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Vandenbulcke S, Condron P, Safaei S, Holdsworth S, Degroote J, Segers P. A computational fluid dynamics study to assess the impact of coughing on cerebrospinal fluid dynamics in Chiari type 1 malformation. Sci Rep 2024; 14:12717. [PMID: 38830910 PMCID: PMC11148133 DOI: 10.1038/s41598-024-62374-8] [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: 01/04/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024] Open
Abstract
Chiari type 1 malformation is a neurological disorder characterized by an obstruction of the cerebrospinal fluid (CSF) circulation between the brain (intracranial) and spinal cord (spinal) compartments. Actions such as coughing might evoke spinal cord complications in patients with Chiari type 1 malformation, but the underlying mechanisms are not well understood. More insight into the impact of the obstruction on local and overall CSF dynamics can help reveal these mechanisms. Therefore, our previously developed computational fluid dynamics framework was used to establish a subject-specific model of the intracranial and upper spinal CSF space of a healthy control. In this model, we emulated a single cough and introduced porous zones to model a posterior (OBS-1), mild (OBS-2), and severe posterior-anterior (OBS-3) obstruction. OBS-1 and OBS-2 induced minor changes to the overall CSF pressures, while OBS-3 caused significantly larger changes with a decoupling between the intracranial and spinal compartment. Coughing led to a peak in overall CSF pressure. During this peak, pressure differences between the lateral ventricles and the spinal compartment were locally amplified for all degrees of obstruction. These results emphasize the effects of coughing and indicate that severe levels of obstruction lead to distinct changes in intracranial pressure.
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Affiliation(s)
- Sarah Vandenbulcke
- Institute of Biomedical Engineering and Technology (IBITECH-BioMMedA), Department of Electronics and Information Systems, Ghent University, Ghent, Belgium.
| | - Paul Condron
- Mātai Medical Research Institute, Tairāwhiti-Gisborne, New Zealand
- Faculty of Medical and Health Sciences & Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Soroush Safaei
- Institute of Biomedical Engineering and Technology (IBITECH-BioMMedA), Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
- Mātai Medical Research Institute, Tairāwhiti-Gisborne, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Samantha Holdsworth
- Mātai Medical Research Institute, Tairāwhiti-Gisborne, New Zealand
- Faculty of Medical and Health Sciences & Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Joris Degroote
- Department of Electromechanical, Systems and Metal Engineering, Ghent University, Ghent, Belgium
| | - Patrick Segers
- Institute of Biomedical Engineering and Technology (IBITECH-BioMMedA), Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
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Wang S, Zhang D, Wu K, Fan W, Fan T. Potential association among posterior fossa bony volume and crowdedness, tonsillar hernia, syringomyelia, and CSF dynamics at the craniocervical junction in Chiari malformation type I. Front Neurol 2023; 14:1069861. [PMID: 36891476 PMCID: PMC9986261 DOI: 10.3389/fneur.2023.1069861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/26/2023] [Indexed: 02/22/2023] Open
Abstract
Objective The characteristic morphological parameters (bony posterior fossa volume (bony-PFV), posterior fossa crowdness, cerebellar tonsillar hernia, and syringomyelia) and CSF dynamics parameters at the craniocervical junction (CVJ) in Chiari malformation type I (CMI) were measured. The potential association between these characteristic morphologies and CSF dynamics at CVJ was analyzed. Methods A total of 46 cases of control subjects and 48 patients with CMI underwent computed tomography and phase-contrast magnetic resonance imaging. Seven morphovolumetric measures and four CSF dynamics at CVJ measures were performed. The CMI cohort was further divided into "syringomyelia" and "non-syringomyelia" subgroups. All the measured parameters were analyzed by the Pearson correlation. Results Compared with the control, the posterior cranial fossa (PCF) area, bony-PFV, and CSF net flow were significantly smaller (P < 0.001) in the CMI group. Otherwise, the PCF crowdedness index (PCF CI, P < 0.001) and the peak velocity of CSF (P < 0.05) were significantly larger in the CMI cohort. The mean velocity (MV) was faster in patients with CMI with syringomyelia (P < 0.05). In the correlation analysis, the degree of cerebellar tonsillar hernia was correlated with PCF CI (R = 0.319, P < 0.05), MV (R = -0.303, P < 0.05), and the net flow of CSF (R = -0.300, P < 0.05). The Vaquero index was well correlated with the bony-PFV (R= -0.384, P < 0.05), MV (R = 0.326, P < 0.05), and the net flow of CSF (R = 0.505, P < 0.05). Conclusion The bony-PFV in patients with CMI was smaller, and the MV was faster in CMI with syringomyelia. Cerebellar subtonsillar hernia and syringomyelia are independent indicators for evaluating CMI. Subcerebellar tonsillar hernia was associated with PCF crowdedness, MV, and the net flow of CSF at CVJ, while syringomyelia was associated with bony-PFV, MV, and the net flow of CSF at the CVJ. Thus, the bony-PFV, PCF crowdedness, and the degree of CSF patency should also be one of the indicators of CMI evaluation.
