Purpose This prospective study aimed to evaluate the use of three-dimensional sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE) in the diagnosis of spontaneous third ventriculostomy (STV) and to compare it with phase-contrast cine magnetic resonance imaging (PC-MRI).

Methods PC-MRI and 3D-SPACE images were obtained in 15 patients with hydrocephalus for evaluation of STV as well as in 10 control cases. The presence of STV was evaluated visually by two experienced radiologists on both PC-MRI and 3D-SPACE images, and the results were statistically compared.

Results There was a strong correlation between PC-MRI and SPACE scores for both readers (correlation coefficient [r] = 0.784; P = 0.001). There was also a good correlation between PC-MRI scores and consensus-based results. Interobserver reliabilities were strong for all STV scores. In addition, there was excellent correlation between 3D-SPACE scores and consensus-based results (first reader's kappa value: 0.87; second reader's kappa value: 1).

Conclusion 3D-SPACE can provide morphological–physiological information for the evaluation of STV with no need for additional PC-MRI analysis or other sequences. As a non-invasive test, it can also be included among the first line of choices of MRI sequences for patients with obstructive hydrocephalus.