pädiatrische Erkrankungen des Liquorsystems

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. MRI protocol for hydrocephalus. Normal images of a 3-year-old boy: a Axial T2-WI. b Axial FLAIR. c Coronal T2-WI through the lateral and third ventricles (asterisk); note the morphology of the ventricular system, especially the temporal horns (arrows). d Midline sagittal T1-WI image shows the corpus callosum (asterisk), the anterior commissure (short arrow), and the fornix (long arrows). The midbrain with aqueduct and tectal plate (dotted arrow), pons, fourth ventricle (4th), and vermis are well seen

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. MRI of a 16-month-old boy with communicating hydrocephalus reveals hyperdynamic CSF flow through the aqueduct of Sylvius. a Sagittal 3D-DRIVE demonstrates flow void through the aqueduct of Sylvius. b Phase-contrast MRI of another patient demonstrates prominent CSF flow through the aqueduct of Sylvius with accelerated CSF flow velocity (c)

Phase-contrast

magnetic resonance imaging in evaluation of hydrocephalus in pediatric patients. A–E A 10-year-old male child with headache and blurring of vision. A Coronal T2W image shows asymmetry of both lateral ventricles being larger on the right side with obstructing membrane in the right foramen of Monro (blue arrow), B sagittal T2 DIVER image reveals patent normal aqueduct (white arrow), C, D axial phase-contrast images reveal normal CSF flow through the aqueduct at systole (C) and diastole (D) (black arrows), and E velocity time curve- and CSF flow curve-associated table reveals irregular CSF flow curve indicating irregular to and fro movement of the CSF proximal to the site of obstruction with PSV: 7.8 cm/s, PDV:7.9 cm/s, MV: 7.8 cm/s, MSF: 0.176 m/s and SV: 61 µl (hyperdynamic CSF circulation with high CSF velocities and stroke volume and normal flow through aqueduct of Sylvius unilateral obstructive hydrocephalus at level of foramen of Monro by a membrane)

Phase-contrast

magnetic resonance imaging in evaluation of hydrocephalus in pediatric patients. A–E A 5-year-old male child with headache and blurred vision. A Axial T2W image shows moderate dilatation of supratentorial ventricles, B sagittal T2 DIVER image reveals caudal cerebellar tonsil herniation through foramen magnum (blue arrow), peaked tectum (white arrow), and narrowing of cerebral aqueduct of Sylvius, C, D sagittal phase-contrast images reveal low CSF flow through the aqueduct at systole (C) and diastole (D) (black arrows), no CSF flow at posterior subarachnoid space (red arrows), and E velocity time curve- and CSF flow curve-associated table reveals CSF in both diastole (above the base line) and systole (below the base line) with PSV: 1.2 cm/s, PDV: 0.9 cm/s, MV: 1.05 cm/s, MSF: 0.02 m/s, and SV: 5 µl (hypodynamic CSF circulation with low CSF velocities and stroke volume at aqueduct of Sylvius and no CSF flow at posterior subarachnoid space at the level of foramen magnum Arnold–Chiari malformation)

Phase-contrast

magnetic resonance imaging in evaluation of hydrocephalus in pediatric patients. A–E A 6-year-old female child with headache and persistent vomiting. A Axial T2W image shows mild-to-moderate supratentorial ventricular dilation, B sagittal T2 DIVER image reveals absent flow void at aqueduct of Sylvius which is obstructed by aqueductal web (white arrow). C, D Sagittal phase-contrast images reveal no CSF flow through the aqueduct at systole (C) and diastole (D) (black arrows), and E velocity time curve- and CSF flow curve-associated table reveals irregular CSF flow curve indicating irregular to and fro movement of the CSF proximal to the site of obstruction with PSV: 0.8 cm/s, PDV:1.02 cm/s, and MV: 0.4 cm/s (hypodynamic CSF circulation with low CSF velocities and no flow through aqueduct of Sylvius obstructive hydrocephalus due to aqueductal web)