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Affiliation(s)
- Shengxi Wang
- Department of Spinal Spine Surgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Dongao Zhang
- Department of Spinal Spine Surgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Kun Wu
- Department of Spinal Spine Surgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Wayne Fan
- Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | - Tao Fan
- Department of Spinal Spine Surgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
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Wolf K, Pfender N, Hupp M, Reisert M, Krafft A, Sutter R, Hohenhaus M, Urbach H, Farshad M, Curt A. Spinal cord motion assessed by phase-contrast MRI - An inter-center pooled data analysis. Neuroimage Clin 2023; 37:103334. [PMID: 36724733 PMCID: PMC9918779 DOI: 10.1016/j.nicl.2023.103334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Phase-contrast MRI of CSF and spinal cord dynamics has evolved among diseases caused by altered CSF volume (spontaneous intracranial hypotension, normal pressure hydrocephalus) and by altered CSF space (degenerative cervical myelopathy (DCM), Chiari malformation). While CSF seems to be an obvious target for possible diagnostic use, craniocaudal spinal cord motion analysis offers the benefit of fast and reliable assessments. It is driven by volume shifts between the intracranial and the intraspinal compartments (Monro-Kellie hypothesis). Despite promising initial reports, comparison of spinal cord motion data across different centers is challenged by reports of varying value, raising questions about the validity of the findings. OBJECTIVE To systematically investigate inter-center differences between phase-contrast MRI data. METHODS Age- and gender matched, retrospective, pooled-data analysis across two centers: cardiac-gated, sagittal phase-contrast MRI of the cervical spinal cord (segments C2/C3 to C7/T1) including healthy participants and DCM patients; comparison and analysis of different MRI sequences and processing techniques (manual versus fully automated). RESULTS A genuine craniocaudal spinal cord motion pattern and an increased focal spinal cord motion among DCM patients were depicted by both MRI sequences (p < 0.01). Higher time-resolution resolved steeper and larger peaks, causing inter-center differences (p < 0.01). Comparison of different processing methods showed a high level of rating reliability (ICC > 0.86 at segments C2/C3 to C6/C7). DISCUSSION Craniocaudal spinal cord motion is a genuine finding. Differences between values were attributed to time-resolution of the MRI sequences. Automated processing confers the benefit of unbiased and consistent analysis, while data did not reveal any superiority.
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Affiliation(s)
- Katharina Wolf
- Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Nikolai Pfender
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Markus Hupp
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marco Reisert
- Department of Radiology, Medical Physics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Axel Krafft
- Department of Radiology, Medical Physics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Reto Sutter
- Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marc Hohenhaus
- Department of Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Mazda Farshad
- University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Vandenbulcke S, De Pauw T, Dewaele F, Degroote J, Segers P. Computational fluid dynamics model to predict the dynamical behavior of the cerebrospinal fluid through implementation of physiological boundary conditions. Front Bioeng Biotechnol 2022; 10:1040517. [PMID: 36483773 PMCID: PMC9722737 DOI: 10.3389/fbioe.2022.1040517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/11/2022] [Indexed: 10/22/2023] Open
Abstract
Cerebrospinal fluid (CSF) dynamics play an important role in maintaining a stable central nervous system environment and are influenced by different physiological processes. Multiple studies have investigated these processes but the impact of each of them on CSF flow is not well understood. A deeper insight into the CSF dynamics and the processes impacting them is crucial to better understand neurological disorders such as hydrocephalus, Chiari malformation, and intracranial hypertension. This study presents a 3D computational fluid dynamics (CFD) model which incorporates physiological processes as boundary conditions. CSF production and pulsatile arterial and venous volume changes are implemented as inlet boundary conditions. At the outlets, 2-element windkessel models are imposed to simulate CSF compliance and absorption. The total compliance is first tuned using a 0D model to obtain physiological pressure pulsations. Then, simulation results are compared with in vivo flow measurements in the spinal subarachnoid space (SAS) and cerebral aqueduct, and intracranial pressure values reported in the literature. Finally, the impact of the distribution of and total compliance on CSF pressures and velocities is evaluated. Without respiration effects, compliance of 0.17 ml/mmHg yielded pressure pulsations with an amplitude of 5 mmHg and an average value within the physiological range of 7-15 mmHg. Also, model flow rates were found to be in good agreement with reported values. However, when adding respiration effects, similar pressure amplitudes required an increase of compliance value to 0.51 ml/mmHg, which is within the range of 0.4-1.2 ml/mmHg measured in vivo. Moreover, altering the distribution of compliance over the four different outlets impacted the local flow, including the flow through the foramen magnum. The contribution of compliance to each outlet was directly proportional to the outflow at that outlet. Meanwhile, the value of total compliance impacted intracranial pressure. In conclusion, a computational model of the CSF has been developed that can simulate CSF pressures and velocities by incorporating boundary conditions based on physiological processes. By tuning these boundary conditions, we were able to obtain CSF pressures and flows within the physiological range.
