Feasibility of 3-Dimensional Sampling Perfection With Application Optimized Contrast Sequence in the Evaluation of Patients With Hydrocephalus

Abstract

Purpose: This study aimed to investigate the effectiveness and additive value of T2W 3-dimensional sampling perfection with application optimized contrast (3D-SPACE) with variant flip-angle mode in imaging of all types of hydrocephalus. Our secondary objective was to assess the reliability of 3D-SPACE sequence and correspondence of the results with phase-contrast magnetic resonance imaging (PC-MRI)-based data.Materials and Methods: Forty-one patients with hydrocephalus have undergone 3-T MRI. T2W 3D-SPACE sequence has been obtained in addition to routine hydrocephalus protocol. Cerebrospinal fluid circulation, presence/type/etiology of hydrocephalus, obstruction level scores, and diagnostic levels of confidence were evaluated separately by 2 radiologists. In the first session, routine sequences with PC-MRI were evaluated, and in another session, only 3D-SPACE and 3-dimensional magnetization prepared rapid acquisition gradient echo sequences were evaluated. Results obtained in these sessions were compared with each other and those obtained in consensus session.Results: Agreement values were very good for both 3D-SPACE and PC-MRI sequences (P < 0.001 for all). Also, the correlation of more experienced reader's 3D-SPACE-based scores and consensus-based scores was perfect (κ = 1, P < 0.001).The mean value of PC-MRI-based confidence scores were lower than those obtained in 3D-SPACE and consensus sessions.Conclusions: T2W 3D-SPACE sequence provides morphologic cerebrospinal fluid flow data. It is a noninvasive technique providing extensive multiplanar reformatted images with a lower specific absorption rate. These advantages over PC-MRI make 3D-SPACE sequence a promising tool in management of patients with hydrocephalus.Key Words: MRI, 3D-SPACE, variable flip angle, hydrocephalus, PC cine MR (J Comput Assist Tomogr 2015;39: 321-328) I n patients with hydrocephalus, proper understanding of the basic pathology is essential to decide the best treatment option, improve postoperative outcome, and avoid unnecessary surgery. [1][2][3][4][5] Routine magnetic resonance imaging (MRI) sequences and techniques usually fail to determine the etiology and severity of the disease. Therefore, to diagnose and plan the management of hydrocephalus as well as to follow up surgically treated patients, such as those who undergo endoscopic third ventriculostomy (ETV), advanced techniques are used. Those techniques include phase-contrast cine MRI (PC-MRI), 3-dimensional heavily T2-weighted (W) sequences, cisternographic or ventriculographic studies, some of which are invasive.6 Besides their invasive nature, these methods usually require additional examination, which decreases patient compliance, increases total cost, and causes patients to quit follow-up. One of the most recent MRI techniques is 3-dimensional sampling perfection with application-optimized contrasts using different flip angle evolutions (3D-SPACE). It is a single slab turbo spin-echo (TSE) sequence with multiple different flip angles (FAs) developed by Mugler et al. 7,8 It...

Evaluation of hydrocephalus patients with 3D-SPACE technique using variant FA mode at 3T

“…This technique is being used more and more in daily practice and related papers are being increasing in the literature. 3D-SPACE technique (GE for CUBE, Philips for VISTA) can be helpful in the diagnosis and follow-up of the patients with hydrocephalus without need for an additional MR examination (such as phase-contrast cine, heavily T2W imaging or cisternography) [1,3].…”

“…The major advantages of this technique are the lower specific absorption rate (SAR) value which makes it safe for using in 3-tesla (3T) scanners and the reasonable acquisition time which takes approximately 5 min for scanning the entire cranium. It provides isotropic three-dimensional (3D) data which is resistant to the most of the artifacts, particularly the susceptibility artifacts [2][3][4][5].…”

“…This feature is useful for differentiation of flowing CSF from stagnant or trapped CSF. Thus, it can provide fast, effective and problem solving data about CSF circulation [1,3]. Isotropic data covering the entire cranium allows obtaining accurate reformatted images, which is helpful in standardizing the protocol, reduces the need for additional scanning and, therefore, decreases total imaging Fig.…”

“…SE spin-echo, GRE gradient-echo, IR inversion-recovery, TSE turbo spin-echo, EPI echo-planar imaging, HASTE half-Fourier acquisition single-shot TSE, FLAIR fluid attenuated IR (long tau IR), STIR short tau IR, PDW proton-density weighted, SSFP steady-state free precession, DESS dual-echo steady-state, 3D-CISS 3D constructive interference in steady state, UTE ultra-short TE, MPRAGE (3D UF-GRE) three dimensional T1-weighted magnetization-prepared rapid acquisition of GRE (3D ultrafast GRE), SS-EPI single-shot EPI, RS-EPI readout-segmented EPI, SMS-EPI simultaneous multi-slice EPI, CAIPIRINHA controlled aliasing in parallel imaging results in higher acceleration, SPI single point imaging, SPRITE single point ramped imaging with T1 enhancement, RUFIS rotating ultra-fast imaging sequences time and increases patient compliance [5][6][7][8][9]. As a result, T2W 3D-SPACE VFAM acquisition at 3T is a fast, flexible and efficacious technique with substantial SAR reduction to evaluate almost all of the patients with hydrocephalus accurately [1,3]. Therefore; in the last few years, in our institution, T2W 3D-SPACE VFAM images have been obtained for the evaluation of the patients with diagnosis or suspicion of hydrocephalus, as a crucial part of the protocol which is described in detail in Table 1.…”

Diagnosis and Differential Diagnosis of Hydrocephalus in Adults

“…An MR imaging protocol (▶ Table 1) for diagnosis of the underlying cause in patients with confirmed hydrocephalus should always include high-resolution sagittal T2w scans (e. g. CISS method) [17]. T2w SPACE scans can be used as an alternative, particularly at 3 T [17].…”