Normal-pressure hydrocephalus: Evaluation with cerebrospinal fluid flow measurements at MR imaging

PURPOSE: To evaluate magnetic resonance (MR) imaging-based quantitative phase-contrast cerebrospinal fluid (CSF) velocity imaging for prediction of successful shunting in patients with normal-pressure hydrocephalus (NPH). MATERIALS AND METHODS: Eighteen patients (mean age, 73 years) with NPH underwent routine MR imaging and CSF velocity MR imaging before ventriculoperitoneal (VP) shunting. The calculated CSF stroke volume and the aqueductal CSF flow void score were compared with the surgical results. RESULTS: All 12 patients with CSF stroke volumes greater than 42 mu L responded favorably to CSF shunting. Of the six patients with stroke volumes of 42 mu L or less, three improved with shunting while three did not. The relationship between CSF stroke volume greater than 42 mu L and favorable response to VP shunting was statistically significant (P <.05). There was no statistically significant relationship between aqueductal CSF flow void score and responsiveness to shunting. CONCLUSION: CSF velocity MR imaging is useful in the selection of patients with NPH to undergo shunt formation.