Cerebrospinal fluid flow imaging by using phase-contrast MR technique

Battal, Bilal; Kocaoğlu, Murat; Bulakbaşı, Nail; Hüsmen, Güray; Sanal, Hatice Tuba; Tayfun, Cem

doi:10.1259/bjr/66206791

Cited by 205 publications

(134 citation statements)

References 14 publications

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“…Fluid movement along this CSF column is commonly measured by MRI. Phase-contrast MRI allows the visualization of CSF flow dynamics and is used clinically in the evaluation of communicating versus noncommunicating hydrocephalus, normal pressure hydrocephalus, and arachnoid cysts (3). Contrast-enhanced magnetic resonance cisternography can also be used to identify CSF leaks in the treatment of spontaneous intracranial hypotension or CSF rhinorrhea (4,5).…”

Section: Introductionmentioning

confidence: 99%

Brain-wide pathway for waste clearance captured by contrast-enhanced MRI

et al. 2013

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The glymphatic system is a recently defined brain-wide paravascular pathway for cerebrospinal fluid (CSF) and interstitial fluid (ISF) exchange that facilitates efficient clearance of solutes and waste from the brain. CSF enters the brain along para-arterial channels to exchange with ISF, which is in turn cleared from the brain along para-venous pathways. Because soluble amyloid β clearance depends on glymphatic pathway function, we proposed that failure of this clearance system contributes to amyloid plaque deposition and Alzheimer's disease progression. Here we provide proof of concept that glymphatic pathway function can be measured using a clinically relevant imaging technique. Dynamic contrast-enhanced MRI was used to visualize CSF-ISF exchange across the rat brain following intrathecal paramagnetic contrast agent administration. Key features of glymphatic pathway function were confirmed, including visualization of para-arterial CSF influx and molecular size-dependent CSF-ISF exchange. Whole-brain imaging allowed the identification of two key influx nodes at the pituitary and pineal gland recesses, while dynamic MRI permitted the definition of simple kinetic parameters to characterize glymphatic CSF-ISF exchange and solute clearance from the brain. We propose that this MRI approach may provide the basis for a wholly new strategy to evaluate Alzheimer's disease susceptibility and progression in the live human brain. IntroductionIn the classical model, cerebrospinal fluid (CSF) is actively secreted by the choroid plexus of the cerebral ventricles and travels by bulk or pulsatile flow through the ventricular system, flowing from the fourth ventricle into the subarachnoid space through the foramina of Luschka and the foramen of Magendie. From the subarachnoid space, CSF is thought to be reabsorbed into the blood stream either via arachnoid granulations of the dural sinuses or by passing out of the cranial cavity along cranial nerve sheathes to be eliminated through the cervical lymphatics (1, 2). Fluid movement along this CSF column is commonly measured by MRI. Phase-contrast MRI allows the visualization of CSF flow dynamics and is used clinically in the evaluation of communicating versus noncommunicating hydrocephalus, normal pressure hydrocephalus, and arachnoid cysts (3). Contrast-enhanced magnetic resonance cisternography can also be used to identify CSF leaks in the treatment of spontaneous intracranial hypotension or CSF rhinorrhea (4,5).In a recent study (6), we reported that, contrary to the textbook model of CSF secretion and reabsorption, a large proportion of subarachnoid CSF recirculates through the brain parenchyma along paravascular spaces and exchanges with the interstitial fluid (ISF) (a process referred to herein as CSF-ISF exchange). The flow of fluid along these paravascular routes and through the interstitium is supported by transglial water movement through astrocytic aquaporin-4 (AQP4) water channels and facilitates the efficient clearance of interstitial solutes, including soluble amyloid...

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Section: Introductionmentioning

confidence: 99%

Brain-wide pathway for waste clearance captured by contrast-enhanced MRI

et al. 2013

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“…Moreover, it is important for the homeostatic regulation, helps maintaining the intracerebral pressure at a constant level, circulates nutrients and rinses waste products from the brain parenchyma. In humans, the majority of the CSF originates from the four choroid plexus in the ventricles, from parenchyma of the brain and of the spinal cord and from ependymal lining of the ventricels [1,2]. CSF is constantly produced and mainly drained through cisternae, subarachnoid space and arachnoid villi into the venous blood.…”

Section: Introductionmentioning

confidence: 99%

The presence of oligoclonal IgG bands in human CSF during the course of neurological diseases

et al. 2014

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The analysis of cerebrospinal fluid (CSF) is an important tool for the diagnosis of neurological diseases. However, there is limited knowledge about the representativity of a single oligoclonal band (OCB) analysis for a neurological disease during its clinical course. In this study, we analyzed the presence of OCB in the CSF of patients who underwent lumbar puncture more than once. We retrospectively analyzed anonymized data from serial 17,002 CSF analyses done in the CSF laboratory of the Department of Neurology, University Hospital Zurich. We included cases with documented diagnosis in whom OCB were determined more than once. We included 144 patients. The median time span between the first and second OCB analysis was 274 days (range, 1-3,533 days). The result of the second OCB analysis was identical in 109 cases, and different in 35 (24 %). Twenty-five patients acquired and ten patients lost OCB over time. Three of 24 MS patients did not show OCB at the first CSF analysis, but in the second. In the entire group, newly occurring OCB were often associated with new symptoms or occurred after the acute phase of CNS infectious diseases, supposedly as a consequence of the immune reaction. A loss of OCB was often associated with remissions from diseases, e.g., during effective treatment. In patients with neurological diseases, both initially positive and negative OCB results may change over time, which often parallels the clinical condition. Such variability must be taken into account for the interpretation of OCB results. analysis for a neurological disaese during its clinical course. In this study we analysed the presence of OCB in the CSF of patients who underwent lumbar puncture more than once.Methods: We retrospectively analyzed anonymized data from serial 17002 CSF analyses done in the CSF laboratory of the Department of Neurology, University Hospital Zurich. We included cases with documented diagnosis in whom OCB were determined more than once.Results: We included 144 patients. Median time span between the first and the second OCB analysis was 274 days (range: 1-3533). The result of the second OCB analysis was identical in 109, and different in 35 cases (24%). 25 patients aquired, and 10 patients lost OCB over time. Three of 24 MS patients did not show OCB at the first CSF analysis, but in the second. In the entire group, newly ocurring OCB were often associated with new symptoms or occured after the acute phase of CNS infectious diseases, supposedly as consequence of the immune reaction. A loss of OCB was often associatd with remissions from diseases, e.g. during effective treatment.Conclusions: In patients with neurological diseases, both initially positive and negative OCB results may change over time, which often paralleles the clinical condition. Such variability must be taken into account for the interpretation of OCB results.

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“…No net fluid was collected after cannulation of the aqueduct for several hours. This result was corroborated by at least 2 separate cine phase-contrast MRI studies, which demonstrated an aqueduct stroke volume (ASV) of essentially zero [26,27] . The invasive nature of aqueductal cannulation and the lack of reproducibility inherent in flow-sensitive MR techniques continues to stoke controversy as to the degree of confidence in these results.…”

Section: The Site and Rate Of Csf Productionmentioning

confidence: 72%