1
|
Rich J, Hubler S, Vidondo B, Raillard M, Schweizer D. Influence of body weight, age, and sex on cerebrospinal fluid peak flow velocity in dogs without neurological disorders. J Vet Intern Med 2024; 38:1608-1617. [PMID: 38664973 PMCID: PMC11099718 DOI: 10.1111/jvim.17073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/28/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Changes in the brain can affect the flow velocity of cerebrospinal fluid (CSF). In humans, the flow velocity of CSF is not only altered by disease but also by age and sex. Such influences are not known in dogs. HYPOTHESIS Peak flow velocity of CSF in dogs is associated with body weight, age, and sex. ANIMALS Peak flow velocity of CSF was measured in 32 client-owned dogs of different breeds, age, and sex. METHODS Peak flow velocity of CSF was determined by phase-contrast magnetic resonance imaging (PC-MRI) at the mesencephalic aqueduct, foramen magnum (FM), and second cervical vertebral body (C2). Dogs were grouped according to body weight, age, and sex. Flow velocity of CSF was compared between groups using linear regression models. RESULTS Dogs with body weight >20 kg had higher CSF peak velocity compared with dogs <10 kg within the ventral and dorsal subarachnoid space (SAS) at the FM (P = .02 and P = .01, respectively), as well as in the ventral and dorsal SAS at C2 (P = .005 and P = .005, respectively). Dogs ≤2 years of age had significantly higher CSF peak flow velocity at the ventral SAS of the FM (P = .05). Females had significantly lower CSF peak flow velocity within the ventral SAS of FM (P = .04). CONCLUSION Body weight, age, and sex influence CSF peak flow velocity in dogs. These factors need to be considered in dogs when CSF flow is quantitatively assessed.
Collapse
Affiliation(s)
- Johannes Rich
- Division of Clinical Radiology, Departement of Clinical Veterinary Medicine, Vetsuisse FacultyUniversity of BernBernSwitzerland
| | - Sarah Hubler
- Division of Clinical Radiology, Departement of Clinical Veterinary Medicine, Vetsuisse FacultyUniversity of BernBernSwitzerland
| | - Beatriz Vidondo
- Veterinary Public Health InstituteUniversity of BernLiebefeldSwitzerland
| | - Mathieu Raillard
- Division of Anesthesiology and Pain Management, Departement of Clinical Veterinary Medicine, Vetsuisse FacultyUniversity of BernBernSwitzerland
| | - Daniela Schweizer
- Division of Clinical Radiology, Departement of Clinical Veterinary Medicine, Vetsuisse FacultyUniversity of BernBernSwitzerland
| |
Collapse
|
2
|
Gholampour S, Frim D, Yamini B. Long-term recovery behavior of brain tissue in hydrocephalus patients after shunting. Commun Biol 2022; 5:1198. [PMID: 36344582 PMCID: PMC9640582 DOI: 10.1038/s42003-022-04128-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
The unpredictable complexities in hydrocephalus shunt outcomes may be related to the recovery behavior of brain tissue after shunting. The simulated cerebrospinal fluid (CSF) velocity and intracranial pressure (ICP) over 15 months after shunting were validated by experimental data. The mean strain and creep of the brain had notable changes after shunting and their trends were monotonic. The highest stiffness of the hydrocephalic brain was in the first consolidation phase (between pre-shunting to 1 month after shunting). The viscous component overcame and damped the input load in the third consolidation phase (after the fifteenth month) and changes in brain volume were stopped. The long-intracranial elastance (long-IE) changed oscillatory after shunting and there was not a linear relationship between long-IE and ICP. We showed the long-term effect of the viscous component on brain recovery behavior of hydrocephalic brain. The results shed light on the brain recovery mechanism after shunting and the mechanisms for shunt failure.
