and interval period after surgery to ETV failure.
Conclusion:
PC MRI cine flow failed to demonstrate significant differences between successful and failed ETV groups. This indicates in addition to achieving an adequate fenestration, CSF pathways beyond the basal cisterns around the brain stem and CMJ may play an essential role in achieving ETV success.
Insights
Phase-contrast cine MRI flow in basal cisterns did not predict endoscopic third ventriculostomy (ETV) success. Cerebrospinal fluid (CSF) pathways beyond the brain stem are crucial for ETV outcomes.
Area of Science:
- Neurosurgery
- Neuroradiology
- Medical Imaging
Background:
- Endoscopic third ventriculostomy (ETV) is a surgical procedure for obstructive hydrocephalus.
- Predicting ETV success is crucial for patient management.
- Phase-contrast cine magnetic resonance imaging (PC MRI) can assess cerebrospinal fluid (CSF) flow.
Purpose of the Study:
- To evaluate the utility of PC MRI in predicting ETV success.
- To assess CSF flow in basal cisterns and the cervical medullary junction (CMJ) pre- and post-operatively.
- To correlate CSF flow dynamics with ETV outcomes.
Main Methods:
- Retrospective analysis of 102 patients undergoing ETV.
- Pre- and post-operative PC MRI to evaluate CSF flow.
- Quantitative scoring of CSF flow in specific cisterns and the CMJ.
Main Results:
- No significant differences in CSF flow scores were observed between successful and failed ETV groups.
- Multivariate analysis of variance, Kaplan-Meier analysis, and Spearman's correlation did not reveal a relationship between MRI cine flow scores and ETV failure.
- PC MRI cine flow parameters did not predict ETV success.
Conclusions:
- PC MRI cine flow analysis of basal cisterns and CMJ is not a reliable predictor of ETV success.
- Factors beyond the evaluated CSF pathways, such as patency of other CSF routes, likely influence ETV outcomes.
- Further research is needed to identify comprehensive predictors of ETV success.
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