Cine MRI in Hydrocephalus

• A Comprehensive Review of Arachnoid Cysts
• Diagnostic efficacy of radionuclide scintigraphy in detecting lumboperitoneal shunt obstructions in idiopathic hydrocephalus and intracranial hypertension
• Evaluation of magnetic resonance imaging features of spontaneous third ventriculostomy in triventricular hydrocephalus
• Challenges in Diagnosis and Management of Altered Mental Status in the Setting of Urosepsis and Hydrocephalus Secondary to an Occlusive Cyst of the Fourth Ventricle: A Case Report
• CSF flow measurement in the mesencephalic aqueduct using 2D cine phase-contrast MRI in dogs with communicating internal hydrocephalus, ventriculomegaly, and physiologic ventricular spaces
• Hydrodynamic and Hemodynamic Interactions in Chronic Hydrocephalus
• Spontaneous Third Ventriculostomy in Cases of Aqueductal Stenosis: A Retrospective Case Series
• Endoscopic third ventriculostomy for patients with Blake's pouch cyst with adult-onset hydrocephalus: Importance of improved cerebrospinal fluid flow in the prepontine cistern - A case report

Cine MRI is an important tool in the evaluation and management of hydrocephalus. This technique is particularly useful in assessing the dynamics of CSF flow and helping to differentiate between various types of hydrocephalus, such as communicating and non-communicating hydrocephalus.

Cine MRI for Cerebrospinal fluid shunt malfunction diagnosis.

CSF Flow Dynamics: Cine MRI allows visualization of the flow of cerebrospinal fluid (CSF) in real-time. By tracking the movement of CSF, physicians can assess whether there is an abnormal flow pattern, which is critical in determining the type of hydrocephalus and deciding on appropriate treatment strategies, such as the need for shunting.

Aqueductal Stenosis: It can detect obstruction in the cerebral aqueduct (the passage that connects the third and fourth ventricles), which is a common cause of non-communicating hydrocephalus. The cine images show if the CSF flow is blocked or restricted at this location.

Assessment of Shunt Function: For patients with a ventriculoperitoneal (VP) shunt, cine MRI can be used to evaluate whether the shunt is functioning properly by observing the flow of CSF around the shunt system.

Differentiating Hydrocephalus from Normal Pressure Hydrocephalus (NPH): Cine MRI is helpful in differentiating NPH, which often affects elderly patients and causes symptoms like gait disturbances, urinary incontinence, and cognitive decline. NPH is characterized by an enlargement of the ventricles without a clear increase in CSF pressure, and cine MRI can reveal subtle CSF flow abnormalities that help distinguish it from other forms of dementia or brain atrophy.

Pre-surgical Evaluation: In cases where surgery is being considered, cine MRI can guide neurosurgeons by providing a detailed map of CSF flow dynamics, aiding in decisions about whether endoscopic third ventriculostomy (ETV) or shunting might be necessary.

Cine MRI typically uses a phase-contrast technique, which allows the measurement of CSF velocity and flow patterns across the ventricular system. It captures images over time, creating a “movie” of CSF movement within the brain. The clinician can then evaluate these sequences to determine if the CSF is moving normally or if there is a blockage or abnormal flow that could be causing the hydrocephalus.

Benefits:

Non-invasive: Provides a detailed analysis without the need for invasive procedures.

Accurate Diagnosis: Helps to pinpoint the exact location and nature of CSF flow abnormalities.

Improves Treatment Decisions: Aids in determining the most appropriate treatment, whether it’s surgical or conservative.

Cine MRI is an invaluable tool for providing dynamic insights into how CSF circulates in the brain, offering critical information in the diagnosis and management of hydrocephalus.