Collapse
Affiliation(s)
| | - David Frim
- Department of Neurological Surgery, University of Chicago, Chicago, IL, USA
| | - Bakhtiar Yamini
- Department of Neurological Surgery, University of Chicago, Chicago, IL, USA.
| |
Collapse
|
3
|
Zhang H, Yang H, Duan W, Li X, Wang Y, Cogswell PM, Elder BD. Influence of the area of the aqueduct and region of interest on quantification of stroke volume in healthy volunteers using phase-contrast cine magnetic resonance imaging. Acta Radiol 2022; 64:1615-1622. [PMID: 37023028 DOI: 10.1177/02841851221125916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Phase-contrast cine magnetic resonance imaging (PC-MRI) has been used to measure cerebrospinal fluid (CSF) flow dynamics, but the influence of the area of the aqueduct and region of interest (ROI) on quantification of stroke volume (SV) has not been assessed. Purpose To assess the influence of the area of the ROI in quantifying the aqueductal SV measured with PC-MRI within the cerebral aqueduct. Material and Methods Nine healthy volunteers (mean age = 29.6 years) were enrolled in the study, and brain MRI examinations were performed on a 3.0-T system. Quantitative analysis of the aqueductal CSF flow was performed using manual ROI placement. ROIs were separately drawn for each of the 12 phases of the cardiac cycle, and changes in aqueduct size during the cardiac cycle were determined. The SV was calculated using 12 different aqueductal ROIs and compared with the SV calculated using a fixed ROI size. Results There was variation in the size of the aqueduct during the cardiac cycle. In addition, the measured SV increased with a greater area of the ROI. A significant difference in the calculated SVs with the 12 variable ROIs was observed compared with that using a fixed ROI throughout the cardiac cycle. Conclusion To establish reliable reference values for the SV in future studies, a variable ROI should be considered.
Collapse
Affiliation(s)
- Hongri Zhang
- Department of Neurosurgery, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan, PR China
| | - Haixin Yang
- Department of Neurosurgery, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan, PR China
| | - Weike Duan
- Department of Neurosurgery, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan, PR China
| | - Xiaopan Li
- Department of Radiology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan, PR China
| | - Yixin Wang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Benjamin D Elder
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
- Department of Bioengineering, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedics, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
4
|
Gholampour S, Fatouraee N. Boundary conditions investigation to improve computer simulation of cerebrospinal fluid dynamics in hydrocephalus patients. Commun Biol 2021; 4:394. [PMID: 33758352 PMCID: PMC7988041 DOI: 10.1038/s42003-021-01920-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/01/2021] [Indexed: 01/31/2023] Open
Abstract
Three-D head geometrical models of eight healthy subjects and 11 hydrocephalus patients were built using their CINE phase-contrast MRI data and used for computer simulations under three different inlet/outlet boundary conditions (BCs). The maximum cerebrospinal fluid (CSF) pressure and the ventricular system volume were more effective and accurate than the other parameters in evaluating the patients' conditions. In constant CSF pressure, the computational patient models were 18.5% more sensitive to CSF volume changes in the ventricular system under BC "C". Pulsatile CSF flow rate diagrams were used for inlet and outlet BCs of BC "C". BC "C" was suggested to evaluate the intracranial compliance of the hydrocephalus patients. The results suggested using the computational fluid dynamic (CFD) method and the fully coupled fluid-structure interaction (FSI) method for the CSF dynamic analysis in patients with external and internal hydrocephalus, respectively.
Collapse
Affiliation(s)
- Seifollah Gholampour
- Department of Biomedical Engineering, North Tehran Branch, Islamic Azad University, Tehran, Iran.
| | - Nasser Fatouraee
- Biological Fluid Mechanics Research Laboratory, Biomechanics Department, Biomedical Engineering Faculty, Amirkabir University of Technology, Tehran, Iran
| |
Collapse
|
5
|
Laganà MM, Jakimovski D, Bergsland N, Dwyer MG, Baglio F, Zivadinov R. Measuring Aqueduct of Sylvius Cerebrospinal Fluid Flow in Multiple Sclerosis Using Different Software. Diagnostics (Basel) 2021; 11:325. [PMID: 33671219 PMCID: PMC7923004 DOI: 10.3390/diagnostics11020325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/14/2021] [Indexed: 01/02/2023] Open
Abstract
Aqueduct of Sylvius (AoS) cerebrospinal fluid flow can be quantified using phase-contrast (PC) Magnetic Resonance Imaging. The software used for AoS segmentation might affect the PC-derived measures. We analyzed AoS PC data of 30 people with multiple sclerosis and 19 normal controls using three software packages, and estimated cross-sectional area (CSA), average and highest AoS velocity (Vmean and Vmax), flow rate and volume. Our aims were to assess the repeatability and reproducibility of each PC-derived measure obtained with the various software packages, including in terms of group differentiation. All the variables had good repeatability, except the average Vmean, flow rate and volume obtained with one software package. Substantial to perfect agreement was seen when evaluating the overlap between the AoS segmentations obtained with different software packages. No variable was significantly different between software packages, with the exception of Vmean diastolic peak and CSA. Vmax diastolic peak differentiated groups, regardless of the software package. In conclusion, a clinical study should preliminarily evaluate the repeatability in order to interpret its findings. Vmax seemed to be a repeatable and reproducible measure, since the pixel with its value is usually located in the center of the AoS, and is thus unlikely be affected by ROI size.