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. Axial T2-WI of a 6-month-old girl with hydrocephalus and non-functioning ventriculoperitoneal shunt demonstrates fluid surrounding the VP shunt (asterisk)

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. A 9-year-old girl with ventriculostomy. a 3D-DRIVE demonstrates flow void through a defect in the third ventricular floor (arrow). b Phase-contrast MRI reveals flow jet through the ventriculostomy (arrow). c, d Phase images through systole and diastole demonstrate the pulsatile flow throughout the cardiac cycle (arrow)

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. A 10-year-old boy with Chiari malformation. a Sagittal T2-WI showing cerebellar tonsil herniation. b Phase-contrast MRI demonstrates obstructed CSF flow at the foramen magnum

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. A 12-month-old girl with Blake’s pouch cyst. a 3D-DRIVE showing infracerebellar cyst (asterisk) associated with dilated third and fourth ventricles. b Phase-contrast MRI reveals absence of communication between the cyst and the posterior cervical subarachnoid space

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. A 3-month-old boy with Dandy-Walker malformation with hydrocephalus. a 3D-DRIVE showing large posterior fossa, cerebellar hypoplasia, and stenosis of the aqueduct of Sylvius. b, c Phase-contrast sequence showing absence of flow through the aqueduct of Sylvius with no communication between the posterior fossa cyst and the posterior cervical subarachnoid space

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. Axial T2-WI (a) and FLAIR (b) of a 5-month-old girl with glutaric aciduria and macrocephaly showing ventriculomegaly with subdural collection (asterisk)

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. A 3-month-old boy with hydrocephalus. a Sagittal 3D-DRIVE demonstrates aqueduct stenosis. b Phase-contrast MRI shows absence of detectable flow at the region of the aqueduct with markedly diminished velocity (c)

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. The value of FLAIR sequence in two different patients. a Axial FLAIR of a 14-year-old boy showing periventricular high signal in a setting of acute hydrocephalus secondary to a colloid cyst (not shown). b Axial FLAIR of an 11-year-old girl with periventricular high signal reflecting poor myelination due to the noxious effect of hydrocephalus. Note the thick skull with prominent diploic space (asterisk) in the chronic shunted patient

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. Midsagittal 3D-DRIVE showing the aqueduct of Sylvius and third ventricular anatomy in a normal infant (a) and patients with aqueduct stenosis (b–d). a A normal third ventricle of a 1-year-old girl. The lamina terminalis and tuber cinereum are concave centrally which may suggest that the mean pressure in the third ventricle may be lower than that in the cisterns. Note the signal void within the patent aqueduct of Sylvius. b MRI of a 3-month-old with mild hydrocephalus showing dilatation of the third ventricle recesses with bulge of the lamina terminalis secondary to multifocal aqueduct stenosis. c An 8-month-old girl with hydrocephalus secondary to congenital aqueduct stenosis (note the proximal funneling) showing more dilatation of the third ventricle recesses and more bulge of the lamina terminalis and third ventricle floor. d A 5-year-old boy with severe hydrocephalus with effacement of the chiasmatic and suprasellar recesses of the third ventricle. Note dilatation of the pineal recesses

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. A 7-month-old girl with hydrocephalus secondary to focal aqueduct stenosis. a Sagittal 3D-DRIVE demonstrates aqueduct stenosis (arrow) with dilated ventricular system. b, c Coronal reformatted image reveals prepontine adhesions (arrows)

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. MRI of a 6-year-old boy with foramen of Monro stenosis. a Axial T2-WI showing dilated left lateral ventricle (asterisk). b Coronal 3D-DRIVE demonstrating foramen of Monro stenosis (arrow)

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. The value of post-contrast T1-WI in different cases with hydrocephalus. a, b MRI of a 16-year-old boy with hydrocephalus secondary to meningitis demonstrating smooth meningeal enhancement. c MRI of an 8-year-old girl with tuberous sclerosis demonstrating enhanced giant cell astrocystoma (asterisk) and subependymal nodule (arrow). d MRI of a 5-year-old girl with medulloblastoma showing nodular enhancement representing meningeal metastasis

