Cine MR in the evaluation of normal and abnormal CSF flow: intracranial and intraspinal studies


Evaluation of intracranial and intraspinal CSF flow was accomplished by the use of cardiac gated gradient echo magnetic resonance (MR) technique. Normal patterns of pulsatile flow within the ventricles, cisterns and cervical subarachnoid space were established by this technique and these observations were compared to prior description of CSF flow. With systole there is downward (caudal) flow of CSF in the aqueduct of Sylvius, the foramen of Magendie, the basal cisterns and the dorsal and ventral subarachnoid spaces while during diastole, upward (cranial) flow of CSF in these same structures is seen. The relationships between the cardiac cycle and the CSF pulsations are demonstrated on both magnitude reconstruction and phase reconstruction MR images. Calculations of actual fluid velocity within CSF containing spaces can be obtained from the phase reconstruction images and holds promise for a more accurate analysis of CSF flow. In conditions which result in alterations of flow, cine MR dramatically shows either obstruction or excessively turbulent flow within the CSF pathways. The site of obstructed flow whether in the third ventricle, aqueduct, fourth ventricle, or subarachnoid space can be appreciated by changes in or absence of the normal hypointense signal. Cystic cord lesions such as congenital syringohydromyelia and posttraumatic spinal cord cysts may show pulsatile flow of CSF, a fact which can relate to progressive enlargement of these cysts. The distinction between myelomalacia and cyst formation in the cord is facilitated by the technique. Although the use of cine MR for the analysis of CSF flow is in its infancy, our experience indicates that this technique is useful in a wide range of pathological conditions including, but not limited to, conditions resulting in hydrocephalus or cystic cord lesions.

This is a preview of subscription content, access via your institution.


  1. 1.

    DuBoulay GH (1966) Pulsatile movements in the CSF pathways. Br J Radiol 39: 255–262

    Google Scholar 

  2. 2.

    DuBoulay GH, O'Connell J, Currie J, Bostic KT, Verity P (1972) Further investigations on pulsatile movements in the cerebrospinal fluid pathways. Acta Radiol 13:496–523

    Google Scholar 

  3. 3.

    Lane B, Kricheff II (1974) Cerebrospinal fluid pulsations at myelography: a videodensitometric study. Radiology 110: 579–587

    Google Scholar 

  4. 4.

    Sherman JL, Citrin CM (1986) Magnetic resonance demonstration of normal CSF flow. AJNR 7: 3–6

    Google Scholar 

  5. 5.

    Citrin CM, Sherman JL, Gangarosa RE, Scanlon D (1986) Physiology of the CSF flow-void sign: modification by cardiac gating. AJNR 7: 1021–1024

    Google Scholar 

  6. 6.

    Sherman JL, Citrin CM, Gangarosa RE, Bowen BJ (1986) The MR appearance of CSF pulsations in the spinal canal. AJNR 7: 879–884

    Google Scholar 

  7. 7.

    Sherman JL, Citrin CM, Bowen BJ, Gangarosa RE (1986) MR demonstration of altered cerebrospinal fluid flow by obstructive lesions. AJNR 7: 571–579

    Google Scholar 

  8. 8.

    Bradley WG, Kortman KE, Burgoyne B (1986) Flowing cerebrospinal fluid in normal and hydrocephalic states: appearance on MR images. Radiology 159: 611–616

    Google Scholar 

  9. 9.

    Bradley WG, Whittemore AR, Kortman KE, Caton WL, Garner JT (1989) Significance of the aqueductal cerebrospinal fluid flow void and deep white matter infarction on the outcome in patients with shunts for normal pressure hydrocephalus. Presented at the 75th Annual Meeting of the RSNA (Paper # 312), November 27, 1989, Chicago IL

  10. 10.

    Rubin JB, Enzmann DR (1988) Differential flip-angle imaging of cerebrospinal fluid flow: clinical applications in the evaluation of syringomyelia. Presented at the 74th Annual Meeting of the RSNA (Paper#150), November 28, 1988, Chicago IL

  11. 11.

    Atlas SW, Mark AS, Fram EK (1988) Aqueductal stenosis: evaluation with gradient echo rapid MR imaging. Radiology 169: 449–453

    Google Scholar 

  12. 12.

    Njemanze PC, Beck OJ (1989) MR gated intracranial CSF dynamics: evaluation of CSF pulsatile flow. AJNR 10: 77–80

    Google Scholar 

  13. 13.

    Quencer RM, Hinks RS, Post MJD, Calabro G (1989) Intracranial flow of cerebrospinal fluid: qualitative and quantitative evaluation with CINE-MR imaging. Presented at the 75th Annual Meeting of the RSNA (Paper#313), November 27, 1989, Chicago IL

  14. 14.

    Post MJD, Quencer RM, Hinks RS (1989) Spinal CSF flow dynamics: It's qualitative and quantitative evaluation by CINE-MR. Presented at the 27th Annual Meeting of the ASNR (Paper # 263), March 27, 1989, Orlando FL

  15. 15.

    Hinks RS, Post MJD, Quencer RM (1989) Quantitative evaluation of CSF flow dynamics in the spine. Presented at the 8th Annual Meeting of the SMRM, August 1989, Amsterdam, The Netherlands

  16. 16.

    Post MJD, Quencer RM, Green BA, Hinks SA, Sklar EM, Patchen S (1988) Cine-MR imaging in determining the flow characteristics of CSF and blood in spinal and intracranial lesions. Presented at the 74th annual meeting of the RSNA, Paper 579, November 30, 1988, Chicago, IL

  17. 17.

