Yilmaz Temel Fatih, Sari Lutfullah, Toprak Huseyin
Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
J Clin Ultrasound. 2024 Feb;52(2):201-207. doi: 10.1002/jcu.23606. Epub 2023 Nov 28.
The aqueductal web (AW) is one of the causes of aqueductus stenosis (AS). Recent advances in Magnetic resonance (MR) imaging have enabled us to better reveal the cerebrospinal fluid (CSF) flow dynamics and aqueductal anatomy.
The aim of this study is to evaluate the CSF flow dynamics of patients with AW with phase contrast Magnetic resonance imaging (MRI) and compare them with the imaging findings.
We evaluated 23 patients under 65-year-old age. On constructive interference in steady-state (T2 CISS) images, the width of prepontine cistern (PPC) and the width of Sylvian aqueduct (SA) were measured. Localization and number of webs were evaluated. The existence of flow at the aqueduct and the presence of spontaneous third ventriculostomy (STV) were evaluated on sagittal Sampling Perfection with Application optimized Contrast (SPACE) sequences.
Of the 23 patients included in the study, 11 were male and 12 were female. The mean age was 34.02 (0.5-64). A total of 31 AWs were detected in 23 patients. Six of 23 patients (26.1%) had STV and 17 of those not. Four of 23 patients (17.4%) had aqueductal flow on SPACE sequences. The PPC distance was significantly wider in patients with STV (median: 6.7-4.5, interquartile range (IQR): 1.35, p = 0.004). In the cases where artifact secondary to flow is observed in SPACE sequences in aqueduct, the Evan index (EI) was significantly lower (median: 0.2955-0.3900, IQR: 0.03-0.14, p < 0.001).
In patients with a low EI, there may be flow in the SA even if there is a web. In patients with a wide PPC distance, it is necessary to consider the presence of STV and evaluate the presence of flow with the SPACE sequences.
中脑导水管膜（AW）是导水管狭窄（AS）的病因之一。磁共振（MR）成像的最新进展使我们能够更好地揭示脑脊液（CSF）流动动力学和导水管解剖结构。
本研究的目的是用相位对比磁共振成像（MRI）评估AW患者的脑脊液流动动力学，并将其与影像学表现进行比较。
我们评估了23名65岁以下的患者。在稳态构成干扰（T2 CISS）图像上，测量脑桥前池（PPC）的宽度和中脑导水管（SA）的宽度。评估膜的定位和数量。在矢状面应用优化对比采样完美（SPACE）序列上评估导水管处的血流情况以及自发性第三脑室造瘘术（STV）的存在情况。
本研究纳入的23例患者中，男性11例，女性12例。平均年龄为34.02岁（0.5 - 64岁）。23例患者共检测到31个AW。23例患者中有6例（26.1%）有STV，17例没有。23例患者中有4例（17.4%）在SPACE序列上有导水管血流。有STV的患者PPC距离明显更宽（中位数：6.7 - 4.5，四分位间距（IQR）：1.35，p = 0.004）。在导水管的SPACE序列中观察到血流继发伪影的病例中，埃文指数（EI）明显更低（中位数：0.2955 - 0.3900，IQR：0.03 - 0.14，p < 0.001）。
EI较低的患者，即使存在膜，SA中也可能有血流。PPC距离较宽的患者，有必要考虑STV的存在，并通过SPACE序列评估血流情况。
