Age-dependent differences of distribution and clearance patterns in normal RIHSA cisternograms

Summary In a retrospective study of 536 unselected consecutive RIHSA cisternographies a total of 84 cases with normal time-sequential scans were reviewed and, after dividing into three age groups, statistically elaborated with regard to the CSF pathways and flow rate. Our findings on a 5% level of significance are: 1) The total CSF flow and turnover depends on age; the highest rate of CSF flow is found in young patients (<25 years) and decreases constantly with increasing age. 2) In old patients (<50 years) the dorsal and lateral CSF pathways predominate over the frontomedial ones which are preferred in the younger age group (<25 years). 3) The washout of the basal cisterns and the clearance of the isotope over the convexities decreases significantly with increasing age. 4) The normal individual cisternographic variations and significant age-dependent differences agree with simultaneous encephalographic findingsThis work was done during Dr. Voigt's leave of absence from the Neurological Clinic of the University of Freiburg i. Br., FRG.     

RIHSA cisternography in cerebral tumours

Summary RIHSA cisternography was abnormal in all of 24 patients with supratentorial tumours. The most common finding was asymmetry caused by ipsilateral obstruction of the sylvian fissure and the subarachnoid space around the convexity. Another frequent finding was partial or total obstruction at the tentorial notch, often in combination with reduced or absent activity along the superior sagittal sinus. These disturbances of CSF flow may explain the pathogenesis of raised CSF pressure with cerebral tumours.     

多层螺旋CT脑池造影对外伤性脑脊液鼻漏的临床价值

目的探讨多层螺旋CT脑池造影(MSCTC)对外伤性脑脊液鼻漏的诊断价值。方法对6例临床诊断外伤性脑脊液鼻漏患者术前进行多层螺旋CT脑池造影检查,采用多平面重建(MPR)、最大密度投影(MIP)、容积再现(VR)技术,选择适当的显示层厚及角度,明确漏口存在,观察漏口的大小、形态及周围结构情况,并与术中所见对照,分析多层螺旋CT脑池造影对外伤性脑脊液鼻漏漏口定位及漏口周围情况评估的准确性,指导临床医师术前准备。结果全部病例检查后发现漏口存在,漏口大小、形态与术中所见基本吻合。结论多层螺旋CT脑池造影及后处理重组技术可以从不同角度较直观的反映漏口的位置、形态及漏口的周围情况,为临床手术治疗脑脊液鼻漏具有重要的指导价值,是术前首选的检查方法。     

Cerebrospinal fluid flow

Summary Cardiac- and respiration-related movements of the cerebrospinal fluid (CSF) were investigated by MRI in 71 patients. In most patients with arteriosclerotic occlusive vascular disease CSF pulsations are normal. Decreased pulsatile flow is detectable in those with arteriovenous malformations, intracranial air and following lumbar puncture and withdrawal of CSF. Increased pulsatile flow in the cerebral aqueduct was found in 2 patients with large aneurysms, idiopathic communicating syringomyelia and in most cases of normal pressure hydrocephalus (NPH). CSF flow in the cervical spinal canal is, however, reduced or normal in NPH, indicating reduction of the unfolding ability of the surface of the brain and/or inhibition of rapid CSF movements in the subarachnoid space over its convexity.     

MSCT结合CTC技术对外伤性脑脊液鼻漏的定位研究

目的：探讨MSCT结合CTC技术在外伤性脑脊液鼻漏漏口定位中的价值。方法：选取16例外伤性脑脊液鼻漏患者，术前经多层螺旋CT结合脑池造影进行检查定位，总结检查技术要点，分析其影像表现特征，并与手术结果进行对比。结果：16例CT均显示颅底骨质改变。其中13例经CTC可直接显示漏口位置，与手术所见完全一致。2例结合鼻棉拭测定进行扫描，可显示漏口位置，与手术所见一致。1例CTC仅发现1处漏口，手术发现为2处漏口。结论：MSCT结合CTC技术是CSF鼻漏漏口定位的一种安全、有效的检查手段，对CSF鼻漏的手术治疗具有重要意义，是术前应首选的检查方法。     

Bowel visualization during indium-111-labelled diethylene triamine penta-acetic acid cisternography due to massive cerebrospinal fluid leak

We report a case of massive cerebrospinal fluid (CSF) leakage where the tracer injected intra-thecally for radionuclide cisternography was later visualized in the bowel as well as the nasopharynx. We discuss the potential implications of this finding in patients with CSF leaks. A brief review of the diagnosis of CSF leaks is included.     

CT evaluation of the CSF spaces of healthy persons

Summary Changes in the width of the CSF space throughout life were studied in CT scans of 170 healthy individuals. The internal and external CSF spaces were evaluated using parameters which can also be employed in routine clinical studies. Tables of normal values for the CSF spaces at various ages are presented.     

