Measurement of Cerebrospinal Fluid Flow at the Cerebral Aqueduct by Use of Phase-contrast Magnetic Resonance Imaging: Technique Validation and Utility in Diagnosing Idiopathic Normal Pressure Hydrocephalus

Luetmer, Patrick H.; Huston, John; Friedman, Jonathan A.; Dixon, G. R.; Petersen, Ronald C.; Jack, Clifford R.; McClelland, Robyn L.; Ebersold, Michael J.

doi:10.1227/00006123-200203000-00020

Cited by 69 publications

(112 citation statements)

References 25 publications

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“…39 The main challenge was measuring aqueductal CSF flow, because of the very small caliber of the aqueduct. However, previous studies have demonstrated a good reliability of PC-MRI CSF quantification, 40 mainly when semi-automated algorithm is used, because it minimizes velocity dispersion when compared with manual contouring. 9 Similar reliability was obtained with these segmentation softwares for assessing cervical CSF flows in this anatomically challenging area.…”

Section: Limitsmentioning

confidence: 99%

Concomitant Analysis of Arterial, Venous, and CSF Flows using Phase-Contrast MRI: A Quantitative Comparison Between MS Patients and Healthy Controls

ElSankari

Balédent

Pesch

et al. 2013

J Cereb Blood Flow Metab

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Venous dysfunction has recently been hypothesized to contribute to the pathophysiology of multiple sclerosis (MS). 2D phasecontrast (PC) magnetic resonance imaging (MRI) is a non-invasive and innocuous technique enabling reliable quantification of cerebrospinal fluid (CSF) and blood flows in the same imaging session. We compared PC-MRI measurements of CSF, arterial and venous flows in MS patients to those from a normative cohort of healthy controls (HC). Nineteen MS patients underwent a standardized MR protocol for cerebral examination on a 3T system including Fast cine PC-MRI sequences with peripheral gating in four acquisition planes. Quantitative data were processed using a homemade software to extract CSF and blood flow regions of interest, animate flows, and calculate cervical and intracranial vascular flow curves during the cardiac cycle (CC). Results were compared with values obtained in 21 HC using multivariate analysis. Venous flow patterns were comparable in both groups without signs of reflux. Arterial flows (P ¼ 0.02) and cervical CSF dynamic oscillations (P ¼ 0.01) were decreased in MS patients. No significant differences in venous cerebral and cervical outflows were observed between groups, thereby contradicting the recently proposed theory of venous insufficiency. Unexpected decrease in arterial perfusion in MS patients warrants further correlation to volumetric measurements of the brain.

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Section: Limitsmentioning

confidence: 99%

Concomitant Analysis of Arterial, Venous, and CSF Flows using Phase-Contrast MRI: A Quantitative Comparison Between MS Patients and Healthy Controls

ElSankari

Balédent

Pesch

et al. 2013

J Cereb Blood Flow Metab

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“…Two major alterations have been observed in CSF physiology during aging, namely, a decrease in CSF production and an increase in resistance against CSF flow (12,13,15). Silverberg et al (17) have suggested that Alzheimer's disease may develop when a decrease in CSF production predominates, but INPH may develop when resistance against CSF flow predominates.…”

Section: Discussionmentioning

confidence: 99%

“…There is still no test that can accurately diagnose NPH patients or predict the potential benefit of surgical treatment (1,2,9,19). A definitive diagnosis of NPH is only made by showing a clinical improvement after a shunt operation (13).…”

mentioning

confidence: 99%

Normal pressure hydrocephalus versus atrophic dilatation to distinguish and predict the benefits of surgical intervention with a phase-contrast MRI technique

