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AJNR - American Journal of Neuroradiology

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Functional Analysis of Third Ventriculostomy Patency by Quantification of CSF Stroke Volume by Using Cine Phase-Contrast MR Imaging

Núria Bargalló^a, Lourdes Olondo^a, Ana I. Garcia^a, Sebastian Capurro^a, Luis Caral^b and Jordi Rumia^b

^a Department of Radiology Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
^b Department of Neurosurgery, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain

View larger version (82K): [in a new window]   FIG 1. A, Sagittal T1-weighted image located in the midsagittal plane shows a cystic lesion inside the aqueduct. B, Sagittal cine phase-contrast image after ventriculostomy shows flow signal intensity between third ventricle and pontine cistern.

View larger version (186K): [in a new window]   FIG 2. An 11-year-old boy with aqueduct stenosis and previous ventriculostomy who had clinical deterioration. A, Coronal T1-weighted image centering in mammillary bodies shows a small defect in the floor of third ventricle (arrow). B, Sagittal cine phase contrast in the ventriculostomy site demonstrates a filiform flow signal intensity (arrow). C and D, Coronal T1-weighted image and sagittal cine phase contrast after new ventriculostomy demonstrate a big defect in the floor of third ventricle and excellent flow passing through the ventriculostomy.

View larger version (179K): [in a new window]   FIG 3. Patients with secondary aqueduct stenosis induced by pineal lesion. A, Sagittal T1-weighted image demonstrated a cystic lesion in the pineal region blocking the aqueduct and producing hydrocephalus. B, Sagittal cine phase-contrast in the ventriculostomy site performed shortly after surgery and treatment of pineal lesion demonstrates a filiform flow signal intensity in the ventriculostomy and subtle flow signal intensity in the aqueduct (arrows). C, Sagittal T1-weighted image obtained long after treatment demonstrates reduction of pineal lesion and aqueduct decompression. D, Sagittal cine phase-contrast performed in the same examination shows absence of flow in the ventriculostomy and aqueduct permeability.

View larger version (11K): [in a new window]   FIG 4. Box plot of the OFA of stroke volume related to clinical outcome. Patients with clinical improvement after surgery showed higher stoke volume than patients without clinical improvement.

View larger version (116K): [in a new window]   FIG 5. Patient with congenital triventricular hydrocephalus. A, Presurgery axial T1-weighted image at the level of ventricular bodies demonstrated an enlarged ventricular size. B, Immediately postsurgery, axial T1-weighted image at the same level shows reduction of ventricular size and 2 subdural collections. Pneumoencephalus was also present. C and D, Axial T1-weighted image, 6 months after surgery, shows that the ventricular bodies regressed to initial size, and sagittal phase-contrast image demonstrates absence of flow in the ventriculostomy. E and F, Coronal and sagittal T1-weighted image, 6 months after surgery, at the level of mammillary bodies demonstrates the persistence of third floor defect.