Rajan P Patel1, Clark W Sitton1, Leena M Ketonen2, Ping Hou3, Jason M Johnson2, Seferino Romo1, Stephen Fletcher4, Manish N Shah4, Marcia Kerr4, Wafik Zaky5, Michael E Rytting5, Soumen Khatua5, David I Sandberg6,7,8. 1. Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA. 2. Department of Diagnostic Imaging, Section of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 3. Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 4. Departments of Pediatric Surgery and Neurosurgery and Mischer Neuroscience Institute, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA. 5. Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 6. Departments of Pediatric Surgery and Neurosurgery and Mischer Neuroscience Institute, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA. David.I.Sandberg@uth.tmc.edu. 7. Divisions of Neurosurgery and Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. David.I.Sandberg@uth.tmc.edu. 8. Dr. Marnie Rose Professorship in Pediatric Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston and The University of Texas MD Anderson Cancer Center, 6431 Fannin Street, MSB 5.144, Houston, TX, 77030, USA. David.I.Sandberg@uth.tmc.edu.
Abstract
PURPOSE: Nuclear medicine studies have previously been utilized to assess for blockage of cerebrospinal fluid (CSF) flow prior to intraventricular chemotherapy infusions. To assess CSF flow without nuclear medicine studies, we obtained cine phase-contrast MRI sequences that assess CSF flow from the fourth ventricle down to the sacrum. METHODS: In three clinical trials, 18 patients with recurrent malignant posterior fossa tumors underwent implantation of a ventricular access device (VAD) into the fourth ventricle, either with or without simultaneous tumor resection. Prior to infusing therapeutic agents into the VAD, cine MRI phase-contrast CSF flow sequences of the brain and total spine were performed. Velocity encoding (VENC) of 5 and 10 cm/s was used to confirm CSF flow from the fourth ventricular outlets to the cervical, thoracic, and lumbar spine. Qualitative CSF flow was characterized by neuroradiologists as present or absent. RESULTS: All 18 patients demonstrated CSF flow from the outlets of the fourth ventricle down to the sacrum with no evidence of obstruction. One of these patients, after disease progression, subsequently showed obstruction of CSF flow. No patient required a nuclear medicine study to assess CSF flow prior to initiation of infusions. Fourteen patients have received infusions to date, and none has had neurological toxicity. CONCLUSIONS: CSF flow including the fourth ventricle and the total spine can be assessed noninvasively with phase-contrast MRI sequences. Advantages over nuclear medicine studies include avoiding both an invasive procedure and radiation exposure.
PURPOSE: Nuclear medicine studies have previously been utilized to assess for blockage of cerebrospinal fluid (CSF) flow prior to intraventricular chemotherapy infusions. To assess CSF flow without nuclear medicine studies, we obtained cine phase-contrast MRI sequences that assess CSF flow from the fourth ventricle down to the sacrum. METHODS: In three clinical trials, 18 patients with recurrent malignant posterior fossa tumors underwent implantation of a ventricular access device (VAD) into the fourth ventricle, either with or without simultaneous tumor resection. Prior to infusing therapeutic agents into the VAD, cine MRI phase-contrast CSF flow sequences of the brain and total spine were performed. Velocity encoding (VENC) of 5 and 10 cm/s was used to confirm CSF flow from the fourth ventricular outlets to the cervical, thoracic, and lumbar spine. Qualitative CSF flow was characterized by neuroradiologists as present or absent. RESULTS: All 18 patients demonstrated CSF flow from the outlets of the fourth ventricle down to the sacrum with no evidence of obstruction. One of these patients, after disease progression, subsequently showed obstruction of CSF flow. No patient required a nuclear medicine study to assess CSF flow prior to initiation of infusions. Fourteen patients have received infusions to date, and none has had neurological toxicity. CONCLUSIONS: CSF flow including the fourth ventricle and the total spine can be assessed noninvasively with phase-contrast MRI sequences. Advantages over nuclear medicine studies include avoiding both an invasive procedure and radiation exposure.
Authors: S Yamada; K Tsuchiya; W G Bradley; M Law; M L Winkler; M T Borzage; M Miyazaki; E J Kelly; J G McComb Journal: AJNR Am J Neuroradiol Date: 2014-07-10 Impact factor: 3.825
Authors: Núria Bargalló; Lourdes Olondo; Ana I Garcia; Sebastian Capurro; Luis Caral; Jordi Rumia Journal: AJNR Am J Neuroradiol Date: 2005 Nov-Dec Impact factor: 3.825
Authors: David I Sandberg; Michael Rytting; Wafik Zaky; Marcia Kerr; Leena Ketonen; Uma Kundu; Bartlett D Moore; Grace Yang; Ping Hou; Clark Sitton; Laurence J Cooper; Vidya Gopalakrishnan; Dean A Lee; Peter F Thall; Soumen Khatua Journal: J Neurooncol Date: 2015-08-09 Impact factor: 4.130
Authors: David I Sandberg; Bangning Yu; Rajan Patel; John Hagan; Emilie Miesner; Jennifer Sabin; Sarah Smith; Stephen Fletcher; Manish N Shah; Rachael W Sirianni; Michael D Taylor Journal: J Neurooncol Date: 2018-11-20 Impact factor: 4.130