Diagnostic performance of heavily T2-weighted techniques in obstructive hydrocephalus: comparison study of two different 3D heavily T2-weighted and conventional T2-weighted sequences

To evaluate efficacy of three-dimensional (3D) heavily T2-weighted (W) MRI sequences in assessment of cerebrospinal fluid (CSF) pathways and to compare two different types of 3D heavily T2W MRI sequences (CISS and SPACE) with two-dimensional (2D) T2W turbo spin echo (TSE) sequences for hydrocephalus with intraventricular obstruction. Sixty-two patients who were diagnosed with intraventricular obstructive hydrocephalus, according to clinical and radiological findings, were included in this retrospective study. 2D-TSE-T2, 3D-CISS, and 3D-SPACE, which are part of the protocol, were analyzed quantitatively by measuring ventricle-to-parenchyma contrast-to-noise ratio (CNR), and qualitatively by evaluating the capabilities of visualization of the obstructive pathology, overall image quality, severity of artifacts, and delineation of the CSF pathways. One-way ANOVA and Friedman's test were used for statistical analysis. CNR between CSF and brain parenchyma was significantly higher using 3D-SPACE sequences compared with 3D-CISS and 2D-TSE-T2 sequences. The qualitative findings showed that 3D heavily T2W sequences were superior to 2D-TSE-T2 sequences. 3D-SPACE sequences showed fewer artifacts than 3D-CISS or 2D-TSE-T2 sequences. 3D heavily T2W sequences are necessary tools for assessment of CSF pathways in patients with intraventricular obstructive hydrocephalus. 3D-SPACE sequences allowed heavy T2W, which is necessary for CSF flow imaging and provided significantly fewer image artifacts and improved CNR in comparison with 3D-CISS sequences.