Neurographics

Principles, Techniques, and Clinical Applications of Phase-Contrast Magnetic Resonance Cerebrospinal Fluid Imaging

Alves, T.; Ibrahim, E.-S.; Martin, B.A.; Malyarenko, D.; Maher, C.; Muraszko, K.M.; Garton, H.J.; Srinivasan, A.; Bapuraj, J.R.

View Article on Neurographics Website

Date of Activity Release: June 1, 2017
Date of Activity Expiration: June 1, 2020

Target Audience:
Intended for neuroradiologists and neuroradiology trainees with varying degrees of experience.

Learning Objectives:
Describe the technique of phase-contrast MRI of CSF flow, describe the technique's challenges and limitations, and identify areas in which this technique may be clinically useful for diagnosis, prognosis, and disease monitoring after treatment.

Abstract
The CSF compartment is dynamic and more complex than previously believed, and there is increasing recognition that abnormalities of CSF flow can be causes or markers of disease. Phase-contrast MRI, commonly used in MR angiography, has also proved to be useful as a reliable and both qualitative and quantitative method of evaluating pulsatile (“to and fro”) CSF flow. Phase-contrast MRI has often been used for the evaluation of normal pressure hydrocephalus, Chiari I malformations, and syringomyelia, and response to endoscopic third ventriculostomy. Phase-contrast MRI can be useful in normal pressure hydrocephalus, both in the diagnosis and in predicting those who would benefit from shunt surgery by examining flow at the cerebral aqueduct, although this latter indication is controversial. The use of phase-contrast MRI to evaluate CSF flow dynamics at the foramen magnum is an area of increasing research interest and may be useful in predicting outcomes and in monitoring the response to posterior fossa decompression surgery in patients with Chiari I malformation. Phase-contrast MRI can also be used to distinguish syringomyelia from its common mimic, myelomalacia. The response to endoscopic third ventriculostomy, used as an alternative to shunt surgery in both communicating and noncommunicating hydrocephalus, can be monitored with phase-contrast MRI.

Commercial Support
No commercial support was received for this activity.

Credit Designation Statement

The American Society of Neuroradiology is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Society of Neuroradiology designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Method of Physician Participation:
Each participant will review the corresponding Neurographics article located at www.neurographics.org. Upon completion, each physician will complete and pass a post-test with a score of at least 80% to receive a CME certificate.

Disclosures:
All individuals in control of content have disclosed the following relevant financial relationships. All of these relationships were treated as a conflict of interest, and have been resolved (C7 SCS 6.1-6.2, 6.5)

Authors:
Authors have no relevant financial relationships.

Planners:

Name

Role

Relationship/Interest

Barton Branstetter 

Editor in Chief

None, N/A

Adam Flanders

Deputy Editor

Royalties, Lippincott Williams and Wilkins

Robert Quencer 

Consulting Editor

None, N/A

Mark Mullins

Associate Editor

Non-remunerative position, AUR6

Meng Law

Associate Editor

Stockholder, Clinical Imaging

Michele Johnson

Associate Editor

Consultant, Boston Scientific, Inc.

Edward Escott

Associate Editor

Grant, Atherysys, Inc.; Royalties, Thieme Medical Publishers

Scott Faro

Associate Editor

None, N/A

Tina Young Poussaint

Associate Editor

None, N/A

Dheeraj Ghandi

Associate Editor

Grant, Arstasis, Axera Inc.; Consultant, Covidien, EV3

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