Hydrocephalus and cerebral atrophy are pathologies characterized by an abnormal increase in intracranial cerebrospinal fluid (CSF) volume accompanied by dilation of the cerebral ventricles and fissures. Measurements of the CSF volume are necessary to accurately assess the clinical course of such patients. A noninvasive and rapid CSF volume measurement method has been developed using heavily T2‐weighted 3D‐FASE MRI, which can selectively visualize the CSF with high signal intensities, and a region‐growing method for extracting the CSF region. Volume measurement requires about 30 minutes, and the segmentation results of CSF are also used to create 3D displays showing the relevant anatomical information. The error in measured volumes was within 10% in phantom experiments. Intracranial and ventricular CSF volumes of normal volunteers ranged between 100 and 150 ml and between 10 and 20 ml, respectively, which agree with the values obtained by conventional methods. Increased intracranial and/or ventricular CSF volumes were observed in patients with hydrocephalus and patients with cerebral atrophy. The results suggest that the ratio of intracranial and ventricular CSF volumes could be useful for the evaluation of patients with neurological diseases. © 1998 Scripta Technica, Syst Comp Jpn, 29(14): 41–49, 1998

Background:It is important to differentiate intramedullary neoplastic lesions from nonneoplastic diseases such as multiple sclerosis (MS) and other demyelinating or inflammatory diseases.Case Description:A 26-year-old Japanese male presented with a history of intracranial germinomas and obstructive hydrocephalus, treated with endoscopic surgery, and adjuvant chemotherapy and radiation therapy. Three years later, he developed paresthesias involving the right hand and both lower extremities. The cervical MR scan demonstrated a heterogeneously enhancing intramedullary C1-C2 lesion with surrounding edema. On cytological examination of the cerebrospinal fluid (CSF), there were no neoplastic cells. However, the fluid was positive for oligoclonal immunoglobulin G (IgG) bands. The patient received steroid pulse therapy to address the potential MS diagnosis. The follow-up MR showed reduced edema, but no change in the size of the intramedullary lesion. Therefore, the patient underwent a cervical laminectomy for tumor resection. The pathology was consistent with the same cranial germinoma treated 3 years previously. He subsequently received whole spinal radiation and three courses of chemotherapy.Conclusion:Some spinal cord tumors may produce oligoclonal IgG bands in CSF. In this case, an intramedullary C1-C2 spinal cord germinoma was originally misdiagnosed as MS due to the presence of oligoclonal IgG bands in CSF. Differentiating this tumor from MS and initiating appropriate treatment were critical into the care of this patient.

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