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Affiliation(s)
- Sarah Vandenbulcke
- Institute of Biomedical Engineering and Technology (IBiTech-bioMMeda), Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Tim De Pauw
- Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium
| | - Frank Dewaele
- Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium
| | - Joris Degroote
- Department of Electromechanical Systems and Metal Engineering, Ghent University, Ghent, Belgium
| | - Patrick Segers
- Institute of Biomedical Engineering and Technology (IBiTech-bioMMeda), Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
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5
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Isoda H, Fukuyama A. Quality Control for 4D Flow MR Imaging. Magn Reson Med Sci 2022; 21:278-292. [PMID: 35197395 PMCID: PMC9680545 DOI: 10.2463/mrms.rev.2021-0165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/08/2022] [Indexed: 01/06/2023] Open
Abstract
In recent years, 4D flow MRI has become increasingly important in clinical applications for the blood vessels in the whole body, heart, and cerebrospinal fluid. 4D flow MRI has advantages over 2D cine phase-contrast (PC) MRI in that any targeted area of interest can be analyzed post-hoc, but there are some factors to be considered, such as ensuring measurement accuracy, a long imaging time and post-processing complexity, and interobserver variability.Due to the partial volume phenomenon caused by low spatial and temporal resolutions, the accuracy of flow measurement in 4D flow MRI is reduced. For spatial resolution, it is recommended to include at least four voxels in the vessel of interest, and if possible, six voxels. In large vessels such as the aorta, large voxels can be secured and SNR can be maintained, but in small cerebral vessels, SNR is reduced, resulting in reduced accuracy. A temporal resolution of less than 40 ms is recommended. The velocity-to-noise ratio (VNR) of low-velocity blood flow is low, resulting in poor measurement accuracy. The use of dual velocity encoding (VENC) or multi-VENC is recommended to avoid velocity wrap around and to increase VNR. In order to maintain sufficient spatio-temporal resolution, a longer imaging time is required, leading to potential patient movement during examination and a corresponding decrease in measurement accuracy.For the clinical application of new technologies, including various acceleration techniques, in vitro and in vivo accuracy verification based on existing accuracy-validated 2D cine PC MRI and 4D flow MRI, as well as accuracy verification on the conservation of mass' principle, should be performed, and intraobserver repeatability, interobserver reproducibility, and test-retest reproducibility should be checked.
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Affiliation(s)
- Haruo Isoda
- Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
- Biomedical Imaging Sciences, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Atsushi Fukuyama
- Faculty of Health Sciences, Department of Radiological Sciences, Japan Healthcare University, Sapporo, Hokkaido, Japan
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Yatsushiro S, Sunohara S, Matsumae M, Atsumi H, Horie T, Kajihara N, Kuroda K. Evaluation of Cardiac- and Respiratory-driven Cerebrospinal Fluid Motions by Applying the S-transform to Steady-state Free Precession Phase Contrast Imaging. Magn Reson Med Sci 2022; 21:372-379. [PMID: 35173115 DOI: 10.2463/mrms.mp.2021-0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To extract the status of hydrocephalus and other cerebrospinal fluid (CSF)-related diseases, a technique to characterize the cardiac- and respiratory-driven CSF motions separately under free breathing was developed. This technique is based on steady-state free precession phase contrast (SSFP-PC) imaging in combination with a Stockwell transform (S-transform). METHODS 2D SSFP-PC at 3 T was applied to measure the CSF velocity in the caudal-cranial direction within a sagittal slice at the midline (N = 3) under 6-, 10-, and 16-s respiratory cycles and free breathing. The frequency-dependent window width of the S-transform was controlled by a particular scaling factor, which then converted the CSF velocity waveform into a spectrogram. Based on the frequency bands of the cardiac pulsation and respiration, as determined by the electrocardiogram (ECG) and respirator pressure sensors, Gaussian bandpass filters were applied to the CSF spectrogram to extract the time-domain cardiac- and respiratory-driven waveforms. RESULTS The cardiac-driven CSF velocity component appeared in the spectrogram clearly under all respiratory conditions. The respiratory-driven velocity under the controlled respiratory cycles was observed as constant frequency signals, compared to a time-varying frequency signal under free breathing. When the widow width was optimized using the scale factor, the temporal change in the respiratory-driven CSF component was even more apparent under free breathing. CONCLUSION Velocity amplitude variations and transient frequency changes of both cardiac- and respiratory-driven components were successfully characterized. These findings indicated that the proposed technique is useful for evaluating CSF motions driven by different cyclic forces.
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Affiliation(s)
- Satoshi Yatsushiro
- Department of Human and Information Science, School of Information Science and Technology, Tokai University.,BioView, Inc
| | | | | | - Hideki Atsumi
- Department of Neurosurgery, School of Medicine, Tokai University
| | - Tomohiko Horie
- Department of Radiological Technology, Tokai University Hospital
| | - Nao Kajihara
- Department of Radiological Technology, Tokai University Hospital
| | - Kagayaki Kuroda
- Department of Human and Information Science, School of Information Science and Technology, Tokai University
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Muccio M, Chu D, Minkoff L, Kulkarni N, Damadian B, Damadian RV, Ge Y. Upright versus supine MRI: effects of body position on craniocervical CSF flow. Fluids Barriers CNS 2021; 18:61. [PMID: 34952607 PMCID: PMC8710028 DOI: 10.1186/s12987-021-00296-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/11/2021] [Indexed: 01/17/2023] Open
Abstract
Background Cerebrospinal fluid (CSF) circulation between the brain and spinal canal, as part of the glymphatic system, provides homeostatic support to brain functions and waste clearance. Recently, it has been observed that CSF flow is strongly driven by cardiovascular brain pulsation, and affected by body orientation. The advancement of MRI has allowed for non-invasive examination of the CSF hydrodynamic properties. However, very few studies have addressed their relationship with body position (e.g., upright versus supine). It is important to understand how CSF hydrodynamics are altered by body position change in a single cardiac phase and how cumulative long hours staying in either upright or supine position can affect craniocervical CSF flow. Methods In this study, we investigate the changes in CSF flow at the craniocervical region with flow-sensitive MRI when subjects are moved from upright to supine position. 30 healthy volunteers were imaged in upright and supine positions using an upright MRI. The cranio-caudal and caudo-cranial CSF flow, velocity and stroke volume were measured at the C2 spinal level over one cardiac cycle using phase contrast MRI. Statistical analysis was performed to identify differences in CSF flow properties between the two positions. Results CSF stroke volume per cardiac cycle, representing CSF volume oscillating in and out of the cranium, was ~ 57.6% greater in supine (p < 0.0001), due to a ~ 83.8% increase in caudo-cranial CSF peak velocity during diastole (p < 0.0001) and extended systolic phase duration when moving from upright (0.25 ± 0.05 s) to supine (0.34 ± 0.08 s; p < 0.0001). Extrapolation to a 24 h timeframe showed significantly larger total CSF volume exchanged at C2 with 10 h spent supine versus only 5 h (p < 0.0001). Conclusions In summary, body position has significant effects on CSF flow in and out of the cranium, with more CSF oscillating in supine compared to upright position. Such difference was driven by an increased caudo-cranial diastolic CSF velocity and an increased systolic phase duration when moving from upright to supine position. Extrapolation to a 24 h timeframe suggests that more time spent in supine position increases total amount of CSF exchange, which may play a beneficial role in waste clearance in the brain.
