Clinical application of single-shot fast spin-echo sequence for cerebrospinal fluid flow MR imaging

In normal-pressure hydrocephalus, disturbances in cerebrospinal fluid (CSF) circulation occur; therefore, understanding CSF dynamics is crucial. The two-dimensional phase-contrast (2D-PC) method, a common approach for visualizing CSF flow on MRI, often presents challenges owing to prominent vein signals and excessively high contrast, hindering the interpretation of morphological information. Therefore, we devised a new imaging method that utilizes T₂-weighted high-signal intensification of the CSF and saturation pulses, without requiring specialized imaging sequences. This sequence utilized a T₂-weighted single-shot fast spin-echo combined with multi-phase imaging synchronized with a pulse wave. Optimal imaging conditions (repetition time, presence/absence of fast recovery, and echo time) were determined using self-made contrast and single-plate phantoms to evaluate signal-to-noise ratio, contrast ratio, and spatial resolution. In certain clinical cases of hydrocephalus, confirming CSF flow using 2D-PC was challenging. However, our method enabled the visualization of CSF flow, proving to be useful in understanding the pathophysiology of hydrocephalus.