On the Pulsatile Nature of Intracranial and Spinal CSF-Circulation Demonstrated by MR Imaging

Greitz, Dan; Franck, Anders; Nordell, Bo

doi:10.1177/028418519303400403

Cited by 144 publications

(38 citation statements)

References 20 publications

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“…Physiological CSF flow is most likely the result of pulsatile movements created by the choroid plexus and the subarachnoid portions of the cerebral arteries [5,14]. Other theories suggest a possible hydrostatic pressure gradient between the site of CSF formation and absorption [15].…”

Section: Discussionmentioning

confidence: 99%

Demonstration of periventricular brain motion during a Valsalva maneuver: description of technique, evaluation in healthy volunteers and first results in hydrocephalic patients

Ertl‐Wagner¹,

Lienemann²,

Reith

et al. 2001

Eur Radiol

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There has long been a need for a sensitive and predictive parameter in the evaluation of hydrocephalic patients. Our goal was to assess ventricular response to a Valsalva maneuver as a potential method of studying patients with hydrocephalus. Twenty-five healthy volunteers and 5 patients with communicating hydrocephalus were examined with an axial and 10 volunteers with an axial, coronal and sagittal true fast imaging steady precession (FISP) sequence in a 1.5-T clinical MR scanner (TR 4.8 ms, TE 2.3 ms, flip angle 70 degrees, slice thickness 5 mm, field of view 330 mm, 3 slices). Images were assessed both as dynamic images in cine mode and by measuring lateral ventricular size over time. All volunteers showed marked periventricular brain motion. The lateral ventricular area was reduced under the Valsalva maneuver by an average of 18% (SD 7) in healthy volunteers, while remaining practically constant in the patient group. Differences were statistically significant with a p<0.0001. The Valsalva maneuver leads to periventricular brain motion, which can be consistently detected by a true FISP sequence. Our method proved to be an easy and reliable method with a capacity to identify hydrocephalic patients.

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Section: Discussionmentioning

confidence: 99%

Demonstration of periventricular brain motion during a Valsalva maneuver: description of technique, evaluation in healthy volunteers and first results in hydrocephalic patients

Ertl‐Wagner¹,

Lienemann²,

Reith

et al. 2001

Eur Radiol

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“…14,19,52 Computational fluid dynamics has been used to complement CINE-MRI measurements by calculating the CSF pressure and velocity fields in the cranial subarachnoid space and cerebral ventricles. 10,15,21,24,30 These computational studies predict and explain complex fluid flow patterns in the CSF spaces, an outcome difficult to establish with CINE-MRI alone.…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal Fluid Flow Dynamics in the Central Nervous System

Sweetman

Linninger

2010

Ann Biomed Eng

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Cine-phase-contrast-MRI was used to measure the three-dimensional cerebrospinal fluid (CSF) flow field inside the central nervous system (CNS) of a healthy subject. Image reconstruction and grid generation tools were then used to develop a three-dimensional fluid-structure interaction model of the CSF flow inside the CNS. The CSF spaces were discretized using the finite-element method and the constitutive equations for fluid and solid motion solved in ADINA-FSI 8.6. Model predictions of CSF velocity magnitude and stroke volume were found to be in excellent agreement with the experimental data. CSF pressure gradients and amplitudes were computed in all regions of the CNS. The computed pressure gradients and amplitudes closely match values obtained clinically. The highest pressure amplitude of 77 Pa was predicted to occur in the lateral ventricles. The pressure gradient between the lateral ventricles and the lumbar region of the spinal canal did not exceed 132 Pa (~1 mmHg) at any time during the cardiac cycle. The pressure wave speed in the spinal canal was predicted and found to agree closely with values previously reported in the literature. Finally, the forward and backward motion of the CSF in the ventricles was visualized, revealing the complex mixing patterns in the CSF spaces. The mathematical model presented in this article is a prerequisite for developing a mechanistic understanding of the relationships among vasculature pulsations, CSF flow, and CSF pressure waves in the CNS.

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“…Spinal macht sich im Subarachnoidalraum dasselbe Phänomen bei der Diagnostik oft störend bemerkbar. Vor allem mit Hilfe von Phasenkontrastsequenzen wurde die Richtung der Bewegung des Liquors im Aquädukt [14][15][16][17][18] und spinal [19][20][21][22] 4,4 ± 2,4 ml/min 11.5 ± 6 subtraction of two flash-5,6 ± 4 ml /min 14,8 ± 9 sequences with/without sensitivity to flow Greitz, 1993 0,017 ± 0,006 5 -10 0,5 , 1,0 venc gated SE 1,5 Henry-Feugas, 1993 -15 -24 1,5 phase contrast cine Parkkola, 2000 ~ 0,2~ 30 1,5 subtraction of two flash-12 ml/min sequences with/without sensitivity to flow Thomsen, 1990 0,03 ml 6 -51 1,5 through plane phase encoded der Schaltung von bipolaren Gradienten in verschiedenen Raumrichtungen. In der Regel werden aus Zeitgrün-den Gradientenechosequenzen verwendet; grundsätz-lich ist jedoch auch die Verwendung von Spinecho-und Inversion-Recovery-Sequenzen möglich.…”