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. Sagittal 3D-DRIVE (a, b, and c) and maximum intensity projection (MIP) images (d, e, and f) in three different patients. a, d A 5-month-old girl with cerebral atrophy shows concave lamina terminalis and tuber cinereum with dilated cortical sulci in the MIP image. b, e A 4-year-old boy with hydrocephalus secondary to aqueduct stenosis demonstrates dilated third and lateral ventricles (note the convex lamina terminalis and tuber cinereum and narrowed cortical sulci in MIP image). c, f A 22-month-old boy with multiple adhesions in cystic spaces representing entrapped CSF cysts as a result of inflammatory adhesions. Note the narrowed cortical sulci and multiple loculations in the MIP image

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. The value of coronal T2-WI in two different patients. a MRI of a 7-month-old girl with hydrocephalus showing commensurate dilatation of the temporal horns (arrowheads) with the lateral ventricles. b MRI of a 5-month-old boy with brain atrophy. The temporal horns (arrows) are small compared to the bodies of the lateral ventricles; they retain their normal shape and the hippocampi are not displaced medially (asterisk)

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. Axial T2-WI in different patients with ventriculomegaly a MRI of a 7-month-old girl with hydrocephalus associated with septo-optic dysplasia showing ventricular dilatation with effacement of extra-axial CSF spaces. b MRI of an 8-month-old boy with delayed development and microcephaly showing ventricular dilatation ex-vacuo; both lateral ventricles and extra-axial CSF spaces are dilated. c MRI of a 5-month-old girl with macrocephaly with normal development showing benign enlargement of subarachnoid spaces

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. Phase-contrast image in axial plane perpendicular to the aqueduct of Sylvius (circle). a Rephrased-image. b, c Phase image through systole and diastole. d Magnitude image. e Graph demonstrating CSF flow velocity wave

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. Phase-contrast sequence in sagittal plane of a 2-year-old girl. a Re-phased image in which there is visible background. b Magnitude image in which the flow is bright with suppressed background. c, d Phase image demonstrates the to-and-fro (pulsatile) bright and black flow of CSF throughout the cardiac cycle. Note the CSF flow in the prepontine-premedullary cisterns (long arrows) and the aqueduct of Sylvius (short arrows)

The value of

CSF flow studies in the management of CSF disorders in children: a pictorial review. a, b Sagittal 3D-DRIVE of a 12-year-old boy demonstrates the anatomy of midline structures: the third ventricle (3rd), aqueduct of Sylvius (white asterisk), fourth ventricle (4th), and cisterna magna (CM). Note the concave floor of the third ventricle (yellow arrows) and lamina terminalis (orange arrow heads), chiasmatic and infundibular recesses of the third ventricle (green, red arrows), pineal (black arrow) and suprapineal (asterisk) recesses of the third ventricle, and anterior commissure (white arrow)

Phase-contrast

magnetic resonance imaging in evaluation of hydrocephalus in pediatric patients. A–E A 10-year-old male child with headache and blurred vision. A Axial FIESTA image shows mild dilation of supratentorial ventricular system, and cystic lesion at floor of third ventricle. B Sagittal T2 DIVER image reveals patent normal aqueduct with normal flow void (white arrow) and a suprasellar cystic lesion (blue arrow) reaching the floor of third ventricle and compressing it with no communication between the cyst and neighboring CSF spaces. C, D Sagittal phase-contrast images reveal normal CSF flow through the aqueduct at systole (C) and diastole (D) (black arrows) with no jet flow between intra ventricular cyst lesion and neighboring CSF spaces, and E velocity time curve- and CSF flow curve-associated table reveals CSF in both diastole (above the base line) and systole (below the base line) with PSV: 5.9 cm/s, PDV:2.92 cm/s, MV: 4.45 cm/s, MSF: 0.04 m/s and SV: 16.6 µl (normal dynamic CSF circulation with normal CSF velocities and stroke volume and normal flow through aqueduct of Sylvius obstructive hydrocephalus due to compression of the third ventricle by a suprasellar arachnoid cyst not communicating with CSF spaces)