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Affiliation(s)
- Marco Muccio
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine, 660 First Avenue, 4th floor, New York, NY, 10016, USA
| | - David Chu
- FONAR Corporation, Melville, NY, USA
| | | | | | | | | | - Yulin Ge
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine, 660 First Avenue, 4th floor, New York, NY, 10016, USA.
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8
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Yavuz Ilik S, Otani T, Yamada S, Watanabe Y, Wada S. A subject-specific assessment of measurement errors and their correction in cerebrospinal fluid velocity maps using 4D flow MRI. Magn Reson Med 2021; 87:2412-2423. [PMID: 34866235 DOI: 10.1002/mrm.29111] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE Phase-contrast MRI (PC-MRI) of cerebrospinal fluid (CSF) velocity is used to evaluate the characteristics of intracranial diseases, such as normal-pressure hydrocephalus (NPH). Nevertheless, PC-MRI has several potential error sources, with eddy-current-based phase offset error being non-negligible in CSF measurement. In this study, we assess the measurement error of CSF velocity maps obtained using 4D flow MRI and evaluate correction methods. METHODS CSF velocity maps of 10 patients with NPH were acquired using 4D flow MRI (velocity-encoding = 5 cm/s). Distributed phase offset error was estimated for a whole 3D background field by polynomial fitting using robust regression analysis. This estimated phase offset error was then used to correct the CSF velocity maps. The estimated error profiles were compared with those obtained using an existing 2D correction approach involving local background information near the region of interest. RESULTS The residual standard error of the polynomial fitting against the phase offset error extracted from the measured velocities was within 0.2 cm/s. The spatial dependencies of the phase offset errors showed similar tendencies in all cases, but sufficient differences in these values were found to indicate requirement of velocity correction. Differences of the estimated errors among other correction approaches were in the order of 10-2 cm/s, and the estimated errors were in good agreement with those obtained using existing approaches. CONCLUSION Our method is capable of estimating the measurement error of CSF velocity maps obtained from 4D flow MRI and provides quantitatively reasonable characteristics for the main CSF profile in the cerebral aqueduct in patients with NPH.
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Affiliation(s)
- Selin Yavuz Ilik
- Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Tomohiro Otani
- Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Shigeki Yamada
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shigeo Wada
- Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
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9
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Williams G, Thyagaraj S, Fu A, Oshinski J, Giese D, Bunck AC, Fornari E, Santini F, Luciano M, Loth F, Martin BA. In vitro evaluation of cerebrospinal fluid velocity measurement in type I Chiari malformation: repeatability, reproducibility, and agreement using 2D phase contrast and 4D flow MRI. Fluids Barriers CNS 2021; 18:12. [PMID: 33736664 PMCID: PMC7977612 DOI: 10.1186/s12987-021-00246-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/03/2021] [Indexed: 11/11/2022] Open
Abstract
Background Phase contrast magnetic resonance imaging, PC MRI, is a valuable tool allowing for non-invasive quantification of CSF dynamics, but has lacked adoption in clinical practice for Chiari malformation diagnostics. To improve these diagnostic practices, a better understanding of PC MRI based measurement agreement, repeatability, and reproducibility of CSF dynamics is needed. Methods An anatomically realistic in vitro subject specific model of a Chiari malformation patient was scanned three times at five different scanning centers using 2D PC MRI and 4D Flow techniques to quantify intra-scanner repeatability, inter-scanner reproducibility, and agreement between imaging modalities. Peak systolic CSF velocities were measured at nine axial planes using 2D PC MRI, which were then compared to 4D Flow peak systolic velocity measurements extracted at those exact axial positions along the model. Results Comparison of measurement results showed good overall agreement of CSF velocity detection between 2D PC MRI and 4D Flow (p = 0.86), fair intra-scanner repeatability (confidence intervals ± 1.5 cm/s), and poor inter-scanner reproducibility. On average, 4D Flow measurements had a larger variability than 2D PC MRI measurements (standard deviations 1.83 and 1.04 cm/s, respectively). Conclusion Agreement, repeatability, and reproducibility of 2D PC MRI and 4D Flow detection of peak CSF velocities was quantified using a patient-specific in vitro model of Chiari malformation. In combination, the greatest factor leading to measurement inconsistency was determined to be a lack of reproducibility between different MRI centers. Overall, these findings may help lead to better understanding for application of 2D PC MRI and 4D Flow techniques as diagnostic tools for CSF dynamics quantification in Chiari malformation and related diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12987-021-00246-3.
