Korean J Radiol.  2014 Dec;15(6):827-835. 10.3348/kjr.2014.15.6.827.

Evaluation of Aqueductal Patency in Patients with Hydrocephalus: Three-Dimensional High-Sampling-Efficiency Technique (SPACE) versus Two-Dimensional Turbo Spin Echo at 3 Tesla

• Ucar M
• Guryildirim M
• Tokgoz N
• Kilic K
• Borcek A
• Oner Y
• Akkan K
• Tali T

• KMID: 1794656
• DOI: http://doi.org/10.3348/kjr.2014.15.6.827

Abstract

OBJECTIVE
To compare the accuracy of diagnosing aqueductal patency and image quality between high spatial resolution three-dimensional (3D) high-sampling-efficiency technique (sampling perfection with application optimized contrast using different flip angle evolutions [SPACE]) and T2-weighted (T2W) two-dimensional (2D) turbo spin echo (TSE) at 3-T in patients with hydrocephalus.
MATERIALS AND METHODS
This retrospective study included 99 patients diagnosed with hydrocephalus. T2W 3D-SPACE was added to the routine sequences which consisted of T2W 2D-TSE, 3D-constructive interference steady state (CISS), and cine phase-contrast MRI (PC-MRI). Two radiologists evaluated independently the patency of cerebral aqueduct and image quality on the T2W 2D-TSE and T2W 3D-SPACE. PC-MRI and 3D-CISS were used as the reference for aqueductal patency and image quality, respectively. Inter-observer agreement was calculated using kappa statistics.
RESULTS
The evaluation of the aqueductal patency by T2W 3D-SPACE and T2W 2D-TSE were in agreement with PC-MRI in 100% (99/99; sensitivity, 100% [83/83]; specificity, 100% [16/16]) and 83.8% (83/99; sensitivity, 100% [67/83]; specificity, 100% [16/16]), respectively (p < 0.001). No significant difference in image quality between T2W 2D-TSE and T2W 3D-SPACE (p = 0.056) occurred. The kappa values for inter-observer agreement were 0.714 for T2W 2D-TSE and 0.899 for T2W 3D-SPACE.
CONCLUSION
Three-dimensional-SPACE is superior to 2D-TSE for the evaluation of aqueductal patency in hydrocephalus. T2W 3D-SPACE may hold promise as a highly accurate alternative treatment to PC-MRI for the physiological and morphological evaluation of aqueductal patency.

Keyword

Hydrocephalus; Cerebrospinal fluid flow; MRI; 3D-SPACE; Aqueductal patency

MeSH Terms

Adolescent
Adult
Aged
Child
Female
Humans
Hydrocephalus/*radiography
Imaging, Three-Dimensional
Magnetic Resonance Imaging
Magnetic Resonance Imaging, Cine
Male
Middle Aged
Retrospective Studies
Sensitivity and Specificity
Young Adult

Figure

• 

  Fig. 1 47-year-old woman presented with worsening headaches.Mid-sagittal (A) 3D-CISS images clearly demonstrates distal aqueductal web. There are no flow void in T2W 2D-TSE (B) and graded as grade 0. Mid-sagittal (C) T2W 3D-SPACE with variable flip angle mode image clearly demonstrates prominent hypointense signal intensity in cerebral aqueduct (arrow). Flow void signal on T2W 3D-SPACE MR image indicates absence of occlusion. (D) Axial phase-contrast image perpendicular to aqueduct demonstrates narrowed but patent aqueduct (arrow) and were well-matched with T2W 3D-SPACE sequence. CISS = constructive interference in steady state, SPACE = sampling perfection with application optimized contrast using different flip angle evolutions, TSE = turbo spin echo, T2W = T2-weighted, 2D = two-dimensional, 3D = three-dimensional

• 

  Fig. 2 20-year-old woman with seconder aqueduct stenosis caused by glioma of middle part of tectum.Mid-sagittal (A) 3D-CISS, (B) T2W 2D-TSE, and (C) T2W 3D-SPACE images show tectal mass (arrow) and narrowing of aqueduct. There is slight heterogeneity through aqueduct in T2W 2D-TSE (B), but flow void is not seen as definite patency. T2W 3D-SPACE (C) and axial phase-contrast image perpendicular to aqueduct (D) show flow void clearly. Image quality in terms of wall conspicuity, continuity, and sharpness is also clearly defined at 3D-CISS than T2W 2D-TSE and T2W 3D-SPACE images. Although contrast between tectum and mass is greater, margins of lesion (arrow, C) are better delineated on T2W 3D-SPACE image compared with T2W 2D-TSE and 3D-CISS images. (D) Axial phase-contrast image demonstrates narrowed but patent aqueduct (arrowhead). CISS = constructive interference in steady state, SPACE = sampling perfection with application optimized contrast using different flip angle evolutions, TSE = turbo spin echo, T2W = T2-weighted, 2D = two-dimensional, 3D = three-dimensional

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