Educational Exhibit at the European Congress of Radiology, Vienna, 2019

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Learning objectives

To the learn physics, protocol and practical applications of cine mode MRI brain sequences. To learn their role in the evaluation of patients with hydrocephalus including but not limited to those due to normal pressure hydrocephalus and aqueductal stenosis.

Background

Why and how Cine flow MR imaging? Differentiate between

1. Communicating and non-communicating hydrocephalus
2. Arachnoid cysts and subarachnoid space
3. Syringomyelia and cystic myelomalacia
   

Also

1. Evaluate flow patterns of posterior fossa cysts
2. Pre-op evaluation of Normal Pressure Hydrocephalus & Chiari 1
3. Post-op follow-up of third ventriculostomy (NTV) and ventriculoperitoneal (VP) shunt

Findings and procedure details

Protocol -Expected velocity of flow stated as velocity encoding (VENC) needs to be taken into account to detect hyperdynamic circulation and to avoid aliasing artefacts.
Technique- Time-resolved 2D phase contrast imaging with velocity encoding is the most widely used method for CSF flow analysis.
Quantification- Net flow = Positive flow + {Negative flow}/2

Case studies

1. NPH
2. Aqueduct web
3. Chiari malformation
4. Post-op follow-up of the third ventriculostomy
5. ventriculoperitoneal shunt
6. Evaluation of Communication between Arachnoid Cysts and Cisterns
7. Endoscopic 3rd ventriculostomy in tectal/aqueductal mass lesion

Conclusion

The abstract concludes with a discussion of the role of cine flow MRI is