Cine Mode MRI in Pre- & Post-Operative Evaluation of Hydrocephalus – Life beyond NPH and aqueduct stenosis

Educational Exhibit at the European Congress of Radiology, Vienna, 2019

(Note: images here are for representation only. Please write to us in case you would like the actual images)

Learning objectives

To the learn physics, protocol and practical applications of cine mode MRI brain sequences. To learn their role in the evaluation of patients with hydrocephalus including but not limited to those due to normal pressure hydrocephalus and aqueductal stenosis.

Classic MR signs of Normal Pressure Hydrocephalus


Why and how Cine flow MR imaging? Differentiate between

  1. Communicating and non-communicating hydrocephalus
  2. Arachnoid cysts and subarachnoid space
  3. Syringomyelia and cystic myelomalacia


  1. Evaluate flow patterns of posterior fossa cysts
  2. Pre-op evaluation of Normal Pressure Hydrocephalus & Chiari 1
  3. Post-op follow-up of third ventriculostomy (NTV) and ventriculoperitoneal (VP) shunt
Quantification of flow generated by defining a ROI and charting velocity vs time

Findings and procedure details

Protocol -Expected velocity of flow stated as velocity encoding (VENC) needs to be taken into account to detect hyperdynamic circulation and to avoid aliasing artefacts.
Technique- Time-resolved 2D phase contrast imaging with velocity encoding is the most widely used method for CSF flow analysis.
Quantification- Net flow = Positive flow + {Negative flow}/2

Case studies

  1. NPH
  2. Aqueduct web
  3. Chiari malformation
  4. Post-op follow-up of the third ventriculostomy
  5. ventriculoperitoneal shunt
  6. Evaluation of Communication between Arachnoid Cysts and Cisterns
  7. Endoscopic 3rd ventriculostomy in tectal/aqueductal mass lesion
Axial cine flow demonstrating systolic and diastolic phases


The abstract concludes with a discussion of the role of cine flow MRI is

Sagittal cine phase-contrast image after ventriculostomy in a tectal mass shows flow signal intensity between third ventricle and pontine cistern.