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Analysis of endoscopic third ventriculostomy patency by MRI: value of different pulse sequences, the sequence parameters, and the imaging planes for investigation of flow void

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Abstract

Purpose

The aim of the study is to evaluate the efficiency of turbo spin-echo (TSE), three-dimensional constructive interference in the steady state (3D CISS) and cine phase contrast (Cine PC) sequences in determining flow through the endoscopic third ventriculostomy (ETV) fenestration, and to determine the effect of various TSE sequence parameters.

Materials and methods

The study was approved by our institutional review board and informed consent from all patients was obtained. Two groups of patients were included: group I (24 patients with good clinical outcome after ETV) and group II (22 patients with hydrocephalus evaluated preoperatively). The imaging protocol for both groups was identical. TSE T2 with various sequence parameters and imaging planes, and 3D CISS, followed by cine PC were obtained. Flow void was graded as four-point scales. The sensitivity, specificity, accuracy, positive and negative predictive values of sequences were calculated.

Results

Bidirectional flow through the fenestration was detected in all group I patients by cine PC. Stroke volumes through the fenestration in group I ranged 10–160.8 ml/min. There was no correlation between the presence of reversed flow and flow void grading. Also, there was no correlation between the stroke volumes and flow void grading. The sensitivity of 3D CISS was low, and 2 mm sagittal TSE T2, nearly equal to cine PC, provided best result.

Conclusion

Cine PC and TSE T2 both have high confidence in the assessment of the flow through the fenestration. But, sequence parameters significantly affect the efficiency of TSE T2.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, School of Medicine, Acibadem University, Inonu Cad. Okur Sok. No:21, Kozyatagi, İstanbul, 34742, Turkey

    Alp Dinçer & Erdem Yildiz

  2. Adult and Pediatric Neurosurgeon, Spinal Surgeon, St. George Private Hospital and Concord Medical Centre, Sydney, Australia

    Saeed Kohan

  3. Department of Neurosurgery, Marmara University Medical Center, Istanbul, Turkey

    M. Memet Özek

  4. Division of Pediatric Neurosurgery, Marmara University Medical Center, Istanbul, Turkey

    M. Memet Özek

  5. Marmara University, Institute of Neurological Sciences, Istanbul, Turkey

    M. Memet Özek

  6. Acıbadem University, School of Medicine, Istanbul, Turkey

    M. Memet Özek

Authors
  1. Alp Dinçer
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  2. Erdem Yildiz
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  3. Saeed Kohan
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  4. M. Memet Özek
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Correspondence to Alp Dinçer.

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Dinçer, A., Yildiz, E., Kohan, S. et al. Analysis of endoscopic third ventriculostomy patency by MRI: value of different pulse sequences, the sequence parameters, and the imaging planes for investigation of flow void. Childs Nerv Syst 27, 127–135 (2011). https://doi.org/10.1007/s00381-010-1219-6

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  • DOI: https://doi.org/10.1007/s00381-010-1219-6

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