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Diffusion Imaging in Obstructive Hydrocephalus

Aziz M. Uluga, Thuy N. Truonga, Christopher G. Filippia, Terry Chuna, Jimmy K. Leeb, Charles Yanga, Mark M. Souweidaneb and Robert D. Zimmermana

a Department of Radiology, Weill Medical College of Cornell University, New York, NY
b Department of Neurosurgery, Weill Medical College of Cornell University, New York, NY



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  		FIG 1. Patient 6. ROIs chosen to measure periventricular Dav values are shown on Dav maps. The Dav value determined from 44 periventricular white matter ROIs was 0.85 10-5 cm2/s (third MR examination).



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  		FIG 2. Pre- and post-treatment periventricular white matter Dav measurements in select patients are displayed relative to values in age-matched control subjects. The dotted line indicates normative values from references 18 and 19.

A, Patients 1–4.

B, Patients 9, 10, 12, and 14–17.



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  		FIG 3. Patient 4. Pre- and post-treatment images in a patient with a third ventricular choroid plexus papilloma.

A, Pretreatment FLAIR images at the level of the foramen of Monro and the lateral ventricles (top row) reveal the presence of the third ventricular choroid plexus papilloma. Ventricular dilatation and a grade 1 PVH are present. The Dav value was 1.08, 21% above normal. Dav maps at the corresponding levels (bottom row) show no evidence of abnormal signal intensity in the periventricular region.

B, Post-treatment images obtained on day 6 after tumor resection. On the FLAIR images (top row), the ventricles are smaller than before, and the PVH has decreased. Postoperative subdural collections are present. The Dav value has decreased to 0.87 (19% change) (bottom row).

C, Subsequent FLAIR images obtained 7 months after surgery reveal no evidence of tumor recurrence (top row). Subdural collections have resolved. The Dav value is 0.85, which is normal for the patient’s age (bottom row).



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  		FIG 4. Patient 16. Pre- and post-treatment images in a 13-year-old patient with a malignant hypothalamic glioma.

A, Pretreatment FLAIR images (top row) reveal the hypothalamic mass, hydrocephalus with symmetric dilatation of the lateral ventricles, and a grade 2 PVH. Dav images (bottom row) demonstrate normal-appearing periventricular white matter. The Dav value was 0.79, only 3% above normal for the patient’s age.

B, Repeat MR study was performed 7 days after partial resection and shunt placement. FLAIR images (top row) reveal residual tumor in the hypothalamus and asymmetric ventricular dilatation. The left lateral ventricle is smaller, but the right lateral ventricle is larger, consistent with unilateral obstruction at the foramen of Monro. The Dav value was also asymmetric (bottom row). In the left periventricular white matter, it had decreased to 0.76, whereas in the right periventricular white matter, it had increased to 0.80.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X