Dynamics of lateral ventricle and cerebrospinal fluid in normal and hydrocephalic brains

PURPOSE: To develop quantitative MRI techniques to measure, model, and visualize cerebrospinal fluid (CSF) hydrodynamics in normal subjects and hydrocephalic patients. MATERIALS AND METHODS: Velocity information was obtained using time-resolved (CINE) phase-contrast imaging of different brain regions. A technique was developed to measure the change of lateral ventricle (LV) size. The temporal relationships between the LV size change, CSF movement, and blood flow could then be established. The data were incorporated into a first-principle CSF hydrodynamic model. The model was then used to generate specific predictions about CSF pressure relationships. To better-visualize the CSF flow, a color-coding technique based on linear transformations was developed that represents the magnitude and direction of the velocity in a single cinematic view. RESULTS: The LV volume change of the eight normal subjects was 0.901+/-0.406%. Counterintuitively, the LV decreases as the choroid plexus expands, so that they act together to produce the CSF oscillatory flow. The amount of oscillatory flow volume is 21.7+/-10.6% of the volume change of the LV from its maximum to its minimum. CONCLUSION: The quantification and visualization techniques, together with the mathematical model, provide a unique approach to understanding CSF flow dynamics.     

CSF pulsation patterns in occlusive hydrocephalus

Fifteen patients with solid and cystic occlusions of the cerebrospinal fluid (CSF) circulation pathways were examined with MRI using an ECG retrogated two-dimensional FISP sequence to determine whether there are certain defined pathological CSF flow patterns in these patients. All patients were clinically still compensated. The results of the measurements of CSF flow velocities at different locations in the CSF system were compared with the results from 8 healthy volunteers. In all patients with occlusive processes of the intraventricular CSF pathways (4 aqueduct stenoses, 1 membranous occlusion of the fourth ventricular outlets, 1 solid tumour at the foramen of Monro and 1 solid fourth ventricular tumour) we observed hyperdynamic CSF pulsation above the lesion. This was transmitted into the spinal canal. Close by a solid occlusion within the aqueduct the flow velocity curve over the RR cycle was typically shifted, resulting in a mirroring of the flow velocity curve compared with normals. In cystic lesions (n = 4) there was transmission of the pulsation wave through the lesion and therefore no mirroring of the flow velocity curve. This technique allows very good delineation of cystic structures in the peripineal region (n = 4), also due to the opposite direction of flow within the cyst compared with the surrounding CSF spaces, depending on the extent of communication. Correspondence to: U. Kunz     

Evaluation of the patency of endoscopic third ventriculostomy using phase contrast MRI-CSF flowmetry as diagnostic approach

Purpose

The aim is to assess the usefulness of cine phase-contrast MRI for evaluation of patency of endoscopic third ventriculostomy operation and correlation with clinical state postoperatively.

Cerebrospinal fluid rhinorrhea: Diagnostic role of gadolinium enhanced MR cisternography

Background

Accurate localization of the defect is crucial for successful surgical repair of CSF rhinorrhea. This could be achieved by MRI cisternography using T1 weighted sequences followed by intra-thecal injection of low dose of gadolinium for valuable localization and characterization of the defect.

Aim

The aim of this study was to evaluate the role of intrathecal gadolinium enhanced MR cisternography in localization of the defect in cases of CSF rhinorrhea to demonstrate how to utilize it as a roadmap to select the most appropriate approach for leak repair.

Patients and methods

This study included 24 patients (16 male and 8 females) with CSF rhinorrhea, referred from Otorhinolaryngology Department. Seventeen leaks were spontaneous, 5 cases were traumatic and two iatrogenic. All cases underwent MR gadolinium enhanced cisternography via lumbar puncture.

Results

Gadolinium enhanced MR cisternography accurately diagnosed and confirmed the site of CSF leak in 22/24 (91.7%) cases. The most common site was the ethmoidal roof in 18/24 cases. Our results were correlated with endoscopic surgery and repair with an accuracy rate of 100%.

Conclusions

Intra-thecal gadolinium enhanced MR cisternography is essential for accurate pre-operative localization and characterization of the defect in cases of CSF rhinorrhea.     

Myxopapillary ependymoma with interval postoperative CSF seeding: A report of an unusual case

Myxopapillary ependymoma (MPE) is a unique slow-growing benign (WHO grade 1) subtype of spinal cord ependymoma arising predominantly in the filum terminale. Despite its benign nature, it occasionally disseminates through the cerebrospinal fluid and metastasizes to distant sites. Here, we report an extremely rare case of MPE with interval CSF seeding and metachronous metastasis in a 47 –year-old female presented as a gradually increasing low back pain for three months with bilateral radiculopathy down to the knees. Magnetic resonance imaging (MRI) showed an intradural extramedullary spinal mass of iso-intense signal to the cord on T1 weighted-images (WIs), heterogeneous, predominantly hyperintense signal on T2WIs with homogenous enhancement after contrast administration. L2 laminectomy with gross total resection (GTR) was performed, and histopathological results confirmed the diagnosis of MPE. Adjuvant radiotherapy was administered, followed by series of MRI scans. 28 months after GTR, Lumbar MRI showed multiple tiny enhancing nodules in the cauda equina. 44 months follow-up whole spine MRI revealed multiple intradural extramedullary nodules throughout the entire spine. The largest one measures about 1.5cm opposite to T3 –T4 intervertebral disc space. The patient underwent T3 and T4 laminectomy and GTR under general anesthesia using microsurgical techniques, and the histopathological result came with the diagnosis of MPE.     

