Cerebrospinal fluid pulsation: benefits and pitfalls in MR imaging

Physiologic cerebrospinal fluid (CSF) pulsation causes a harmonic modulation of proton precessional phase with two-dimensional Fourier transform (2DFT) imaging, which results in predictable regions of signal loss and the presence of phase-shift images ("ghost images"). CSF that is not pulsating exhibits a higher signal than does pulsatile CSF. This phenomenon can be diagnostically useful in disease entities associated with decreased CSF pulsation amplitude, such as arachnoid cyst, intraventricular cyst, spinal stenosis, and spinal block caused by extramedullary or epidural tumor. Unfortunately, this increased signal can also mimic disease such as epidural tumor in the spine or acoustic neuroma in the internal auditory canal. An abnormal pattern of CSF pulsation, as occurs in patients with arachnoiditis, can cause unusual areas of signal loss, which complicate image interpretation and can mimic pathologic conditions. Recognition of CSF pulsation effects will increase in importance as thin-section magnetic resonance imaging becomes more common, because thin sections enhance these effects with 2DFT.