Physiology of the CSF flow-void sign: modification by cardiac gating

Low-intensity signal seen within areas of narrowing within the ventricular system has been termed the CSF flow-void sign. This decreased signal is related to CSF flow and turbulence. Seven normal volunteers were examined, and the changes that occurred in the appearance of the CFVS were noted when data acquisition was modified by cardiac gating. Flow-void patterns within the internal cerebral veins and basilar artery were also examined. The results of this study confirm that CSF flow is related to cardiac systole and diastole. An increase in hypointensity is seen in the areas of the aqueduct of Sylvius and the foramen of Magendie during the time at which the systemic arterial pulse wave is transmitted into the brain. The physiology of this observation is related either to a direct hydraulic effect of the venous system on the CSF or to filling and expansion of the thin-walled cerebral venous system. Hypointensity or an increase in the width of the basilar artery and internal cerebral veins during systolic data acquisition was also noted. The mechanism of this phenomenon is related to propagation of the systemic arterial pulse wave.