Evaluating the added value of quantitative over qualitative CSF flowmetry in pediatric posterior fossa cystic malformations: a prospective multicenter study

Abstract Aim Traditional CSF evaluation has relied on invasive methods, such as lumbar puncture. Recent advances, particularly phase-contrast MRI (PC-MRI), offer a non-invasive alternative capable of both qualitative and quantitative CSF flow assessment. This study investigated whether quantitative CSF flowmetry adds diagnostic value in pediatric posterior fossa cystic malformations. Methods In this multicenter, prospective study, 45 pediatric patients (aged 1–14 years) with suspected hydrocephalus and increased intracranial pressure completed MRI protocols between October 2024 and April 2025. Patients with mixed or solid lesions, or who did not complete the protocol, were excluded. Results No significant intergroup differences were found in end-diastolic velocity (EDV). Peak systolic velocity (PSV) was significantly lower in the Dandy-Walker Malformation (DWM) + Vermis Hypoplasia (VH) group. Stroke volume (SV) was significantly lower in Mega Cisterna Magna (MCM) and Arachnoid Cyst (AC) groups. Hydrocephalus distribution showed no significant association with cyst type. Conclusion Quantitative CSF flowmetry alone does not significantly enhance diagnostic differentiation among posterior fossa cystic malformations. However, qualitative assessment proved valuable in distinguishing communicating from non-communicating ACs, with implications for surgical planning. Advances in knowledge While quantitative PC-MRI provides detailed flow metrics, its standalone diagnostic value in routine evaluation of pediatric posterior fossa malformations appears limited. Its role may be best reserved for complementing qualitative CSF flowmetry in select cases.