{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T11:43:52Z","timestamp":1792755832243,"version":"4.5.0"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Standard MRI protocols lack a quantitative sequence that can be used to evaluate shunt-treated patients with a history of hydrocephalus. The objective of this study was to investigate the use of phase-contrast MRI (PC-MRI), a quantitative MR sequence, to measure CSF flow through the shunt and demonstrate PC-MRI as a useful adjunct in the clinical monitoring of shunt-treated patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The rapid (96 seconds) PC-MRI sequence was calibrated using a flow phantom with known flow rates ranging from 0 to 24 mL\/hr. Following phantom calibration, 21 patients were scanned with the PC-MRI sequence. Multiple, successive proximal and distal measurements were gathered in 5 patients to test for measurement error in different portions of the shunt system and to determine intrapatient CSF flow variability. The study also includes the first in vivo validations of PC-MRI for CSF shunt flow by comparing phase-contrast\u2013measured flow rate with CSF accumulation in a collection burette obtained in patients with externalized distal shunts.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The PC-MRI sequence successfully measured CSF flow rates ranging from 6 to 54 mL\/hr in 21 consecutive pediatric patients. Comparison of PC-MRI flow measurement and CSF volume collected in a bedside burette showed good agreement in a patient with an externalized distal shunt. Notably, the distal portion of the shunt demonstrated lower measurement error when compared with PC-MRI measurements acquired in the proximal catheter.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The PC-MRI sequence provided accurate and reliable clinical measurements of CSF flow in shunt-treated patients. This work provides the necessary framework to include PC-MRI as an immediate addition to the clinical setting in the noninvasive evaluation of shunt function and in future clinical investigations of CSF physiology.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.7.jns231326","type":"journal-article","created":{"date-parts":[[2023,10,7]],"date-time":"2023-10-07T01:42:51Z","timestamp":1696642971000},"page":"1117-1128","source":"Crossref","is-referenced-by-count":8,"title":["Quantitative noninvasive measurement of cerebrospinal fluid flow in shunted hydrocephalus"],"prefix":"10.3171","volume":"140","author":[{"given":"Joseph H.","family":"Ha","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Children\u2019s Hospital Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew T.","family":"Borzage","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology, Fetal and Neonatal Institute, Children\u2019s Hospital Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik B.","family":"Vanstrum","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eamon K.","family":"Doyle","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children\u2019s Hospital Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meenakshi","family":"Upreti","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Children\u2019s Hospital Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benita","family":"Tamrazi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children\u2019s Hospital Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marvin","family":"Nelson","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children\u2019s Hospital Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Bl\u00fcml","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children\u2019s Hospital Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malkiat S.","family":"Johal","sequence":"additional","affiliation":[{"name":"Department of Chemistry, Pomona College, Claremont;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Gordon","family":"McComb","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Children\u2019s Hospital Los Angeles;"},{"name":"Keck School of Medicine of University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Chu","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Children\u2019s Hospital Los Angeles;"},{"name":"Keck School of Medicine of University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Durham","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Children\u2019s Hospital Los Angeles;"},{"name":"Keck School of Medicine of University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark D.","family":"Krieger","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Children\u2019s Hospital Los Angeles;"},{"name":"Keck School of Medicine of University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rex A.","family":"Moats","sequence":"additional","affiliation":[{"name":"The Saban Research Institute, Children\u2019s Hospital Los Angeles; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Chiarelli","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Children\u2019s Hospital Los Angeles;"},{"name":"Keck School of Medicine of University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Cerebrospinal Fluid Res","first-page":"2","article-title":"The definition and classification of hydrocephalus: a personal recommendation to stimulate debate","volume":"5","author":"Rekate HL","year":"2008","unstructured":"Rekate HL. The definition and classification of hydrocephalus: a personal recommendation to stimulate debate. Cerebrospinal Fluid Res. 2008;5:2."