Intracranial CSF flow in pediatric hydrocephalus: evaluation with cine-MR imaging.

PURPOSE 1) To describe the pattern of normal intracranial CSF flow in children and 2) to demonstrate altered CSF flow patterns in pediatric hydrocephalus and ventriculomegaly with flow-sensitized cine-MR examinations. METHOD Cardiac gated, multiframe, gradient echo sequences on a 1.5-T system were displayed on a closed loop cine format and compared to standard MR images. Areas of normal flow and areas of diminished flow were determined. RESULTS 1) In normal children, the CSF flow follows a consistent pattern with a to-and-fro movement of flow in the aqueduct, foramen of Magendie, and in the dorsal and ventral subarachnoid space at the cervicomedullary junction. 2) In patients with ventricular enlargement, the flow studies showed regional abnormalities of the CSF flow patterns: specifically, lack of flow and hyperdynamic flow. CONCLUSION Cine-MR for CSF flow evaluation is a useful adjunct to routine MR in the evaluation of pediatric hydrocephalus because it can assist in determining the probable level of CSF obstruction.