Collapse
Affiliation(s)
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center (BNAC), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; (D.J.); (M.G.D.); (R.Z.)
| | - Niels Bergsland
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (N.B.); (F.B.)
- Buffalo Neuroimaging Analysis Center (BNAC), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; (D.J.); (M.G.D.); (R.Z.)
| | - Michael G. Dwyer
- Buffalo Neuroimaging Analysis Center (BNAC), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; (D.J.); (M.G.D.); (R.Z.)
| | - Francesca Baglio
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (N.B.); (F.B.)
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center (BNAC), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA; (D.J.); (M.G.D.); (R.Z.)
- Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
| |
Collapse
|
6
|
Christen MA, Schweizer‐Gorgas D, Richter H, Joerger FB, Dennler M. Quantification of cerebrospinal fluid flow in dogs by cardiac-gated phase-contrast magnetic resonance imaging. J Vet Intern Med 2021; 35:333-340. [PMID: 33274812 PMCID: PMC7848380 DOI: 10.1111/jvim.15932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/20/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Cerebrospinal fluid (CSF) flow in disease has been investigated with two-dimensional (2D) phase-contrast magnetic resonance imaging (PC-MRI) in humans. Despite similar diseases occurring in dogs, PC-MRI is not routinely performed and CSF flow and its association with diseases is poorly understood. OBJECTIVES To adapt 2D and four-dimensional (4D) PC-MRI to dogs and to apply them in a group of neurologically healthy dogs. ANIMALS Six adult Beagle dogs of a research colony. METHODS Prospective, experimental study. Sequences were first optimized on a phantom mimicking small CSF spaces and low velocity flow. Then, 4D PC-MRI and 2D PC-MRI at the level of the mesencephalic aqueduct, foramen magnum (FM), and cervical spine were performed. RESULTS CSF displayed a bidirectional flow pattern on 2D PC-MRI at each location. Mean peak velocity (and range) in cm/s was 0.92 (0.51-2.08) within the mesencephalic aqueduct, 1.84 (0.89-2.73) and 1.17 (0.75-1.8) in the ventral and dorsal subarachnoid space (SAS) at the FM, and 2.03 (range 1.1-3.0) and 1.27 (range 0.96-1.82) within the ventral and dorsal SAS of the cervical spine. With 4D PC-MRI, flow velocities of >3 cm/s were visualized in the phantom, but no flow data were obtained in dogs. CONCLUSION Peak flow velocities were measured with 2D PC-MRI at all 3 locations and slower velocities were recorded in healthy Beagle dogs compared to humans. These values serve as baseline for future applications. The current technical settings did not allow measurement of CSF flow in Beagle dogs by 4D PC-MRI.
