Download 169_eposter - Stanley Radiology

1150
ROLE OF 3D CISS SEQUENCES AND
CSF FLOW STUDY IN
INTRAVENTRICULAR
NEUROCYSTICERCOSIS.

Neurocysticercosis is the most common
parasitic infection of CNS world wide.

Intraventricular cysticercosis contributes
to 7 to 25% of neurocysticercosis
infection.

The lesions are silent until obstruction
occurs secondary to the location of
cystic lesion or associated ependymitis
caused by adjacent granulomatous
response.

IV ventricle is the most common site of
involvement.
Two patients came to radiology
department Coimbatore MCH with
clinical features of increased ICT
 Patients undergone MRI Brain with
routine T1,T2 FLAIR SEQUENCES
 After observing tetraventricular system
dilatation and suspicious intraventricular
lesion ,3D CISS sequence,CSF Flow
study and contrast MRI was done

3D CISS(Constructive Interference
in Steady State Imaging)

Since small intraventricular lesion was
suspected patients undergone 3D CISS

3D CISS is a gradient echo sequence in
which Image contrast is determined byT2/T1
of the tissue.
So tissues having long T2 and short T1
relaxation time have increased signal
intensity.eg-water
With CISS there will be excellent contrast
between CSF and other strucures


CASE 1
59 yr old male presented with severe
headache, ataxia and visual disturbance
 15 days back patient undergone MRI
elsewhere and reported as a case of
Normal pressure hydrocephalus.

T2 W images show dilated ventricles
with periventricular seepage. Lesion in
the IV ventricle with cerebellar oedema
FLAIR SHOWS
CYSTIC LESION IN
IV Ventricle
T1 SAG image shows IV
ventricular obstruction
CISS showing
cyst
3d
CISS
Adherent cyst in the
right lateral wall of IV
ventricle
Adhesion and obstruction in
Foramen of Luschka
CSF flow study shows
obstruction at IV ventricle
CISS Shows cystic
lesion in IV ventricle with
mural nodule
Post contrast T1
images show ring
enhancing lesion
in IV ventricle and
ependymal
enhancement
(ependymitis)
CASE 2
29 YR Old female patient presnted with c/o
severe headache and visual disturbance.
 Fundal examination showed papilloedema.
 Patient undergoneMRI Brain with routine
T1,T2 FLAIR SEQUENCES
 After observing tetraventricular system
dilatation and suspicious intraventricular
lesion ,3D CISS sequence,CSF Flow study
and contrast MRI was done

1
T2 image showing dilated lateral ventricles
with no seepage.
2
FLAIR image shows dilated IV ventricle with
intraventricular cystic lesion.
Pre and post contrast sag T1 Images show dilated IV ventricle with
cystic lesion and enhancing mural nodule.
3D CISS showing cysticercosis
CISS
IV NC





RESULTS
BOTH CASES SHOWED 4TH VENTRICULAR
NEUROCYSTICERCOSIS WITH
OBSTRUCIVE HYDROCEPHALUS
INTRAVENTRICULAR CYST WITH MURAL
NODULE IS VERY WELL SEEN IN 3D CISS
SEQ DUE TO HIGH SNR
CSF FLOW STUDIES SHOWED THE
OBTRUCTION AT IV VENTRICLE
POST CONTRAST STUDIES WERE USEFUL
IN IDENTIFYING COMPLICATIONS LIKE
EPENDYMITIS
CONCLUSION
 3D CISS SEQUENCE IS HIGHLY
DIAGNOSTIC IN IDENTIFICATION OF
INTRAVENTRICULAR
NEUROCYSTICECOSIS

Reference
Anne Osborne brain imaging pathology
and anatomy. 1st edition
 AJNR 2000, 21, 679-684
 IJRI 2002 VOL12 329-332
 IJRI 2001 VOL21