},{"issue":"3","key":"b2","series-title":"Prog Neurobiol","first-page":"238","article-title":"Development of hydrocephalus and classical hypothesis of cerebrospinal fluid hydrodynamics: facts and illusions","volume":"94","author":"Ore\u0161kovi\u0107 D","year":"2011","unstructured":"Ore\u0161kovi\u0107 D, Klarica M. Development of hydrocephalus and classical hypothesis of cerebrospinal fluid hydrodynamics: facts and illusions. Prog Neurobiol. 2011;94(3):238\u2013258."},{"issue":"5","key":"b3","series-title":"Semin Fetal Neonatal Med","first-page":"285","article-title":"Pathophysiology of congenital and neonatal hydrocephalus","volume":"17","author":"McAllister JP II","year":"2012","unstructured":"McAllister JP II. Pathophysiology of congenital and neonatal hydrocephalus. Semin Fetal Neonatal Med. 2012;17(5):285\u2013294."},{"issue":"4","key":"b4","series-title":"J Neurosurg","first-page":"1065","article-title":"Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis","volume":"130","author":"Dewan MC","year":"2018","unstructured":"Dewan MC, Rattani A, Mekary R,  Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis. J Neurosurg. 2018;130(4):1065\u20131079."},{"issue":"2","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"131","article-title":"Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths","volume":"1","author":"Simon TD","year":"2008","unstructured":"Simon TD, Riva-Cambrin J, Srivastava R, Bratton SL, Dean JM, Kestle JRW. Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths. J Neurosurg Pediatr. 2008;1(2):131\u2013137."},{"issue":"5","key":"b6","series-title":"Pediatr Neurosurg","first-page":"254","article-title":"Epidemiology of cerebrospinal fluid shunting","volume":"23","author":"Bondurant CP","year":"1995","unstructured":"Bondurant CP, Jimenez DF. Epidemiology of cerebrospinal fluid shunting. Pediatr Neurosurg. 1995;23(5):254\u2013259."},{"issue":"2","key":"b7","series-title":"Neurosurgery","first-page":"294","article-title":"Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus","volume":"43","author":"Drake JM","year":"1998","unstructured":"Drake JM, Kestle JR, Milner R,  Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery. 1998;43(2):294\u2013305."},{"issue":"4","key":"b8","series-title":"JAMA","first-page":"372","article-title":"Pediatric readmission prevalence and variability across hospitals","volume":"309","author":"Berry JG","year":"2013","unstructured":"Berry JG, Toomey SL, Zaslavsky AM,  Pediatric readmission prevalence and variability across hospitals. JAMA. 2013;309(4):372\u2013380."},{"issue":"1","key":"b9","series-title":"J Neurosurg Pediatr","first-page":"15","article-title":"Revision rate of pediatric ventriculoperitoneal shunts after 15 years","volume":"11","author":"Stone JJ","year":"2013","unstructured":"Stone JJ, Walker CT, Jacobson M, Phillips V, Silberstein HJ. Revision rate of pediatric ventriculoperitoneal shunts after 15 years. J Neurosurg Pediatr. 2013;11(1):15\u201319."},{"issue":"2","key":"b10","series-title":"Pediatr Neurol","first-page":"83","article-title":"Failure of cerebrospinal fluid shunts: part I: obstruction and mechanical failure","volume":"34","author":"Browd SR","year":"2006","unstructured":"Browd SR, Ragel BT, Gottfried ON, Kestle JRW. Failure of cerebrospinal fluid shunts: part I: obstruction and mechanical failure. Pediatr Neurol. 2006;34(2):83\u201392."},{"issue":"5","key":"b11","series-title":"Pediatr Neurosurg","first-page":"230","article-title":"Long-term follow-up data from the Shunt Design Trial","volume":"33","author":"Kestle J","year":"2000","unstructured":"Kestle J, Drake J, Milner R,  Long-term follow-up data from the Shunt Design Trial. 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J Neurosurg Pediatr. 2008;1(1):40\u201347."},{"issue":"5","key":"b14","series-title":"Pediatr Neurosurg","first-page":"248","article-title":"Cerebrospinal fluid shunt survival and etiology of failures: a seven-year institutional experience","volume":"36","author":"McGirt MJ","year":"2002","unstructured":"McGirt MJ, Leveque JC, Wellons JC III,  Cerebrospinal fluid shunt survival and etiology of failures: a seven-year institutional experience. Pediatr Neurosurg. 2002;36(5):248\u2013255."},{"issue":"4","key":"b15","series-title":"J Neurosurg Pediatr","first-page":"364","article-title":"Reliability of the radiopharmaceutical shunt flow study for the detection of a CSF shunt malfunction in the presence of stable ventricular size","volume":"26","author":"Quezada JJ","year":"2020","unstructured":"Quezada JJ, McComb JG. Reliability of the radiopharmaceutical shunt flow study for the detection of a CSF shunt malfunction in the presence of stable ventricular size. 