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Affiliation(s)
- Gwendolyn Williams
- Department of Chemical and Biological Engineering, University of Idaho, 875 Perimeter Dr. MC1122, Moscow, ID, 83844, USA
| | - Suraj Thyagaraj
- Department of Mechanical Engineering, Conquer Chiari Research Center, University of Akron, Akron, OH, 44325, USA
| | - Audrey Fu
- Department of Mathematics and Statistical Science, University of Idaho, Moscow, ID, 83844, USA
| | - John Oshinski
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, 30322, USA
| | - Daniel Giese
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Alexander C Bunck
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Eleonora Fornari
- CIBM, Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Francesco Santini
- Division of Radiological Physics, Department of Radiology, University Hospital of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Mark Luciano
- Department of Neurosurgery, John Hopkins University, Baltimore, MD, USA
| | - Francis Loth
- Department of Mechanical Engineering, Conquer Chiari Research Center, University of Akron, Akron, OH, 44325, USA
| | - Bryn A Martin
- Department of Chemical and Biological Engineering, University of Idaho, 875 Perimeter Dr. MC1122, Moscow, ID, 83844, USA. .,Alcyone Therapeutics Inc, Lowell, MA, USA.
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10
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Hupp M, Pfender N, Vallotton K, Rosner J, Friedl S, Zipser CM, Sutter R, Klarhöfer M, Spirig JM, Betz M, Schubert M, Freund P, Farshad M, Curt A. The Restless Spinal Cord in Degenerative Cervical Myelopathy. AJNR Am J Neuroradiol 2021; 42:597-609. [PMID: 33541903 DOI: 10.3174/ajnr.a6958] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 10/12/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The spinal cord is subject to a periodic, cardiac-related movement, which is increased at the level of a cervical stenosis. Increased oscillations may exert mechanical stress on spinal cord tissue causing intramedullary damage. Motion analysis thus holds promise as a biomarker related to disease progression in degenerative cervical myelopathy. Our aim was characterization of the cervical spinal cord motion in patients with degenerative cervical myelopathy. MATERIALS AND METHODS Phase-contrast MR imaging data were analyzed in 55 patients (37 men; mean age, 56.2 [SD,12.0] years; 36 multisegmental stenoses) and 18 controls (9 men, P = .368; mean age, 62.2 [SD, 6.5] years; P = .024). Parameters of interest included the displacement and motion pattern. Motion data were pooled on the segmental level for comparison between groups. RESULTS In patients, mean craniocaudal oscillations were increased manifold at any level of a cervical stenosis (eg, C5 displacement: controls [n = 18], 0.54 [SD, 0.16] mm; patients [n = 29], monosegmental stenosis [n = 10], 1.86 [SD, 0.92] mm; P < .001) and even in segments remote from the level of the stenosis (eg, C2 displacement: controls [n = 18], 0.36 [SD, 0.09] mm; patients [n = 52]; stenosis: C3, n = 21; C4, n = 11; C5, n = 18; C6, n = 2; 0.85 [SD, 0.46] mm; P < .001). Motion at C2 differed with the distance to the next stenotic segment and the number of stenotic segments. The motion pattern in most patients showed continuous spinal cord motion throughout the cardiac cycle. CONCLUSIONS Patients with degenerative cervical myelopathy show altered spinal cord motion with increased and ongoing oscillations at and also beyond the focal level of stenosis. Phase-contrast MR imaging has promise as a biomarker to reveal mechanical stress to the cord and may be applicable to predict disease progression and the impact of surgical interventions.
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Affiliation(s)
- M Hupp
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - N Pfender
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - K Vallotton
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - J Rosner
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.).,Department of Neurology (J.R.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - S Friedl
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - C M Zipser
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | | | - M Klarhöfer
- Siemens Healthcare AG (M.K.), Zurich, Switzerland
| | - J M Spirig
- University Spine Center Zurich (J.M.S., M.B., M.F., A.C.), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - M Betz
- University Spine Center Zurich (J.M.S., M.B., M.F., A.C.), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - M Schubert
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - P Freund
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - M Farshad
- University Spine Center Zurich (J.M.S., M.B., M.F., A.C.), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - A Curt
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.).,University Spine Center Zurich (J.M.S., M.B., M.F., A.C.), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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11
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Wolf K, Reisert M, Beltrán SF, Klingler JH, Hubbe U, Krafft AJ, Egger K, Hohenhaus M. Focal cervical spinal stenosis causes mechanical strain on the entire cervical spinal cord tissue - A prospective controlled, matched-pair analysis based on phase-contrast MRI. NEUROIMAGE-CLINICAL 2021; 30:102580. [PMID: 33578322 PMCID: PMC7875814 DOI: 10.1016/j.nicl.2021.102580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Focally increased spinal cord motion at the level of cervical spinal stenosis has been revealed by phase-contrast MRI (PC-MRI). OBJECTIVE To investigate spinal cord motion among patients suffering of degenerative cervical myelopathy (DCM) across the entire cervical spine applying automated segmentation and standardized PC-MRI post-processing protocols. METHODS Prospective, matched-pair controlled trial on 29 patients with stenosis at C5/C6. MRI-protocol covering all cervical segments: 3D T2-SPACE, prospectively ECG-triggered sagittal PC-MRI. Segmentation by trained 3D hierarchical deep convolutional neural network and data processing were conducted via in-house software pipeline. Parameters per segment: maximum velocity, peak-to-peak (PTP)-amplitude, total displacement, PTP-amplitudeHB (PTP-amplitude per duration of heartbeat), and, for characterization of intraindividual alterations, the PTP-amplitude index between the cervical segments C3/C4-C7/T1 and C2/C3. RESULTS Spinal cord motion was increased at C4/C5, C5/C6 and C6/C7 among patients (all parameters, p < 0.001-0.025). The PTP-amplitude index revealed an increase from C3/C4 to C4/C5 (p = 0.002), C4/C5 to C5/C6 (p = 0.037) and a decrease from C5/C6 to C6/C7 and C6/C7 to C7/T1 (p < 0.001, each). This implied an up-building stretch on spinal cord tissue cranial and a mechanical compression caudal of the stenotic level. Furthermore, significant far range effects across the entire cervical spinal cord were observed (e.g. PTP-amplitude C2/C3 vs. C6/C7, p = 0.026) in contrast to controls (p = 1.00). CONCLUSION This study revealed the nature and extends of mechanical stress on the entire cervical spinal cord tissue due to focal stenosis. These pathophysiological alterations of spinal cord motion can be expected to be clinically relevant.
