Article Figures & Data
Figures
- Fig 1.
Brain region-of-interest placement and ventricular measurement. A, ROIs were placed in the 3 axial levels of the cerebrum near the vertex and just above the centrum semiovale. B and C. Additional ROIs were placed in bilateral periventricular white matter, and the deep gray matter, including the bilateral thalami and putamina. D, Ventricular measurement of the bilateral frontal horns was performed at the level of the caudate heads.
- Fig 2.
Comparison of ASL-CBF among controls, asymptomatic patients, and patients with hydrocephalus.
- Fig 3.
ASL-CBF values before and after alleviation of obstructive hydrocephalus.
- Fig 4.
ASL perfusion of a 6-year-old girl presenting with hydrocephalus from a diffuse intrinsic pontine glioma. A, The patient presented with acute symptoms, including headache, nausea/vomiting, and somnolence. Enlarged ventricles and periventricular edema were noted and low CBF of 9, 13, 8, and 6 mL/100 g/min at the cerebral vertex, putamina, thalami, and periventricular white matter, respectively. A shunt was placed a day after the MR imaging. B, Improved CBF (30, 40, 36, 27 mL/100 g/min) and resolution of acute symptoms were noted in the respective brain regions a month later. Note the shunt catheter in place (arrow) and residual ventricular enlargement and edema.
- Fig 5.
ASL perfusion of a 5-year-old boy presenting with acute hydrocephalus due to aqueduct obstruction from a tectal glioma. A, The patient presented with acute gait abnormality, nausea/vomiting, and somnolence. Enlarged ventricles and low global CBF of 16, 20, 17, and 8 mL/100 g/mL were seen at the cerebral vertex, putamina, thalami, and periventricular white matter, respectively. The patient underwent third ventriculostomy a day later and subsequently showed symptomatic relief. B, Two months later, improved CBF was seen, with CBF of 43, 58, 50, and 32 mL/100 g/min in the respective brain regions. Note a CSF jet at the patent third ventriculostomy site (arrow).
- Fig 6.
Serial ASL perfusion of a 10-year-old boy with hydrocephalus from medulloblastoma. A, The patient presented acutely with headaches and nausea/vomiting. Relatively low CBF of 29, 50, 45, 20 mL/100 g/min, compared with controls, was noted in the cerebral vertex, putamina, thalami, and periventricular white matter. The patient underwent PF tumor resection and extraventricular drain placement 2 days later. B, One day after the surgery, the patient continued to have high ICP despite extraventricular drain placement and showed low CBF of 22, 34, 30, and 12 mL/100 g/min in the respective brain regions. C, The symptoms continued to worsen with high ICP and further decrease in CBF of 17, 31, 18, and 10 mL/100 g/min 2 days later. Due to extraventricular drain malfunction, a new ventriculoperitoneal shunt was subsequently placed. D, Several months later, the patient presented for routine surveillance of medulloblastoma with a functioning ventriculoperitoneal shunt and decreased ventricular size and was clinically asymptomatic at this time. While some perfusion alteration may be expected from interval chemotherapy and radiation, it has, nevertheless, improved, with a CBF of 36, 44, 34, 21 mL/100 g/min in the respective brain regions.
Tables
Characteristic Age at initial diagnosis (yr) Median 6.2 Range 0.9–18 Sex Male 17 (74%) Female 6 (26%) Diagnosis (in order of frequency) Medulloblastoma 8 (35%) Pilocytic astrocytoma 5 (22%) Ependymoma 5 (22%) Choroid plexus papilloma 2 (9%) Tectal astrocytoma 2 (9%) Diffuse intrinsic pontine glioma 1 (5%) Hydrocephalus at presentation 19 (83%) - Table 2:
Cerebral blood flow in healthy controls (n = 16) and patients with PF Tumor (n = 23)
Median Cerebral Blood Flow (mL/100 g/min) (Range) Cerebrum Basal Ganglia Thalamus White Matter Healthy control 62.3 (50.4–68.9) 57.3 (44.6–70.8) 56.4 (45.4–67.8) 37.3 (26–43.4) PF tumor without hydrocephalus 56.7 (46.4–63.1) 57.4 (49.7–60.0) 59.7 (53.2–65.4) 32.3 (20.8–35.8) PF tumor with hydrocephalus 34.3 (8.6–59.0) 39.8 (12.5–59.6) 32.4 (8.1–50.5) 17.7 (6.0–28.1) - Table 3:
Cerebral blood flow before and after alleviation of obstructive hydrocephalus (n = 16)a
Median Cerebral Blood Flow (mL/100 mg/min) (Range) Cerebrum Basal Ganglia Thalamus White Matter Before alleviation of hydrocephalus 35.8 (8.6–59) 38.0 (12.5–59.6) 29.9 (8.1–50.3) 17.5 (6.0–28.1) After alleviation of hydrocephalus 52.6 (29.8–69.7) 53.9 (40.2–68.8) 55.3 (29.1–63.3) 31 (23.4–45.4) ↵a For each site, CBF was increased following alleviation of hydrocephalus (Wilcoxon signed rank test for related samples, P < .002).