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Radiology. 1986;159(3):611\u2013616."},{"issue":"5","key":"b21","series-title":"J Magn Reson Imaging","first-page":"604","article-title":"In vitro validation of phase-contrast flow measurements at 3 T in comparison to 1.5 T: precision, accuracy, and signal-to-noise ratios","volume":"21","author":"Lotz J","year":"2005","unstructured":"Lotz J, D\u00f6ker R, Noeske R,  In vitro validation of phase-contrast flow measurements at 3 T in comparison to 1.5 T: precision, accuracy, and signal-to-noise ratios. J Magn Reson Imaging. 2005;21(5):604\u2013610."},{"issue":"4","key":"b22","series-title":"AJNR Am J Neuroradiol","first-page":"623","article-title":"Current and emerging MR imaging techniques for the diagnosis and management of CSF flow disorders: a review of phase-contrast and time-spatial labeling inversion pulse","volume":"36","author":"Yamada S","year":"2015","unstructured":"Yamada S, Tsuchiya K, Bradley WG,  Current and emerging MR imaging techniques for the diagnosis and management of CSF flow disorders: a review of phase-contrast and time-spatial labeling inversion pulse. AJNR Am J Neuroradiol. 2015;36(4):623\u2013630."},{"issue":"8","key":"b23","series-title":"J Appl Physiol (1985)","first-page":"976","article-title":"Predictors of cerebral blood flow in patients with and without anemia","volume":"120","author":"Borzage MT","year":"2016","unstructured":"Borzage MT, Bush AM, Choi S,  Predictors of cerebral blood flow in patients with and without anemia. J Appl Physiol (1985). 2016;120(8):976\u2013981."},{"issue":"5","key":"b24","series-title":"Am J Crit Care","first-page":"408","article-title":"Measuring stroke volume: impedance cardiography vs phase-contrast magnetic resonance imaging","volume":"26","author":"Borzage M","year":"2017","unstructured":"Borzage M, Heidari K, Chavez T, Seri I, Wood JC, Bl\u00fcml S. Measuring stroke volume: impedance cardiography vs phase-contrast magnetic resonance imaging. Am J Crit Care. 2017;26(5):408\u2013415."},{"issue":"3","key":"b25","series-title":"Clinical experimental studies. Arch Neurol Psychiatry","first-page":"523","article-title":"Cerebrospinal hydrodynamics: IV","volume":"32","author":"Masserman JH","year":"1934","unstructured":"Masserman JH. Cerebrospinal hydrodynamics: IV. Clinical experimental studies. Arch Neurol Psychiatry. 1934;32(3):523\u2013553."},{"issue":"4","key":"b26","series-title":"Brain","first-page":"707","article-title":"Formation and absorption of cerebrospinal fluid in man","volume":"91","author":"Cutler RWP","year":"1968","unstructured":"Cutler RWP, Page L, Galicich J, Watters GV. Formation and absorption of cerebrospinal fluid in man. Brain. 1968;91(4):707\u2013720."},{"issue":"138","key":"b27","series-title":"Clin Neurosurg","first-page":"142","article-title":"Phase-contrast magnetic resonance imaging of intracranial shunt tube: a valuable adjunct in the diagnosis of ventriculoperitoneal shunt malfunction","volume":"58","author":"Kurwale NS","year":"2011","unstructured":"Kurwale NS, Agrawal D. Phase-contrast magnetic resonance imaging of intracranial shunt tube: a valuable adjunct in the diagnosis of ventriculoperitoneal shunt malfunction. Clin Neurosurg. 2011;58(138):142."},{"issue":"6","key":"b28","series-title":"J Neuroimaging","first-page":"746","article-title":"Phase-contrast MRI detection of ventricular shunt CSF flow: proof of principle","volume":"30","author":"K\u00f6nig RE","year":"2020","unstructured":"K\u00f6nig RE, Stucht D, Baecke S,  Phase-contrast MRI detection of ventricular shunt CSF flow: proof of principle. J Neuroimaging. 2020;30(6):746\u2013753."},{"issue":"1","key":"b29","series-title":"Radiology","first-page":"243","article-title":"Cerebrospinal fluid shunts: flow measurements with MR imaging","volume":"173","author":"Martin AJ","year":"1989","unstructured":"Martin AJ, Drake JM, Lemaire C, Henkelman RM. Cerebrospinal fluid shunts: flow measurements with MR imaging. 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J Clin Neurosci. 2019;64(141):144."},{"issue":"3","key":"b32","series-title":"J Theor Biol","first-page":"409","article-title":"Laminar and turbulent flow in the mammalian aorta: Reynolds number","volume":"135","author":"Li JKJ","year":"1988","unstructured":"Li JKJ. Laminar and turbulent flow in the mammalian aorta: Reynolds number. J Theor Biol. 1988;135(3):409\u2013414."},{"issue":"49","key":"b33","series-title":"J R Soc Interface","first-page":"1195","article-title":"Cerebrospinal fluid dynamics in the human cranial subarachnoid space: an overlooked mediator of cerebral disease. I. Computational model","volume":"7","author":"Gupta S","year":"2010","unstructured":"Gupta S, Soellinger M, Grzybowski DM,  Cerebrospinal fluid dynamics in the human cranial subarachnoid space: an overlooked mediator of cerebral disease. I. Computational model. 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