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Affiliation(s)
- Katharina Wolf
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Marco Reisert
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Saúl Felipe Beltrán
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Jan-Helge Klingler
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Ulrich Hubbe
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Axel J Krafft
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Karl Egger
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Department of Radiology, Tauernklinikum Zell am See/Mittersill, Salzburg, Austria
| | - Marc Hohenhaus
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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12
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Yamada S, Ito H, Ishikawa M, Yamamoto K, Yamaguchi M, Oshima M, Nozaki K. Quantification of Oscillatory Shear Stress from Reciprocating CSF Motion on 4D Flow Imaging. AJNR Am J Neuroradiol 2021; 42:479-486. [PMID: 33478942 DOI: 10.3174/ajnr.a6941] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/05/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Oscillatory shear stress could not be directly measured in consideration of direction, although cerebrospinal fluid has repetitive movements synchronized with heartbeat. Our aim was to evaluate the important of oscillatory shear stress in the cerebral aqueduct and foramen magnum in idiopathic normal pressure hydrocephalus by comparing it with wall shear stress and the oscillatory shear index in patients with idiopathic normal pressure hydrocephalus. MATERIALS AND METHODS By means of the 4D flow application, oscillatory shear stress, wall shear stress, and the oscillatory shear index were measured in 41 patients with idiopathic normal pressure hydrocephalus, 23 with co-occurrence of idiopathic normal pressure hydrocephalus and Alzheimer-type dementia, and 9 age-matched controls. These shear stress parameters at the cerebral aqueduct were compared with apertures and stroke volumes at the foramen of Magendie and cerebral aqueduct. RESULTS Two wall shear stress magnitude peaks during a heartbeat were changed to periodic oscillation by converting oscillatory shear stress. The mean oscillatory shear stress amplitude and time-averaged wall shear stress values at the dorsal and ventral regions of the cerebral aqueduct in the idiopathic normal pressure hydrocephalus groups were significantly higher than those in controls. Furthermore, those at the ventral region of the cerebral aqueduct in the idiopathic normal pressure hydrocephalus group were also significantly higher than those in the co-occurrence of idiopathic normal pressure hydrocephalus with Alzheimer-type dementia group. The oscillatory shear stress amplitude at the dorsal region of the cerebral aqueduct was significantly associated with foramen of Magendie diameters, whereas it was strongly associated with the stroke volume at the upper end of the cerebral aqueduct rather than that at the foramen of Magendie. CONCLUSIONS Oscillatory shear stress, which reflects wall shear stress vector changes better than the conventional wall shear stress magnitude and the oscillatory shear index, can be directly measured on 4D flow MR imaging. Oscillatory shear stress at the cerebral aqueduct was considerably higher in patients with idiopathic normal pressure hydrocephalus.
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Affiliation(s)
- S Yamada
- From the Department of Neurosurgery (S.Y., K.N.), Shiga University of Medical Science, Shiga, Japan .,Department of Neurosurgery and Normal Pressure Hydrocephalus Center (S.Y., K.Y., M.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan.,Interfaculty Initiative in Information Studies/Institute of Industrial Science (S.Y., M.O.), The University of Tokyo, Tokyo, Japan
| | - H Ito
- Medical System Research and Development Center (H.I.), Fujifilm Corporation, Tokyo, Japan
| | | | - K Yamamoto
- Department of Neurosurgery and Normal Pressure Hydrocephalus Center (S.Y., K.Y., M.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan
| | - M Yamaguchi
- Department of Neurosurgery and Normal Pressure Hydrocephalus Center (S.Y., K.Y., M.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan
| | - M Oshima
- Interfaculty Initiative in Information Studies/Institute of Industrial Science (S.Y., M.O.), The University of Tokyo, Tokyo, Japan
| | - K Nozaki
- From the Department of Neurosurgery (S.Y., K.N.), Shiga University of Medical Science, Shiga, Japan
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13
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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 2020; 35:333-340. [PMID: 33274812 PMCID: PMC7848380 DOI: 10.1111/jvim.15932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [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.
