Evaluation of CSF flow metrics in patients with communicating hydrocephalus and idiopathic intracranial hypertension

  • Temel Fatih Yılmaz
  • Ayse AralasmakEmail author
  • Huseyin Toprak
  • Elnur Mehdi
  • Gulsen Kocaman
  • Serpil Kurtcan
  • Mehmet Onur Kaya
  • Alpay Alkan



To search for CSF dynamics of idiopathic intracranial hypertension (IIH) and communicating hydrocephalus and any correlation between MRI findings, CSF metrics and CSF opening pressure in IIH.

Materials and methods

Healthy subjects (30) and subjects with IIH (29) and high-pressure communicating hydrocephalus (43) were enrolled. Nonparametric Kruskal–Wallis test (p = 0.05) was used to compare three groups, Mann–Whitney U test with Bonferroni correction to compare two groups (p = 0.016). Correlation of MRI findings of IIH with CSF metrics and CSF opening pressure was analyzed by Spearman’s Rank correlation coefficient (p = 0.05).


In IIH, no correlation between MRI findings and aqueductal stroke volume (ASV) but statistically significantly CSF opening pressure in the presence of transverse sinus compression was noted. Comparing with healthy subjects, ASV was nonsignificantly lower and standardized diastolic and sum and difference of systolic and diastolic flow durations were statistically significantly lower. Comparing with hydrocephalus, the width of prepontine cistern (PPC)/the width of aqueductus sylvii (AS) was significantly higher and other CSF metrics with standardized systolic and sum of systolic and diastolic flow durations were significantly lower. In hydrocephalus, ASV and peak velocities were significantly higher. Compared with normal group, PPC/AS and reverse/forward flow duration were significantly lower and other CSF metrics were significantly higher.


In hydrocephalus, significant increase in ASV and peak velocities were noted. In IIH, CSF opening pressure was statistically significantly high in the presence of transverse sinus compression and standardized diastolic flow durations were statistically significantly short that are probably effects of increased impedance of CSF flow against increased intracranial pressure and unchanged or even decreased intraventricular CSF volume.


CSF flow Idiopathic intracranial intracranial hypertension Communicating hydrocephalus MRI findings 



Magnetic resonance imaging


Idiopathic intracranial hypertension


Cerebrospinal fluid


Aqueductal stroke volume


Phase contrast magnetic resonance imaging


Prepontine cistern


Aqueductus sylvii


3D sampling perfection with application-optimized contrasts using different flip angle evolutions


3D constructive interference in steady state


Authors’ contribution

TFY and HT contributed to data collection, data archiving, manuscript writing; AA was involved in project development, data collection, data archiving, manuscript writing; EM contributed to data collection, data archiving; GK, Neurologist, took care of the patients; SK and AA were involved in project development; MOK contributed to biostatistical analysis.

Compliance with ethical standards

Conflict of interest

The authors have declared no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Italian Society of Medical Radiology 2018

Authors and Affiliations

  1. 1.Department of RadiologyBezmialemVakif UniversityIstanbulTurkey
  2. 2.Department of NeurologyBezmialemVakif UniversityIstanbulTurkey
  3. 3.Department of BiostatisticsBezmialemVakif UniversityIstanbulTurkey

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