Collapse
Affiliation(s)
- Muriel A. Christen
- Division of Clinical Radiology, Vetsuisse FacultyUniversity of BernBernSwitzerland
| | | | - Henning Richter
- Clinic of Diagnostic Imaging, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Fabiola B. Joerger
- Department of Clinical Diagnostics and Services, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Matthias Dennler
- Clinic of Diagnostic Imaging, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| |
Collapse
|
7
|
Nowosławska E, Gwizdała D, Barańska D, Grzelak P, Podgórski M, Zakrzewski K, Polis B, Stasiołek M, Polis L. The oscillatory flow of the cerebrospinal fluid in the Sylvian aqueduct and the prepontine cistern measured with phase contrast MRI in children with hydrocephalus-a preliminary report. Childs Nerv Syst 2018; 34:845-851. [PMID: 29322338 PMCID: PMC5895674 DOI: 10.1007/s00381-017-3699-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 12/12/2017] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Recognizing patients with ventriculomegaly who are at risk of developing acute hydrocephalus presents a challenge for the clinician. The association between disturbed cerebrospinal fluid flow (CSF) and impaired brain compliance may play a role in the pathogenesis of hydrocephalus. Phase contrast MRI is a noninvasive technique which can be used to assess CSF parameters. The aim of the work is to evaluate the effectiveness of phase contrast MRI in recognizing patients at risk of acute hydrocephalus, based on measuring the pulsatile CSF flow parameters in the Sylvian aqueduct and prepontine cistern in children with ventriculomegaly. AIM The aim of the work is to characterize the parameters of cerebrospinal fluid (CSF) flow in the Sylvian aqueduct and prepontine cistern in children with ventriculomegaly with regard to patient age and symptoms. We hypothesize that the relationship between CSF flow parameters in these two regions will vary according to analyzed factors and it will allow to recognize children at risk of hydrocephalus. MATERIALS AND METHODS A group of 26 children with ventriculomegaly (five girls and 21 boys) underwent phase contrast MRI examinations (Philips 3T Achieva with Q-flow integral application). Amplitudes of average and peak velocities of the CSF flow through the Sylvian aqueduct and prepontine cistern were used to calculate ratios of oscillation and peak velocities, respectively. The relationship between the oscillation coefficient, the peak velocity coefficient, and stroke volume was then assessed in accordance with age and clinical symptoms. RESULTS The peak velocity coefficient was significantly higher in patients with hyper-oscillating flow through the Sylvian aqueduct (3.04 ± 3.37 vs. 0.54 ± 0.28; p = 0.0094). Moreover, these patients tended to develop symptoms more often (p = 0.0612). No significant age-related changes were observed in CSF flow parameters. CONCLUSION Phase contrast MRI is a useful tool for noninvasive assessment of CSF flow parameters. The application of coefficients instead of direct values seems to better represent hemodynamic conditions in the ventricular system. However, further studies are required to evaluate their clinical significance and normal limits.
Collapse
Affiliation(s)
- Emilia Nowosławska
- Department of Neurosurgery, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland.
| | - Dominika Gwizdała
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Dobromiła Barańska
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Piotr Grzelak
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Michał Podgórski
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Krzysztof Zakrzewski
- Department of Neurosurgery, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Bartosz Polis
- Department of Neurosurgery, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Mariusz Stasiołek
- Department of Neurology, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Lech Polis
- Department of Neurosurgery, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| |
Collapse
|
8
|
Cerebrospinal Fluid Dynamics and Intrathecal Delivery. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00067-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
9
|
|
10
|
Siasios I, Kapsalaki EZ, Fountas KN, Fotiadou A, Dorsch A, Vakharia K, Pollina J, Dimopoulos V. The role of diffusion tensor imaging and fractional anisotropy in the evaluation of patients with idiopathic normal pressure hydrocephalus: a literature review. Neurosurg Focus 2017; 41:E12. [PMID: 27581308 DOI: 10.3171/2016.6.focus16192] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Diffusion tensor imaging (DTI) for the assessment of fractional anisotropy (FA) and involving measurements of mean diffusivity (MD) and apparent diffusion coefficient (ADC) represents a novel, MRI-based, noninvasive technique that may delineate microstructural changes in cerebral white matter (WM). For example, DTI may be used for the diagnosis and differentiation of idiopathic normal pressure hydrocephalus (iNPH) from other neurodegenerative diseases with similar imaging findings and clinical symptoms and signs. The goal of the current study was to identify and analyze recently published series on the use of DTI as a diagnostic tool. Moreover, the authors also explored the utility of DTI in identifying patients with iNPH who could be