Phase-contrast and three-dimensional driven equilibrium (3D-DRIVE)
sequences in the assessment of paediatric obstructive hydrocephalus
Shaimaa Abdelsattar Mohammad
Noha Mohamed Osman
Reham M. Khalil
Received: 9 February 2018 /Accepted: 21 May 2018
Springer-Verlag GmbH Germany, part of Springer Nature 2018
Background Recently, most cases of hydrocephalus are related to obstruction. Accurate localization of the site of obstruction is
crucial in determination of the treatment strategy.
Purpose To describe the phase-contrast and 3D-DRIVE findings in cases of obstructive hydrocephalus in paediatric patients and
to determine their functional and anatomical correlates.
Material and methods Brain MRIs of 25 patients (2 months to 11 years) with obstructive hydrocephalus were retrospectively
reviewed. Phase-contrast and 3D-DRIVE were performed to assess cerebrospinal (CSF) pathways through the aqueduct of
Sylvius and subarachnoid spaces. In addition to flow velocity measurement at the aqueduct of Sylvius, functional and anatomical
correlation was analysed at the level of aqueduct of Sylvius, infracerebellar CSF space and at the third ventriculostomy using
Results Aqueduct of Sylvius was the most common site of obstruction (19 patients) either secondary to focal, multifocal or
tubular stenosis, adhesions, or secondary to extrinsic compression. Functional and anatomical correlation was analysed in 58
regions revealing strong correlation (ro = 0.8, p < .001). Functional anatomical mismatch was found in nine regions. Flow
velocity measurements revealed diminished flow in most of the cases with obstruction at the aqueduct and normal velocity in
cases with obstruction proximal to aqueductal level, while accelerated flow was seen in cases with infra-aqeuductal obstruction.
Conclusion Phase-contrast and 3D-DRIVE sequences are essential sequences in the diagnosis of hydrocephalus enabling perfect
localization of the site of obstruction. Both sequences should be interpreted in conjunction to avoid false results. Velocity
measurements through the aqueduct can help understand CSF hydrodynamics.
Paediatric obstructive hydrocephalus
Hydrocephalus is a complex neurological disease that can
result in deleterious effects if untreated. It is characterised by
dynamic imbalance between the production and absorption of
the cerebrospinal fluid (CSF) leading to ventriculomegaly,
that is mostly accompanied by increase in the intracranial
tension [1, 2]. Recently, members of the international society
for hydrocephalus and CSF research proposed that hydro-
cephalus is mostly related to obstruction to the CSF pathway
and the different types of hydrocephalus are differentiated
according to the site of obstruction . Among causes of
hydrocephalus, aqueduct stenosis is the commonest that could
be idiopathic or secondary to inflammatory or neoplastic pa-
thologies [4, 5]. In addition to shunt surgeries, interventional
procedures, such as endoscopic third ventriculostomy (ETV)
and aqueductoplasty are among the treatment options [6, 7].
Accurate diagnosis of obstructive hydrocephalus with demon-
stration of the site of obstruction and detection of combination
of pathologies are crucial for proper selection of the treatment
strategy and improving the postoperative outcome .
In addition to demonstration of the site of obstruction, con-
ventional MRI sequences provide the specific morphologic
features of hydrocephalus in the form of ventriculomegaly,
decreased mamillopontine distance, and thinning and eleva-
tion of the corpus callosum . However, those signs are not
specific for hydrocephalus with poor sensitivities [6, 10].
Therefore, new MRI techniques have been developed aiming
for proper diagnosis of hydrocephalus and its differentiation
* Shaimaa Abdelsattar Mohammad
Department of Radiodiagnosis, Pediatric Radiology Section, Faculty
of Medicine, Ain-Shams University, Abbasia, Cairo 11657, Egypt
Child's Nervous System