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. 2016 Nov;89(1067):20160392.
doi: 10.1259/bjr.20160392. Epub 2016 Sep 29.

Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves

David J Noble  1 , Daniel Scoffings  2 , Thankamma Ajithkumar  1 , Michael V Williams  1 , Sarah J Jefferies  1
Affiliations

Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves

David J Noble et al. Br J Radiol. 2016 Nov.

Abstract

Objective: There is no consensus approach to covering skull base meningeal reflections-and cerebrospinal fluid (CSF) therein-of the posterior fossa cranial nerves (CNs VII-XII) when planning radiotherapy (RT) for medulloblastoma and ependymoma. We sought to determine whether MRI and specifically fast imaging employing steady-state acquisition (FIESTA) sequences can answer this anatomical question and guide RT planning.

Methods: 96 posterior fossa FIESTA sequences were reviewed. Following exclusions, measurements were made on the following scans for each foramen respectively (left, right); internal acoustic meatus (IAM) (86, 84), jugular foramen (JF) (83, 85) and hypoglossal canal (HC) (42, 45). A protocol describes measurement procedure. Two observers measured distances for five cases and agreement was assessed. One observer measured all the remaining cases.

Results: IAM and JF measurement interobserver variability was compared. Mean measurement difference between observers was -0.275 mm (standard deviation 0.557). IAM and JF measurements were normally distributed. Mean IAM distance was 12.2 mm [95% confidence interval (CI) 8.8-15.6]; JF was 7.3 mm (95% CI 4.0-10.6). The HC was difficult to visualize on many images and data followed a bimodal distribution.

Conclusion: Dural reflections of posterior fossa CNs are well demonstrated by FIESTA MRI. Measuring CSF extension into these structures is feasible and robust; mean CSF extension into IAM and JF was measured. We plan further work to assess coverage of these structures with photon and proton RT plans. Advances in knowledge: We have described CSF extension beyond the internal table of the skull into the IAM, JF and HC. Oncologists planning RT for patients with medulloblastoma and ependymoma may use these data to guide contouring.

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Figures

Figure 1.
Figure 1.
Fast imaging employing steady-state acquisition MR images are showing cerebrospinal fluid and cranial nerves evaginating into the left internal acoustic meatus (IAM) (a), jugular foramen (JF) (b) and hypoglossal canal (HC) (c).
Figure 2.
Figure 2.
An example of measurement protocol—measurement of cerebrospinal fluid into the right internal acoustic meatus.
Figure 3.
Figure 3.
A scatter plot of internal acoustic meatus and jugular foramen measurements by the two observers.
Figure 4.
Figure 4.
A scatter plot is showing differences between observations against mean measurement.
Figure 5.
Figure 5.
Histograms are showing the distribution of cerebrospinal fluid extension into internal acoustic meatus (a), jugular foramen (b) and hypoglossal canal (c).
Figure 6.
Figure 6.
Examples of well (a) and poorly (b) visualized hypoglossal canals (HCs).
Figure 7.
Figure 7.
Radiotherapy planning CT images are clearly showing the bony anatomy of the internal acoustic meatus (IAM) (a), jugular foramen (JF) (b) and hypoglossal canal (HC) (c).
Figure 8.
Figure 8.
Sagittal reconstruction of a radiotherapy planning scan is showing steep caudocranial angulation of hypoglossal canal (HC). FIESTA, fast imaging employing steady-state acquisition.
See this image and copyright information in PMC

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