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Affiliation(s)
- Muriel A Christen
- Division of Clinical Radiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | | | - Henning Richter
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Fabiola B Joerger
- Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Matthias Dennler
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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14
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Jaeger E, Sonnabend K, Schaarschmidt F, Maintz D, Weiss K, Bunck AC. Compressed-sensing accelerated 4D flow MRI of cerebrospinal fluid dynamics. Fluids Barriers CNS 2020; 17:43. [PMID: 32677977 PMCID: PMC7364783 DOI: 10.1186/s12987-020-00206-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 4D flow magnetic resonance imaging (MRI) of CSF can make an important contribution to the understanding of hydrodynamic changes in various neurological diseases but remains limited in clinical application due to long acquisition times. The aim of this study was to evaluate the accuracy of compressed SENSE accelerated MRI measurements of the spinal CSF flow. METHODS In 20 healthy subjects 4D flow MRI of the CSF in the cervical spine was acquired using compressed sensitivity encoding [CSE, a combination of compressed sensing and parallel imaging (SENSE) provided by the manufacturer] with acceleration factors between 4 and 10. A conventional scan using SENSE was used as reference. Extracted parameters were peak velocity, absolute net flow, forward flow and backward flow. Bland-Altman analysis was performed to determine the scan-rescan reproducibility and the agreement between SENSE and compressed SENSE. Additionally, a time accumulated flow error was calculated. In one additional subject flow of the spinal canal at the level of the entire spinal cord was assessed. RESULTS Averaged acquisition times were 10:21 min (SENSE), 9:31 min (CSE4), 6:25 min (CSE6), 4:53 min (CSE8) and 3:51 min (CSE10). Acquisition of the CSF flow surrounding the entire spinal cord took 14:40 min. Bland-Altman analysis showed good agreement for peak velocity, but slight overestimations for absolute net flow, forward flow and backward flow (< 1 ml/min) in CSE4-8. Results of the accumulated flow error were similar for CSE4 to CSE8. CONCLUSION A quantitative analysis of acceleration factors CSE4-10 showed that CSE with an acceleration factor up to 6 is feasible. This allows a scan time reduction of 40% and enables the acquisition and analysis of the CSF flow dynamics surrounding the entire spinal cord within a clinically acceptable scan time.
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Affiliation(s)
- Elena Jaeger
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Kristina Sonnabend
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany.
| | - Frank Schaarschmidt
- Institute of Cell Biology and Biophysics, Biostatistics Department, Leibniz University Hannover, Hannover, Germany
| | - David Maintz
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Kilian Weiss
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany.,Philips GmbH, Hamburg, Germany
| | - Alexander C Bunck
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany
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15
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Yamada S, Ishikawa M, Ito H, Yamamoto K, Yamaguchi M, Oshima M, Nozaki K. Cerebrospinal fluid dynamics in idiopathic normal pressure hydrocephalus on four-dimensional flow imaging. Eur Radiol 2020; 30:4454-4465. [PMID: 32246220 DOI: 10.1007/s00330-020-06825-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/27/2020] [Accepted: 03/19/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To evaluate complex CSF movements and shear stress in patients with idiopathic normal pressure hydrocephalus (iNPH) on four-dimensional (4D) flow MRI. METHODS Three-dimensional velocities and volumes of the reciprocating CSF movements through 12 ROIs from the foramen of Monro to the upper cervical spine were measured in 41 patients with iNPH, 23 patients with co-occurrence of iNPH and Alzheimer's disease (AD), and 9 age-matched controls, using 4D flow imaging and application. Stroke volume, reversed-flow rate, and shear stress were automatically calculated. Relationships between flow-related parameters and morphological measurements were also assessed. RESULTS Stroke volumes, reversed-flow rates, and shear stress at the cerebral aqueduct were significantly higher in patients with iNPH than in controls. Patients with pure iNPH had significantly higher shear stress at the ventral aspect of the cerebral aqueduct than those with co-occurrence of iNPH and AD. The stroke volume at the upper end of the cerebral aqueduct had the strongest association with the anteroposterior diameter of the lower end of the cerebral aqueduct (r = 0.52). The stroke volume at the foramen of Monro had significant associations with the indices specific to iNPH. The shear stress at the dorsal aspect of the cerebral aqueduct had the strongest association with the diameter of the foramen of Magendie (r = 0.52). CONCLUSIONS Stroke volumes, reversed-flow rates, and shear stress through the cerebral aqueduct on 4D flow MRI are useful parameters for iNPH diagnosis. These findings can aid in elucidating the mechanism of ventricular enlargement in iNPH. KEY POINTS • The CSF stroke volume and bimodal shear stress at the cerebral aqueduct were considerably higher in patients with iNPH. • The patients with pure iNPH had significantly higher shear stress at the ventral aspect of the cerebral aqueduct than those with co-occurrence of iNPH and AD. • The shear stress at the cerebral aqueduct was significantly associated with the diameter of the foramen of Magendie.
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Affiliation(s)
- Shigeki Yamada
- Department of Neurosurgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan. .,Department of Neurosurgery and Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Japan. .,Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, Tokyo, Japan.