来源于RSP-2·P3细胞系与人尿的集落刺激因子生物学特性的比较研究

本文研究了从RSP-2·P3细胞系与正常人尿申分离纯化的两类集落刺激因子(RSP-2·P3-CSF与HU-CSF)的生物学特性。从集落生成的动态分析结果表明,这两类CSF的生物学活性是不均一的。在小鼠骨髓细胞的体外琼脂培养条件下,RSP-2·P3-CSF主要刺激粒系祖细胞(G-CFC)与粒-巨噬系祖细胞(GM-CFC)的增殖并生成由粒细胞(G-CFUc)或粒与巨噬细胞混合组成的集落(GM-CFUc);随着培养时间的延长,G-CFUc逐渐退化、消失,GM-CFUc则由最初主要为粒细胞组成逐渐过渡到粒与巨噬细胞的混合组成,最后生成由巨噬细胞组成的集落。然而,HU-CSF则主要刺激GM-CFC与巨噬系祖细胞(M-CFC)的增殖并生成相应的集落,随着体外培养时间的延长和HU-CSF浓度的增加,则巨噬细胞集落的比例急剧增高。     

MR visualization of CSF flow through a ventriculo-cisternostomy

Summary The MRI findings in a 6-year-old boy with an astrocytoma of the mesancephalon are reported. A ventriculocisternostomy had been performed in order to reduce the hydrocephalus. At the site of the ventriculocisternostomy, the T2-weighted images showed a low signal in the anterior part of the third ventricle, the interpeduncular and the pontine cistern. This was attributed to CSF flow void. We conclude that MRI can provide information about the precise location and normal functioning of a ventriculocisternostomy.     

MRI水抑制技术在颅内病变诊断中的应用

目的 :探讨 MRI水抑制技术在颅内病变诊断中的应用价值。方法 :71例颅内病变行水抑制技术与常规 SE序列成像 ,并对该二种技术对上述病变检出敏感性进行了比较。结果 :71例颅内病变水抑制与常规 SE分别检出 6 7例和 5 0例 ,P<0 .0 1,有显著差异。结论 :MRI水抑制技术可提高脑膜脑炎的检出率 ,可显示常规 SE难以显示的急性蛛网膜下腔出血 ,对颅内肿瘤、脑挫伤、脑梗塞和脱髓鞘病变的显示有一定优势     

颅内疾病对导水管脑脊液流量的影响

目的：探讨用磁共振相位对比电影(PC cine)对导水管脑脊液定量测量的临床应用价值。方法：将35例中枢神经系统不同疾病分三组，用PC cine方法进行导水管脑脊液流量测量。结果：在脑血管病组伴白质改变时导水管流量增加；梗阻性脑积水导水管流量减少，流动波形异常；交通性脑积水导水管流量增加，波形圆钝。结论：磁共振PC cine方法测量导水管脑脊液流量简单易行，可为临床提供更多的影像信息。     

MR phase imaging and cerebrospinal fluid flow in the head and spine

Summary Motion of the cerebrospinal fluid (CSF) in and around the brain and spinal cord was examined in healthy subjects and in a number of patients with abnormalities of the CSF circulation. The pulsatile motion of the CSF was determined by spin echo phase (velocity) imaging, sometimes in combination with gradient echo phase contrast cine. Differences in flow patterns across CSF spaces were observed: flow reversal in the cerebellomedullary cistern and lumbar area relative to cervical CSF, and in the posterior versus the anterior subarachnoid space in the spinal canal. Flow communication was demonstrated in known communicating cysts or cavities. Differences in flow were also noted across spinal narrowing or block, and across the walls of a variety of cystic lesions in the brain and spinal cord. MR phase imaging of CSF flow provides pathophysiological information of potential clinical importance for the assessment of diseases affecting the CSF circulation.     

OIL FLAIR: Optimized interleaved fluid-attenuated inversion recovery in 2D fast spin echo

Inversion recovery may be used to suppress signal from cerebrospinal fluid, a technique which has been named “fluid attenuated with inversion recovery” (FLAIR). This report describes interleaving a slice selective inversion pulse within a rapid spin-echo sequence to obtain the desirable contrast characteristics of FLAIR in imaging times comparable to standard rapid spin echo. Additionally, the pulse repetition time is allowed to float above a defined minimum, which can further shorten scan times and dramatically ease the optimization process. The optimized interleaved sequence is referred to as OIL FLAIR.     

The diagnosis of CSF fistulas with rhinorrhea by isotope cisternography

Summary The experience with the use of RIHSA cisternography in cases of spontaneous or post-traumatic CSF rhinorrhea is reported. The utility of this method for identifying the fistulous tract so that the neurosurgeon can, as far as he is able, carry out a direct and not solely exploratory operation is pointed out.