The Added Value of Magnetic Resonance Imaging Cisternography and Ventriculography as a Diagnostic Aid in Pediatric Hydrocephalus.

BACKGROUND: Magnetic resonance imaging (MRI) is the "gold standard" method for the evaluation of hydrocephalus. However, diagnosing an obstruction in the ventricular or subarachnoid spaces may pose a challenge for standard diagnostic sequences. In this study, we describe our experience with MRI cisternography (MRIC) or ventriculography (MRIV) for diagnosing or excluding intra- and extraventricular obstructions. Such a differentiation may have a significant impact on choosing the optimal surgical solution.

METHODS: We retrospectively collected data on patients undergoing MRIC/MRIV for diagnosing or excluding obstructions in patients with ventriculomegaly. All patients had MRI suggesting an obstruction, but without a clear cause.

RESULTS: Five children aged 1-17 years were included (3 females). Four underwent an MRIV, and 1 underwent an MRIC. Three children presented with headaches and had a suspected prior endoscopic third ventriculostomy (ETV) failure, and 2 presented with macrocephalus and increasing head circumferences. MRIV showed a patent ETV stoma in 2 cases, one of which had a T2 SPACE MRI showing no flow void through the stoma, and a closed stoma in 1 case with a flow void above and below the stoma on T2 SPACE MRI. MRIV and MRIC differentiated between two cases with panventriculomegaly, one of which had an obstruction at the level of the Liliequist membrane, and another with no identifiable obstruction.

CONCLUSIONS: MRIC and MRIV have a complementary role to MRI in assessing selected patients with hydrocephalus suspected of being secondary to an obstruction, but with no clear obstruction location.