Magnetic resonance cisternography for visualization of intracisternal fine structures

Abstract

Object. To assess its usefulness in demonstrating cisternal anatomy, the authors investigated magnetic resonance (MR) cisternography in which a heavily T2-weighted turbo spin—echo method was used to visualize normal anatomical fine structures and lesions in the basal cisterns in 20 healthy volunteers and 43 patients. The authors applied peripheral pulse gating, which had been optimized to reduce artifacts in the cisterns attributable to cerebrospinal fluid (CSF) flow. Methods. The detectability of each cranial nerve was determined in healthy volunteers. The first, second, and third nerves and the seventh—eighth nerve complex were clearly visualized in all participants; the fifth nerve was clearly seen in 80% and the sixth cranial nerve in 50%. The fourth nerve and the ninth through 12th nerves were difficult to identify individually, except in some volunteers. To reduce artifacts caused by fast CSF flow, we determined the delays as a function of the time elapsed between two consecutive peaks of pulse wave in a peripheral pulse gate (P—P interval) at which there was reversal of flow direction to minimize the CSF flow—related artifact. Using peripheral pulse gating and a time delay of 30% of the R—R interval, the authors succeeded in minimizing the CSF flow—related artifacts. Magnetic resonance cisternography appears to be very useful for demonstrating intracisternal fine anatomy and enhancing the contours of the juxtacisternal lesion. A minute amount of CSF interposed between lesions and normal structures such as nerves, vessels, or bone structures can be detected by means of this sequence. In patients with facial spasm, axial images and oblique coronal images obtained in a plane parallel to the seventh—eighth cranial nerve complex demonstrated vascular compression in all 13 patients. The MR cisternography finding of compression was confirmed in all nine patients who underwent microvascular decompression. Conclusions. Magnetic resonance cisternography appears to show great promise for evaluation of patients with neurovascular compression or tumors in and around the basal cisterns; the procedure adds only a small amount of imaging time.