managed by surgical intervention. METHODS The authors performed a literature search of the PubMed database by using any possible combinations of the following terms: "Alzheimer's disease," "brain," "cerebrospinal fluid," "CSF," "diffusion tensor imaging," "DTI," "hydrocephalus," "idiopathic," "magnetic resonance imaging," "normal pressure," "Parkinson's disease," and "shunting." Moreover, all reference lists from the retrieved articles were reviewed to identify any additional pertinent articles. RESULTS The literature search retrieved 19 studies in which DTI was used for the identification and differentiation of iNPH from other neurodegenerative diseases. The DTI protocols involved different approaches, such as region of interest (ROI) methods, tract-based spatial statistics, voxel-based analysis, and delta-ADC analysis. The most studied anatomical regions were the periventricular WM areas, such as the internal capsule (IC), the corticospinal tract (CST), and the corpus callosum (CC). Patients with iNPH had significantly higher MD in the periventricular WM areas of the CST and the CC than had healthy controls. In addition, FA and ADCs were significantly higher in the CST of iNPH patients than in any other patients with other neurodegenerative diseases. Gait abnormalities of iNPH patients were statistically significantly and negatively correlated with FA in the CST and the minor forceps. Fractional anisotropy had a sensitivity of 94% and a specificity of 80% for diagnosing iNPH. Furthermore, FA and MD values in the CST, the IC, the anterior thalamic region, the fornix, and the hippocampus regions could help differentiate iNPH from Alzheimer or Parkinson disease. Interestingly, CSF drainage or ventriculoperitoneal shunting significantly modified FA and ADCs in iNPH patients whose condition clinically responded to these maneuvers. CONCLUSIONS Measurements of FA and MD significantly contribute to the detection of axonal loss and gliosis in the periventricular WM areas in patients with iNPH. Diffusion tensor imaging may also represent a valuable noninvasive method for differentiating iNPH from other neurodegenerative diseases. Moreover, DTI can detect dynamic changes in the WM tracts after lumbar drainage or shunting procedures and could help identify iNPH patients who may benefit from surgical intervention.
Collapse
Affiliation(s)
- Ioannis Siasios
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York;,Department of Neurosurgery, Kaleida Health, Buffalo, New York; and
| | | | | | | | - Alexander Dorsch
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York;,Department of Neurosurgery, Kaleida Health, Buffalo, New York; and
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York;,Department of Neurosurgery, Kaleida Health, Buffalo, New York; and
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York;,Department of Neurosurgery, Kaleida Health, Buffalo, New York; and
| | - Vassilios Dimopoulos
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York;,Department of Neurosurgery, Kaleida Health, Buffalo, New York; and
| |
Collapse
|
11
|
Phase-Contrast MRI CSF Flow Measurements for the Diagnosis of Normal-Pressure Hydrocephalus: Observer Agreement of Velocity Versus Volume Parameters. AJR Am J Roentgenol 2017; 208:838-843. [PMID: 28140607 DOI: 10.2214/ajr.16.16995] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Manual segmentation of the aqueduct for CSF flow analysis may induce measurement variability. The aim of our study was to assess observer agreement of manual segmentation and to compare the repeatability and accuracy of different flow parameters in differentiating normal-pressure hydrocephalus (NPH) from brain atrophy. SUBJECTS AND METHODS Thirty-two subjects were included and were divided into three groups: control, NPH, and brain atrophy. Subjects underwent phase-contrast MRI. Quantitative analysis of aqueductal CSF flow using manual ROI placement was performed by two independent readers. Reader 1 repeated measurements 3 months after the first session to assess interobserver and intraobserver agreement. Intraclass correlation coefficients (ICCs), within-subject SD, and repeatability were calculated. Peak systolic velocity (PSV), peak mean velocity, and aqueductal CSF stroke volume, which we refer to as "stroke volume," were recorded and compared between the three patient groups. The ROC curves of diagnostic accuracy for NPH were compared. RESULTS PSV was ROI-independent, so only one measurement was obtained. The NPH group had significantly higher PSV, peak mean velocity, and stroke volume values in all readings than both the control and brain atrophy groups. The accuracy of PSV for the diagnosis of NPH was 82.7%, and the accuracy of peak mean velocity was 92.5-93.3% for the three readings. Stroke volume had perfect accuracy of 100% for the three readings. The stroke volume had higher ICCs (0.97 and 0.98) than the peak mean velocity (0.88). The intraobserver repeatability and interobserver repeatability of peak mean velocity were 1.9 cm/s, and the intraobserver repeatability and interobserver repeatability of stroke volume were 27.4 and 19.6 µL/cycle, respectively. CONCLUSION Stroke volume had better agreement and repeatability and was more accurate than peak mean velocity for the diagnosis of NPH. PSV lacks variability but was the least accurate.
Collapse
|