Assessment of Cerebrospinal Fluid Flow Patterns Using the Time-Spatial Labeling Inversion Pulse Technique with 3T MRI: Early Clinical Experiences

Abstract

CSF imaging using the time-spatial labeling inversion pulse (time-SLIP) technique at 3T magnetic resonance imaging (MRI) was performed to assess cerebrospinal fluid (CSF) dynamics. The study population comprised 15 healthy volunteers and five patients with MR findings showing expansive dilation of the third and lateral ventricles suggesting aqueductal stenosis (AS). Signal intensity changes were evaluated in the tag-labeled CSF, untagged brain parenchyma, and untagged CSF of healthy volunteers by changing of black-blood time-inversion pulse (BBTI). CSF flow from the aqueduct to the third ventricle, the aqueduct to the fourth ventricle, and the foramen of Monro to the lateral ventricle was clearly rendered in all healthy volunteers with suitable BBTI. The travel distance of CSF flow as demonstrated by the time-SLIP technique was compared with the distance between the aqueduct and the fourth ventricle. The distance between the foramen of Monro and the lateral ventricle was used to calculate the CSF flow/distance ratio (CD ratio). The CD ratio at each level was significantly reduced in patients suspected to have AS compared to healthy volunteers. CSF flow was not identified at the aqueductal level in most of the patients. Two patients underwent time-SLIP assessments before and after endoscopic third ventriculostomies (ETVs). CSF flow at the ETV site was confirmed in each patient. With the time-SLIP technique, CSF imaging is sensitive enough to detect kinetic changes in CSF flow due to AS and ETV.