Aslan¹,

Tokatlioğlu²,

Aydin³

et al. 2014

Turkish Neurosurgery

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AIM:To compare mean cerebrospinal fluid (CSF) volume in the aqueduct by using phase-contrast magnetic resonance imaging for the patients with idiopathic normal pressure hydrocephalus (INPH) and atrophic dilation (AD) to investigate the efficacy of this technique in predicting surgery. MATERIAL and METHODS:The MR images of a total of 80 individuals, consisting of 30 patients considered to have INPH, 20 patients with AD not proportional with cerebral sulci, and 30 control cases without a hydrocephalus clinical picture, were evaluated retrospectively. The minute mean aqueductal CSF flow rates of the three groups were compared using the Kruskall-Wallis analysis of variance, and the inter-group statistical comparisons were made using the Mann-Whitney U test. RESULTS:The mean aqueductal flow rates were 46.56 ± 25.06 ml/min for the INPH group, 9.28 ± 4.68 ml/min for the AD group, and 8.68 ± 3.40 ml/min for the control group. The mean flow rate of the INPH group was significantly higher than those of the control and ADH groups (p < 0.001). CONCLUSION:The mean CSF flow rate may be useful in the diagnosis and differential diagnosis, and the prediction of the potential benefits of surgical intervention for patients considered to have INPH.KEywORDS: Phase-contrast magnetic resonance imaging, Normal pressure hydrocephalus, Cerebrospinal fluid ÖZ AMAÇ: Faz kontrast manyetik rezonans görüntüleme kullanarak, idiyopatik normal basınçlı hidrosefali (İNBH) li hastalar ile atrofik dilatasyonu (AD) bulunan hastalarda akuaduktustaki ortalama beyin omurilik sıvısı (BOS) volümünü karşılaştırmak ve bu tekniğin cerrahi yararı öngörmedeki etkinliğini araştırmaktır. yÖNTEM ve GEREÇLER: İNBH olarak değerlendirilen 30 hasta, serebral sulkuslar ile orantısız AD bulunan 20 hasta, hidrosefali kliniği bulunmayan kontrol grubu 30 olgu olmak üzere toplam 80 olgunun MR görüntüleri retrospektif olarak incelendi. Üç grup arasında akuaduktustaki dakikalık ortalama BOS debileri Kruskall-Wallis varyans analizi ile, gruplar birbirleri ile Mann-Whitney U testi ile istatistiksel olarak karşılaştırıldı. BULGULAR:Akuaduktus düzeyinden elde edilen ortalama debi değerleri; İNBH grubunda 46,56 ± 25,06 ml/dk, AD grubunda 9,28 ± 4,68 ml/ dk, kontrol grubunda 8,68 ± 3,40 ml/dk idi. İNBH grubundaki ortalama debi, kontrol grubu ve AD grubu ile karşılaştırıldığında istatistiksel olarak anlamlı fazla bulundu (p < 0,001). SONUÇ:Ortalama BOS debi oranları, İNBH düşünülen olgularda tanıda, ayırıcı tanıda ve cerrahi yararı öngörmede faydalı olabilir.ANAHTAR SÖZCÜKLER: Faz kontrast manyetik rezonans görüntüleme, Normal basınçlı hidrosefali, Beyin omurilik sıvısı

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“…19 ) Studies of CSF flow in hydrocephalus secondary to intracranial pressure changes demonstrated by invasive monitoring have found up to a 10-fold increased pulsatile aqueductal flow 15,17,[19][20][21][22][23][24] compared with that in healthy controls. This finding has been used to build criteria for diagnosing idiopathic normal pressure hydrocephalus (NPH) based on stroke volumes of Ͼ42 L 19 or pulsatile flow rates above a threshold of 18 mL/min, for example.…”

Section: Quantitative Measurements From Pcmentioning

confidence: 99%

“…This finding has been used to build criteria for diagnosing idiopathic normal pressure hydrocephalus (NPH) based on stroke volumes of Ͼ42 L 19 or pulsatile flow rates above a threshold of 18 mL/min, for example. 20 However, setting thresholds such as these has so far not proved to be clinically reliable. For example, Greitz 15 found, along with an increased aqueductal flow rate, a corresponding decreased flow rate through the craniocervical junction.…”

Section: Quantitative Measurements From Pcmentioning

confidence: 99%

Current and Emerging MR Imaging Techniques for the Diagnosis and Management of CSF Flow Disorders: A Review of Phase-Contrast and Time–Spatial Labeling Inversion Pulse

Yamada

Tsuchiya

Bradley

et al. 2014

AJNR Am J Neuroradiol

114

103

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SUMMARY:This article provides an overview of phase-contrast and time-spatial labeling inversion pulse MR imaging techniques to assess CSF movement in the CNS under normal and pathophysiologic situations. Phase-contrast can quantitatively measure stroke volume in selected regions, notably the aqueduct of Sylvius, synchronized to the heartbeat. Judicious fine-tuning of the technique is needed to achieve maximal temporal resolution, and it has limited visualization of CSF motion in many CNS regions. Phase-contrast is frequently used to evaluate those patients with suspected normal pressure hydrocephalus and a Chiari I malformation. Correlation with successful treatment outcome has been problematic. Time-spatial labeling inversion pulse, with a high signal-to-noise ratio, assesses linear and turbulent motion of CSF anywhere in the CNS. Time-spatial labeling inversion pulse can qualitatively visualize whether CSF flows between 2 compartments and determine whether there is flow through the aqueduct of Sylvius or a new surgically created stoma. Cine images reveal CSF linear and turbulent flow patterns. ABBREVIATIONS:CSP ϭ cavum septi pellucidi; NPH ϭ normal pressure hydrocephalus; PC ϭ phase-contrast; Time-SLIP ϭ time-spatial labeling inversion pulse;

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Measurement of Cerebrospinal Fluid Flow at the Cerebral Aqueduct by Use of Phase-contrast Magnetic Resonance Imaging: Technique Validation and Utility in Diagnosing Idiopathic Normal Pressure Hydrocephalus

Cited by 69 publications

References 25 publications

Concomitant Analysis of Arterial, Venous, and CSF Flows using Phase-Contrast MRI: A Quantitative Comparison Between MS Patients and Healthy Controls

Concomitant Analysis of Arterial, Venous, and CSF Flows using Phase-Contrast MRI: A Quantitative Comparison Between MS Patients and Healthy Controls

Normal pressure hydrocephalus versus atrophic dilatation to distinguish and predict the benefits of surgical intervention with a phase-contrast MRI technique

Current and Emerging MR Imaging Techniques for the Diagnosis and Management of CSF Flow Disorders: A Review of Phase-Contrast and Time–Spatial Labeling Inversion Pulse

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