Current and Emerging MR Imaging Techniques for the Diagnosis and Management of CSF Flow Disorders: A Review of Phase-Contrast and Time–Spatial Labeling Inversion Pulse

An 18-year-old healthy female volunteer. A, A series of midline sagittal images depicting pulsatile CSF flow, where flow magnitude and direction are represented as gray-scale. Flow changes from positive to negative and back to positive (white indicates peak caudal flow; black, peak cranial flow). B, Depiction of a series of axial images at the level of the aqueduct (arrow). In both series, every odd phase of the 16 cardiac phases that were acquired is displayed.

Hydrocephalus in a 74-year-old woman. The patient had undergone endoscopic third ventriculostomy. Patency of the fenestration on the floor of the third ventricle is readily and noninvasively confirmed postsurgery by the presence of CSF flow between the third ventricle and the basal cisterns (asterisk) emerging from the tagged region (dotted lines). (See On-line Video 1, which demonstrates postsurgical CSF flow between the third ventricle and the basal cisterns.)

Idiopathic normal pressure hydrocephalus in a 78-year-old man. Time-SLIP has consistently shown the presence of reflux flow from the third ventricle into the lateral ventricle in adult patients without hydrocephalus (A). This flow is shown to be restricted in NPH (B). Time-SLIP in the same patient confirms that this flow is restored after surgical intervention by inserting a CSF diverting shunt (C, artifacts on the right are from the shunt valve). (See On-line Videos 2 and 3, which demonstrate restricted flow and restored flow pre- and postsurgery, respectively.)