American Journal of Neuroradiology 2009;30:1898.
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American Journal of Neuroradiology
DOI 10.3174/ajnr.A1726
BRAIN
Is All "Communicating" Hydrocephalus Really Communicating? Prospective Study on the Value of 3D-Constructive Interference in Steady State Sequence at 3T
From Acibadem University, School of Medicine, Departments of Radiology (A.D.) and Neurosurgery (M.M.Ö.), Istanbul, Turkey; University of New South Wales (S.K.), St. George Hospital, Sydney, Australia; and Marmara University Medical Center, Division of Pediatric Neurosurgery (M.M.Ö.), Istanbul, Turkey.
Please address correspondence to Alp Dinçer, MD, Acibadem Kozyatagi Hospital, Department of Radiology, Inonu Cad. Okur Sok. No:21, Kozyatag
, Istanbul, 34742 Turkey; e-mail: adincer{at}asg.com.tr or alpdincer{at}yahoo.com
BACKGROUND AND PURPOSE: 3D-constructive interference in steady state (3D-CISS) sequence has been used to assess the CSF pathways. The aim of this study was to investigate the additive value of 3D-CISS compared with conventional sequences in the diagnosis of obstructive membranes in hydrocephalus.
MATERIALS AND METHODS: A total of 134 patients with hydrocephalus underwent MR imaging examination with a 3T unit consisting of turbo spin-echo, 3D-CISS, and cine phase-contrast (cine PC) sequences. 3D-CISS was used to assess obstructive membranes in CSF pathways compared with other sequences. Cine PC, follow-up imaging, and surgical findings were used to confirm obstructive membranes.
RESULTS: Comparing the number of noncommunicating cases by using the conventional and 3D-CISS images, we found 26 new cases (19.4%) of 134 cases that were previously misdiagnosed as communicating hydrocephalus by conventional images. 3D-CISS sequence identified obstructive membranes invisible in other sequences, which facilitated selection of neuroendoscopy in the treatment of 31 patients (23.1%) in total who would have been otherwise treated with shunt insertion. These patients included 26 newly diagnosed noncommunicating cases after demonstration of intraventricular and/or fourth ventricular outlet membranes and 5 cases of communicating hydrocephalus with obstructing cisternal membranes. There were obstructions of the foramina of Luschka in 22 of 26 newly found noncommunicating cases.
CONCLUSIONS: Conventional sequences are insensitive to obstructive membranes in CSF pathways, especially in the fourth ventricular exit foramina and the basal cisterns. 3D-CISS sequence, revealing these obstructive membranes, can alter patient treatment and prognosis.