Artikel
Significance of (early) high-resolution MRI imaging for a better understanding of paediatric hydrocephalus
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Veröffentlicht: | 20. Mai 2009 |
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Gliederung
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Objective: The biggest challenge in paediatric hydrocephalus is to understand the individual cause of hydrocephalus - to be able to think beyond symptomatic therapy by draining excess CSF via a shunt. Therefore we performed – in addition to standard sequences – high-resolution MR imaging on a routine basis in pediatric hydrocephalus cases to gain maximum knowledge of a possible underlying pathophysiology before first treatment or before a shunt revision was undertaken.
Methods: Hydrocephalic children were included before initial treatment or at shunt failure. To visualize the CSF spaces we performed - in addition to standard T2 spin echo sequences - either an incubator coil operated high resolution T2 sequence (newborns and premature babies, SL 1-2 mm, TR 5711, TE 120), a 3D-CISS sequence (constructive Interference in Steady State SL 0.7 mm, TR 12.06, TE 6.03) or a 3D-trueFISP sequence (True Fast Imaging with Steady Precession, SL 1 mm, TR 4.97, TE 2.49). If possible, CSF pulsation studies were added. A standard 1.5 T MR scanners were used.
Results: 30 children (age 32w-16y) were recruited. There were 13 premature and mature newborns, 9 and 7 children up to 6 years without a shunt or with a shunt, respectively, and 1 older child with a shunt. In contrast to standard T2 weighted SE images, high-resolution MRI did point to an obstructive nature of the hydrocephalus in all patients by visualising an intra- or extraventricular obstruction within the CSF pathways. Especially in all 14 post-hemorrhagic cases, where hydrocephalus is often perceived as aresorptive, obstruction was clearly visible.
Conclusions: The findings of high resolution MRI imaging do support the theory that all cases of pediatric hydrocephalus are of an obstructive nature. It especially makes it possible to visualize extraventricular obstruction, e.g. within the basal cisterns. This information is crucial for the decision about endoscopic treatment options. All children should receive high resolution MR scanning prior to any therapeutic decision in order to reveal as much of the underlying pathology as possible.