    Post MJD, Quencer RM, Green BA, Hinks SA, Horen M, Labus J (1988) The role of cine-MR in the evaluation of the pulsatile characteristic of post-traumatic spinal cord cysts. Presented at the 26th annual meeting of the ASNR, Paper#6, May 15, 1988, Chicago, IL

  18. 18.

    Quencer RM, Hinks RS, Pattany PH, Horen M, Post MJD (1988) Improved MR imaging of the brain using compensating gradients to suppress motion-induced artifacts. AJNR 9: 431–438

    Google Scholar 

  19. 19.

    Elster AD (1988) Motion artifact suppression technique (MAST) for cranial MR imaging: superiority over cardiac gating for reducing phase-shift artifacts. AJNR 9: 671–674

    Google Scholar 

  20. 20.

    Hinks RS, Quencer RM (1988) Motion artifacts in brain and spine MR. Radiol Clin North Am 26: 737–753

    Google Scholar 

  21. 21.

    Thomsen C, Stahlberg F, Mogelvang J, Stubgaard M, Nordell B (1989) Fourier analysis of cerebrospinal fluid flow in cerebral aqueduct. Presented at the 75th Annual Meeting of the RSNA (Paper#311), November 27, 1989, Chicago IL

  22. 22.

    Enzmann DR, Rubin J, Pelc N (1989) Cine phase contrast maps of cervical cerebrospinal fluid motion. Presented at the 75th Annual Meeting of the RSNA (Paper # 425), November 28, 1989, Chicago IL

  23. 23.

    Itabashi T, Arai S, Kitahura H, Watanabe T, Asahina K, Suzuki H (1988) Quantitative analysis of cervical cerebrospinal fluid pulsation. Presented at the 74th Annual Meeting of the RSNA (Paper # 569), November 30, 1988, Chicago IL

  24. 24.

    Levy M, DiChiro G, DeSouza B, McCullough DC, McVeigh E, Heffey D (1989) Fixed cord: effects of surgery and correlation with MR imaging. Presented at the 75th Annual Meeting of the RSNA (Paper # 428), November 28, 1989, Chicago IL

  25. 25.

    Quencer RM (1988) The injured spinal cord: evaluation with magnetic resonance and intraoperative sonography. Radiol Clin North Am 26: 1025–1045

    Google Scholar 

  26. 26.

    Bradley WG (1988) Flow phenomena in MR imaging. AJR 150: 983–994

    Google Scholar 

  27. 27.

    Nayler GL, Firmin DN, Longmore DB (1986) Blood flow imaging by cine magnetic resonance. J CAT 10: 715–722

    Google Scholar 

  28. 28.

    Masaryk TJ, Modic MT, Ruggieri RM, Ross JS, et al. (1989) Three dimensional (volume) gradient echo imaging of the carotid bifurcation: preliminary clinical experience. Radiology 171: 801–806

    Google Scholar 

  29. 29.

    Sherman JL, Citrin CM, Gangarosa RE, Bowen BJ (1986) The MR appearance of CSF flow in patients with ventriculomegaly. AJNR 7: 1025–1031

    Google Scholar 

  30. 30.

    Castillo M, Quencer RM, Green BA, Montalvo BM (1987) Syringomyelia as a consequence of compressive extramedullary lesions: postoperative clinical and radiological manifestations. AJNR 8: 973–978

    Google Scholar 

  31. 31.

    Quencer RM, El Gammal T, Cohen G (1986) Syringomyelia associated with intradural extramedullary masses of the spinal canal. AJNR 7: 143–148

    Google Scholar 

  32. 32.

    Simmons JD, Norman D, Newton TH (1983) Preoperative demonstration of post-inflammatory syringomyelia. AJNR 4: 625–628

    Google Scholar 

  33. 33.

    Pojunas K, Williams AL, Daniels DL, Haughton VM (1984) Syringomyelia and hydromyelia: magnetic resonance evaluation. Radiology 153: 679–683

    Google Scholar 

  34. 34.

    Castillo M, Quencer RM, Post MJD (1988) MR of intramedullary spinal cysticercosis. AJNR 9: 393–395

    Google Scholar 

  35. 35.

    Schlessinger AE, Naidich TP, Quencer RM (1986) Concurrent hydromyelia and diastematomyelia. AJNR 7: 473–477

    Google Scholar 

  36. 36.

    Itabashi T, Arai S, Kithara H, Watanabe T, Asahina K, Suzuki H (1988) Quantitative analysis of syrinx fluid pulsation. Presented at the 74th Annual Meeting of the RSNA (Paper # 570), November 30, 1988, Chicago IL

  37. 37.

    Sherman JL, Barkovich AJ, Citrin CM (1986) The MR appearance of syringomyelia: new observations. AJNR 7: 985–995

    Google Scholar 

  38. 38.

    Quent DJ, Patel SC, Sanders WP, Hearshen DO, Boulas RS (1989) Importance of absence of CSF pulsation artifacts in the MR detection of significant myelographic block at 1.5 T. AJNR 10: 1089–1095

    Google Scholar 

Download references

Author information



Rights and permissions

Reprints and Permissions

About this article

Cite this article

Quencer, R.M., Donovan Post, M.J. & Hinks, R.S. Cine MR in the evaluation of normal and abnormal CSF flow: intracranial and intraspinal studies. Neuroradiology 32, 371–391 (1990).

Download citation

Key words

  • Magnetic resonance imaging
  • Cerebrospinal fluid flow
  • Hydrocephalus
  • Spinal cord cyst
  • Cine-MR