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Evaluation of CSF flow patterns of posterior fossa cystic malformations using CSF flow MR imaging

  • Diagnostic Neuroradiology
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Abstract

Introduction

Differential radiologic diagnosis of cystic malformations of the posterior fossa is often difficult with conventional imaging techniques because of overlapping features of these entities. Posterior fossa cystic malformations occupy the cerebrospinal fluid (CSF) spaces. They may create secondary dynamic effects on the movements of CSF. The aim of this study was to investigate CSF flow alterations in posterior fossa cystic malformations with CSF flow MR imaging.

Methods

The study included 40 patients with cystic malformations of the posterior fossa. The patients underwent cardiac-gated phase-contrast cine MR imaging. CSF flow was qualitatively evaluated using an in-plane phase-contrast sequence in the midsagittal plane. The MR images were displayed in a closed-loop cine format.

Results

Twelve of the patients had communicating arachnoid cyst, seven had non-communicating arachnoid cyst, ten had mega cisterna magna, six had Dandy-Walker malformation, two had Dandy-Walker variant, and three had Blake’s pouch cyst. CSF flow MR imaging indicated the regions of no, slow or higher flow, direction of flow, and abnormal cystic fluid motion. Each malformation displayed a distinct CSF flow pattern.

Conclusion

Phase-contrast cine MR imaging for CSF flow evaluation may be a useful adjunct to routine MR imaging in the evaluation of the cystic malformations of the posterior fossa because it can improve the specificity in differentiating such malformations.

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Acknowledgement

We gratefully acknowledge Fatih Kantarci, MD, for his suggestions and for reviewing of the manuscript.

Conflict of interest statement

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiology, School of Medicine, University of Uludag, 16159, Bursa, Turkey

    Harun Yildiz, Zeynep Yazici, Bahattin Hakyemez, Cuneyt Erdogan & Mufit Parlak

Authors
  1. Harun Yildiz
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  2. Zeynep Yazici
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  3. Bahattin Hakyemez
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  4. Cuneyt Erdogan
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  5. Mufit Parlak
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Corresponding author

Correspondence to Harun Yildiz.

Additional information

Part of this article was presented as a poster exhibition at the ESNR 28th Annual Congress and 12th Advanced Course, 11–14 September 2003, Istanbul.

Electronic supplementary materials

Below is the link to the electronic supplementary materials.

Movie 1

Midsagittal closed looped phase contrast cine-MR image for Dandy-Walker Malformation

Movie 2

Midsagittal closed looped phase contrast cine-MR image for Dandy-Walker variant

Movie 3

Midsagittal closed looped phase contrast cine-MR image for Mega cisterna magna

Movie 4

Midsagittal closed looped phase contrast cine-MR image for Communicating arachnoid cyst

Movie 5

Midsagittal closed looped phase contrast cine-MR image for Non-communicating arachnoid cyst

Illustration 1

Dandy-Walker malformation

Midsagittal illustration shows that the tentorium is elevated, and the posterior fossa is markedly enlarged. The vermis is dysgenetic. An enormous 4th ventricle fills the large posterior fossa. The brain stem is compressed against the clivus

Illustration 2

Dandy-Walker variant

Midsagittal illustration shows hypoplasia of the cerebellar vermis, and dilatation of the 4th ventricle and the posterior fossa. There is no compression of the cerebellum and the brain stem

Illustration 3

Blake’s pouch cyst

Midsagittal illustration shows mass effect of the cyst on the inferior vermis and media cerebellar hemispheres. The cyst is displaces the inferior vermis upwards, and the 4th ventricle is dilated but not dilatation the posterior fossa. The tentorium is not elevated

Illustration 4

Mega cisterna magna

Midsagittal illustration shows enlarged retrocerebellar cistern, intact vermis, and internal scalloping of the occipital bone. The tentorium is not elevated. The 4th ventricle and the cerebellum appears normal

Illustration 5

Communicating arachnoid cyst

Midsagittal illustration shows mild high tentorium and scalloping of the inner table of the occipital bone. The 4th ventricle and the cerebellum appears normal

Illustration 6

Non-communicating arachnoid cyst

Midsagittal illustration shows a large retrocerebellar cyst compressing the cerebellum, 4th ventricle and brain stem, scalloping of the inner table of the occipital bone, enlarging the posterior fossa, and elevating the tentorium

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Yildiz, H., Yazici, Z., Hakyemez, B. et al. Evaluation of CSF flow patterns of posterior fossa cystic malformations using CSF flow MR imaging. Neuroradiology 48, 595–605 (2006). https://doi.org/10.1007/s00234-006-0098-8

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  • DOI: https://doi.org/10.1007/s00234-006-0098-8

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