Section: Methoden Der Darstellung Der Liquorpulsationunclassified

“…200 ms nach der R-Zacke im EKG oder 23% der Zeit eines Herzschlags [29] wird Friese S, et al Zur Pulsation des Liquor cerebrospinalis der Bluteinstrom jedoch durch einen Liquorausstrom durch den Aquädukt kompensiert [21]. Auch der Ausstrom aus dem vierten Ventrikel durch das Foramen Magendie wird erst 175 ms nach der R-Zacke gemessen [20]. Die Pulswelle in den basalen Zisternen erscheint jedoch bereits etwa 100 ms (etwa 10% eines Herzschlags) nach dem systolischen Peak, und es strömt Liquor von den basalen Zisternen in den Spinalkanal [24], weil die Volumenzunahme des Gehirns später stattfindet als die Volumenzunahme der basalen Arterien.…”

Section: Die Liquorbewegung Spinalunclassified

Zur Pulsation des Liquor cerebrospinalis

Friese¹,

Klose²,

Voigt³

2002

Klinische Neuroradiologie

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ZusammenfassungHintergrund: Das neuroanatomische Wissen über die Liquorräume und aus der Schädel-Hirn-Traumatologie offenbare Phänomene wie das Pulsieren des Gehirns bei bestehendem Kreislauf sind seit dem Altertum bekannt. Die Geschichte der Entdeckung des Liquors und dessen Flusses ist jedoch relativ jung. Seit Einführung von Pneumenzephalographie und Myelographie, von nuklearmedizinischen Techniken und insbesondere mit der Entwicklung der Kernspintomographie ist die Kenntnis der Liquordynamik fortgeschritten. Bildgebende Darstellung: Die langsame Komponente der Liquorbewegung, die Durchmischung und Verteilung von Substanzen im Liquor können szintigraphisch und myelographisch gezeigt werden. Die schnelle Komponente der Liquorbewegung, die Pulsation des Liquors mit dem Herzschlag und der Atmung, ist kernspintomographisch am besten darstellbar und quantifizierbar. Die Bewegung im intrakraniellen und spinalen Subarachnoidalraum sowie die Bewegung des Gehirns und des Myelons selbst können durch geschwindigkeitskodierte Sequenzen sichtbar gemacht werden. In der Regel werden EKG-getriggerte Phasenkontrast-, aber auch Spinecho-oder InversionRecovery-Sequenzen verwendet. Pathophysiologie: Der Hauptmotor der Liquorbewegung ist der arterielle Bluteinstrom ins Gehirn. Die konsekutive Ausdehnung der Gefäße auf der Hirnoberfläche, des Gehirns selbst und in geringerem Umfang des Plexus choroideus führt zu einem Liquorausstrom aus dem Schädelinneren, dessen Dynamik beschrieben wird. Die Pulsationsbewegung setzt sich in den Spinalkanal fort. Dort sind neben der Propulsion von kranial weitere Einflüsse auf die Liquorbewegung wie die Ausdehnung des Epiduralraums anzunehmen. Schlussfolgerung: Da die Kernspintomographie arteriellen und venösen Fluss sowie auch die Bewegung des Liquors messen kann, kann sie einen Beitrag zur Darstellung und Erklärung pathologischer Veränderungen leisten. So ist bei der Entstehung eines Normaldruckhydrozephalus die Störung der Liquordynamik ein maßgeblicher Faktor. Schlüsselwörter: MR-Tomographie · Liquor · LiquordynamikBackground: Neuroanatomical knowledge about the cerebrospinal spaces and phenomena like pulsation of the brain after fractures of the skull have been known in ancient times. However, the history of the discovery of the cerebrospinal fluid (CSF) and of its flow phenomena is relatively new. Due to the introduction of the techniques of pneumencephalography, myelography and nuclear medicine, as well as especially the development of MR tomography this knowledge has improved. Imaging: The slow component of cerebrospinal fluid movement, the mixture and distribution of substances in the cerebrospinal fluid, can be delineated scintigraphically and by myelography. The fast component which is the pulsation of cerebrospinal fluid according to the cardiac cycle and respiration can be measured by MR tomography. The movement in the intracranial and intraspinal cerebrospinal fluid spaces and the movement of the brain and myelon itself can be shown by velocity-encoded sequences. As a rule ECG-trigger...

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On the Pulsatile Nature of Intracranial and Spinal CSF-Circulation Demonstrated by MR Imaging

Cited by 144 publications

References 20 publications

Demonstration of periventricular brain motion during a Valsalva maneuver: description of technique, evaluation in healthy volunteers and first results in hydrocephalic patients

Demonstration of periventricular brain motion during a Valsalva maneuver: description of technique, evaluation in healthy volunteers and first results in hydrocephalic patients

Cerebrospinal Fluid Flow Dynamics in the Central Nervous System

Zur Pulsation des Liquor cerebrospinalis

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