A Cinemyelographic Study of Cerebrospinal Fluid Dynamics

Gilland, Olof; Chin, F; Wb, Anderson; Nelson, Bradley J.

doi:10.2214/ajr.106.2.369

Cited by 14 publications

(10 citation statements)

References 5 publications

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“…[5][6][7] The pulsatility of the CSF, initially determined myelographically, is associated with choroid plexus pulsations and is modulated by the respiratory cycle. 18,19 Cine phase-contrast flow methods can image and perhaps quantify CSF pulsatile flow. 5,20 To the best of our Figure 4 Peak systolic and diastolic velocities of CSF in normal controls and SCI patients.…”

Section: Evoked Potentialsmentioning

confidence: 99%

“…Although bidirectional CSF flow through the narrow cerebral aqueduct is purely laminar, CSF flow in larger regions, such as the cervical SAS, is often turbulent. 18,19 This turbulence can cause phase dispersion and signal loss in PC-MRI, resulting in an underestimation of net flow in the cervical SAS. Therefore, the diastolic velocities in below level (region 3) might have been underestimated owing to turbulence through the level of stenosis.…”

Section: Evoked Potentialsmentioning

confidence: 99%

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Correlation of diffusion tensor imaging and phase-contrast MR with clinical parameters of cervical spinal cord injuries

Chang

et al. 2015

Spinal Cord

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Study design: This is a cross-sectional study. Objectives: The goal of this study was to characterize the diffusion properties across segments of the spinal cord and peak cerebrospinal fluid (CSF) velocities in the stenotic spinal canal, and to determine the correlation between these properties and clinical and electrophysiological parameters in patients with cervical spinal cord injury (SCI). Setting: This study was conducted in the University teaching hospital. Methods: The study involved 17 patients with cervical SCI. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of the spinal cord and peak systolic and diastolic velocities of CSF were measured at the level of maximum compression (region 1) and at the levels above (region 2) and below (region 3) the level of injury with no signal change in conventional magnetic resonance imaging. Neurological and electrophysiological parameters were measured, including American Spinal Injury Association (ASIA) Impairment Scale (AIS), ASIA motor score, ASIA sensory score, Modified Barthel Index, Spinal Cord Independence Measure III (SCIM III), somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP). Results: The ADC was significantly higher and the FA was significantly lower in regions 1, 2 and 3 of the SCI patients than in the normal controls (Po0.05 each). FA of the level below correlated with AIS, ASIA sensory score and SCIM III score, and FA of the level above correlated with SSEP latencies and MEP amplitudes (Po0.05 each). The reductions in FA correlated with CSF flow, functional measurements and evoked potentials. INTRODUCTIONOwing to its high soft-tissue resolution, conventional magnetic resonance imaging (MRI) is used routinely in the diagnosis of spinal cord injury (SCI). However, conventional MRI has low sensitivity for diffusion abnormalities in the white matter, limiting the associations between MRI results and clinical status. 1,2 Diffusion tensor imaging (DTI) with fiber tractography provides a threedimensional model of water diffusion for longitudinal evaluations of the central nervous system. 3 Although the application of DTI to the human spinal cord is challenging technically, owing to the small cross-sectional area of the spinal cord, cardiac and respiratory motion, and widely varying magnetic susceptibility, 4 recent developments in magnetic resonance (MR) pulse sequence design have greatly reduced these problems. Moreover, phase-contrast MRI (PC-MRI) is a noninvasive technique that can be used to quantify variations in the flow of the cerebrospinal fluid (CSF) gated with the cardiac cycle. 5 CSF flow can be influenced by stenotic lesions in the brain and spinal cord. 6,7 Initially, SCI results in the physical disruption of structures in the spinal cord (primary insult), and it might also induce secondary events that injure intact, neighboring tissues in the epidural, subdural,

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Section: Evoked Potentialsmentioning

confidence: 99%

Section: Evoked Potentialsmentioning

confidence: 99%

Correlation of diffusion tensor imaging and phase-contrast MR with clinical parameters of cervical spinal cord injuries

Chang

et al. 2015

Spinal Cord

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“…We also investigated mechanical-based slosh mitigation, in the form of a jugular vein compression collar fashioned off of the diagnostic Queckenstedt manoeuvre 13. This approach demonstrated an 83% reduction in amyloid precursor protein-positive axons—a widely accepted biomarker of TBI—during a 900 g impact protocol studied in animals 14.…”

Section: Introductionmentioning

confidence: 99%

Analysis of head impact exposure and brain microstructure response in a season-long application of a jugular vein compression collar: a prospective, neuroimaging investigation in American football

et al. 2016

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BackgroundHistorical approaches to protect the brain from outside the skull (eg, helmets and mouthpieces) have been ineffective in reducing internal injury to the brain that arises from energy absorption during sports-related collisions. We aimed to evaluate the effects of a neck collar, which applies gentle bilateral jugular vein compression, resulting in cerebral venous engorgement to reduce head impact energy absorption during collision. Specifically, we investigated the effect of collar wearing during head impact exposure on brain microstructure integrity following a competitive high school American football season.MethodsA prospective longitudinal controlled trial was employed to evaluate the effects of collar wearing (n=32) relative to controls (CTRL; n=30) during one competitive football season (age: 17.04±0.67 years). Impact exposure was collected using helmet sensors and white matter (WM) integrity was quantified based on diffusion tensor imaging (DTI) serving as the primary outcome.ResultsWith similar overall g-forces and total head impact exposure experienced in the two study groups during the season (p>0.05), significant preseason to postseason changes in mean diffusivity, axial diffusivity and radial diffusivity in the WM integrity were noted in the CTRL group (corrected p<0.05) but not in the collar group (p>0.05). The CTRL group demonstrated significantly larger preseason to postseason DTI change in multiple WM regions compared with the collar group (corrected p<0.05).DiscussionReduced WM diffusivity alteration was noted in participants wearing a neck collar after a season of competitive football. Collar wearing may have provided a protective effect against brain microstructural changes after repetitive head impacts.Trial registration numberNCT02696200.

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“…Pulsatility of the CSF was initially demonstrated on the basis of myelographic studies 12,13 . It is thought to be the consequence of the Monro-Kellie doctrine 14 which states that the sum of volumes of brain, CSF and intracranial blood is constant.…”

Section: Normal Circulation Of Csfmentioning

confidence: 99%