Abstract
Reduced cerebral perfusion has been observed with elevated intracranial pressure. We hypothesized that arterial spin-labeled CBF can be used as a marker for symptomatic hydrocephalus. We compared baseline arterial spin-labeled CBF in 19 children (median age, 6.5 years; range, 1-17 years) with new posterior fossa brain tumors and clinical signs of intracranial hypertension with arterial spin-labeled CBF in 16 age-matched controls and 4 patients with posterior fossa tumors without ventriculomegaly or signs of intracranial hypertension. Measurements were recorded in the cerebrum at the vertex, deep gray nuclei, and periventricular white matter and were assessed for a relationship to ventricular size. In 16 symptomatic patients, we compared cerebral perfusion before and after alleviation of hydrocephalus. Patients with uncompensated hydrocephalus had lower arterial spin-labeled CBF than healthy controls for all brain regions interrogated (P < .001). No perfusion difference was seen between asymptomatic patients with posterior fossa tumors and healthy controls (P = 1.000). The median arterial spin-labeled CBF increased after alleviation of obstructive hydrocephalus (P < .002). The distance between the frontal horns inversely correlated with arterial spin-labeled CBF of the cerebrum (P = .036) but not the putamen (P = .156), thalamus (P = .111), or periventricular white matter (P = .121). Arterial spin-labeled-CBF was reduced in children with uncompensated hydrocephalus and restored after its alleviation. Arterial spin-labeled-CBF perfusion MR imaging may serve a future role in the neurosurgical evaluation of hydrocephalus, as a potential noninvasive method to follow changes of intracranial pressure with time.
Highlights
BACKGROUND AND PURPOSEReduced cerebral perfusion has been observed with elevated intracranial pressure
The median arterial spin-labeled CBF increased after alleviation of obstructive hydrocephalus (P Ͻ .002)
Arterial spin-labeled–CBF was reduced in children with uncompensated hydrocephalus and restored after its alleviation
Summary
We compared baseline arterial spin-labeled CBF in 19 children (median age, 6.5 years; range, 1–17 years) with new posterior fossa brain tumors and clinical signs of intracranial hypertension with arterial spin-labeled CBF in 16 age-matched controls and 4 patients with posterior fossa tumors without ventriculomegaly or signs of intracranial hypertension. In 16 symptomatic patients, we compared cerebral perfusion before and after alleviation of hydrocephalus. The study cohort was identified by using the following inclusion criteria: The patients underwent a baseline ASL perfusion MR imaging at 3T, presented acutely with clinical signs of elevated ICP that required neurosurgical intervention (tumor resection or CSF diversion) within 7 days of a baseline ASL scan, had ventriculomegaly, and received no prior medical/radiation therapy or neurosurgical intervention, including CSF diversion. Asymptomatic Patients Patients with an incidentally discovered PF tumor but without signs of elevated ICP based on neurosurgical assessment and without ventriculomegaly or interstitial periventricular edema on MR imaging were included for comparison if they had undergone a treatment-naïve ASL perfusion MR imaging at 3T. Whole-brain images were acquired with a 3D background-suppressed fast spin-echo stack-of-spirals method, with a TR of approximately 5 seconds. Other ASL MR imaging parameters were TR/TE, 4632/10.5 ms; FOV, 24 cm; matrix, 512 ϫ 8; and NEX, 3
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