Ventriculography

65-year old woman with multiple cerebral metastases and hydrocephalus probably secondary to carcinomatous meningitis.A, Contrast-enhanced CT scan of the brain shows a peripherally enhancing mass (black arrow) in the right frontal region, with surrounding edema. There is dilatation of the lateral and third ventricles that cannot be explained by the location of the mass. Air from the external ventricular drain is noted in the frontal horns (white arrow). Histopathologic examination revealed this tumor to be a metastatic adenocarcinoma.B, Contrast-enhanced CT scan through the posterior fossa shows another enhancing mass (arrow) in the left cerebellar hemisphere. The recesses of the fourth ventricle are well seen.C, Contrast-enhanced CT scan shows the dilated upper fourth ventricle with no evidence of basal arachnoiditis.D, Axial MR ventriculogram shows contrast material in the lateral and third ventricles.E, Coronal MR ventriculogram shows contrast material in both lateral ventricles, open foramina of Monro, and third ventricle. There is no contrast material in the basal subarachnoid cisterns.F, Sagittal MR ventriculogram shows contrast material in the lateral, third, and fourth ventricles. Note contrast material exiting the fourth ventricle through the foramen of Magendie into the cisterna magna (arrow).G, Axial MR ventriculogram shows contrast material in the lower fourth ventricle exiting the foramen of Magendie. Note the absence of contrast material in the right foramen of Luschka.H, Axial MR ventriculogram shows contrast material in the lower fourth ventricle entering the left foramen of Luschka (white arrow). Note the absence of contrast material in the right foramen of Luschka. The absence of contrast material in the basal subarachnoid spaces and the block in the right foramen of Luschka led us to a diagnosis of basal arachnoiditis due to leptomeningeal seeding in this patient with metastatic adenocarcinoma.

9-year-old girl with hydrocephalus and hydromyelia.A and B, Axial contrast-enhanced CT scans of the brain show dilatation of the lateral, third, and fourth ventricles. There is suspicion of a cystic lesion (arrow in B) in the fourth ventricle. MR ventriculography was performed to study the intraventricular CSF flow and to delineate the fourth ventricle.C, Axial MR ventriculogram after injection of gadodiamide into the right lateral ventricle shows contrast material layered in the dependent portion of the right lateral ventricle (arrow) and no contrast material in the left lateral ventricle.D, Coronal MR ventriculogram after injection of gadodiamide into the right lateral ventricle shows contrast material limited to the body and temporal horn of the right lateral ventricle (arrow). There is minimal contrast material in the third ventricle, suggesting a partial block in the right foramen of Monro.E, Sagittal MR ventriculogram after injection of contrast material into the right lateral ventricle shows minimal contrast material entering the third and fourth ventricles. Note the presence of a syringomyelia in the upper cervical cord (arrow).F, Axial MR ventriculogram through the bodies of the lateral ventricles. Contrast material was injected into the left lateral ventricle 100 minutes after the previous injection into the right lateral ventricle. This image shows a more uniform distribution of the contrast material in the right lateral ventricle, with no evidence of layering.G, Coronal MR ventriculogram after injection of contrast material into the left lateral ventricle shows good flow of the contrast material through the left foramen of Monro into the third ventricle.H, Sagittal MR ventriculogram shows flow of contrast material from the third ventricle into the fourth ventricle with no intraventricular lesion. The syrinx in the upper cervical cord (arrow) is again noted.