| | - Masatsune Ishikawa
- Department of Neurosurgery and Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Japan.,Rakuwa Villa Ilios, Kyoto, Japan
| | - Hirotaka Ito
- Medical System Research & Development Center, FUJIFILM Corporation, Tokyo, Japan
| | - Kazuo Yamamoto
- Department of Neurosurgery and Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Makoto Yamaguchi
- Department of Neurosurgery and Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Marie Oshima
- Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
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16
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Bert RJ, Settipalle N, Muddasani D, Tiwana E, Wellman B, Negahdar MJ, Mihlon F, Amini A, Boakye M. ECG Gating Is More Precise Than Peripheral Pulse Gating When Quantifying Spinal CSF Pulsations Using Phase Contrast Cine MRI. Acad Radiol 2020; 27:552-562. [PMID: 31353089 DOI: 10.1016/j.acra.2019.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare accuracy of spinal cerebrospinal fluid (CSF) pulsatile flow measurements at cervical, thoracic, and lumbar levels using Phase Contrast Cine MRI (PCCMRI) with retrospective electrocardiogram (recg) vs. retrospective peripheral pulse gating (rppg) gating. METHODS We scanned 10 healthy volunteers, ages 23-46 years, using external recg-gated or rppg-gated 2D PCCCMRI at 3T. Transverse scans of CSF, arteries and veins scans were at C1/C4/T1/T7/L1-L3. Data were analyzed with custom Matlab-based software, measuring CSF, arterial (descending aorta, abdominal aorta, common carotid artery, ICA, and vertebral artery) and venous (internal jugular vein and inferior vena cava) flow, velocity and region of interest area. RESULTS recgPCCMRI produced less quantitative and temporal statistical variation than pcgPCCMRI when analyzing CSF flow. The instantaneous recgPCCMRI CSF flows consistently decreased craniocaudally, while the results with rppgPCCMRI were less consistent. The recgPCCMRI root mean square error values were 6.04, 6.94, 4.81, 4.49, and 4.16 for C1, C4, T1, T7, and L2, compared with 7.24, 8.97, 7.9, 7.82, and 6.68 for rppgPCCMRI. Results were independent of analysts. Summations of standard errors produced similar results. RppgPCCMRI also showed increase variability of CSF flow correlations with arteries and veins compared to recgPCCMRI. None-the-less, when recgPCCMRI is considered the reference standard, there is good correlations between rppgPCCMRI and recgPCCMRIdata sets, when averaged over cohorts of at least five subjects. CONCLUSION Our results indicated that recgPCCMRI is more quantitatively and temporally precise than rppgPCCMRI in CSF quantitative flow analysis. Pulse-gating CSF flow results are reasonable when averaged over cohorts of at least five subjects, but subtle conclusions should be interpreted with caution.
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Affiliation(s)
- Robert J Bert
- Department of Radiology, University of Louisville, 530 South Jackson Street, Louisville, KY 40202.
| | | | - Dheeraj Muddasani
- Department of Radiology, University of Louisville, 530 South Jackson Street, Louisville, KY 40202
| | - Emily Tiwana
- Department of Radiology, University of Louisville, 530 South Jackson Street, Louisville, KY 40202
| | - Brandon Wellman
- Department of Radiology, University of Louisville, 530 South Jackson Street, Louisville, KY 40202
| | - Mohammad J Negahdar
- Department of Radiology, University of Louisville, 530 South Jackson Street, Louisville, KY 40202
| | | | - Amir Amini
- Department of Radiology, University of Louisville, 530 South Jackson Street, Louisville, KY 40202
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, KY
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17
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Khani M, Sass LR, McCabe AR, Zitella Verbick LM, Lad SP, Sharp MK, Martin BA. Impact of Neurapheresis System on Intrathecal Cerebrospinal Fluid Dynamics: A Computational Fluid Dynamics Study. J Biomech Eng 2020; 142:021006. [PMID: 31343659 PMCID: PMC7104775 DOI: 10.1115/1.4044308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 07/18/2019] [Indexed: 11/08/2022]
Abstract
It has been hypothesized that early and rapid filtration of blood from cerebrospinal fluid (CSF) in postsubarachnoid hemorrhage patients may reduce hospital stay and related adverse events. In this study, we formulated a subject-specific computational fluid dynamics (CFD) model to parametrically investigate the impact of a novel dual-lumen catheter-based CSF filtration system, the Neurapheresis™ system (Minnetronix Neuro, Inc., St. Paul, MN), on intrathecal CSF dynamics. The operating principle of this system is to remove CSF from one location along the spine (aspiration port), externally filter the CSF routing the retentate to a waste bag, and return permeate (uncontaminated CSF) to another location along the spine (return port). The CFD model allowed parametric simulation of how the Neurapheresis system impacts intrathecal CSF velocities and steady-steady streaming under various Neurapheresis flow settings ranging from 0.5 to 2.0 ml/min and with a constant retentate removal rate of 0.2 ml/min simulation of the Neurapheresis system were compared to a lumbar drain simulation with a typical CSF removal rate setting of 0.2 ml/min. Results showed that the Neurapheresis system at a maximum flow of 2.0 ml/min increased average steady streaming CSF velocity 2× in comparison to lumbar drain (0.190 ± 0.133 versus 0.093 ± 0.107 mm/s, respectively). This affect was localized to the region within the Neurapheresis flow loop. The mean velocities introduced by the flow loop were relatively small in comparison to normal cardiac-induced CSF velocities.
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Affiliation(s)
- Mohammadreza Khani
- Department of Biological Engineering, University of Idaho, Moscow, ID 83844
| | - Lucas R. Sass
- Department of Biological Engineering, University of Idaho, Moscow, ID 83844
| | | | | | - Shivanand P. Lad
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710
| | - M. Keith Sharp
- Department of Mechanical Engineering, University of Louisville, Louisville, KY 40292
| | - Bryn A. Martin
- Department of Biological Engineering, University of Idaho, Moscow, ID 83844
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18
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Khani M, Sass LR, Xing T, Keith Sharp M, Balédent O, Martin BA. Anthropomorphic Model of Intrathecal Cerebrospinal Fluid Dynamics Within the Spinal Subarachnoid Space: Spinal Cord Nerve Roots Increase Steady-Streaming. J Biomech Eng 2019; 140:2683234. [PMID: 30003260 DOI: 10.1115/1.4040401] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Indexed: 11/08/2022]
Abstract
Cerebrospinal fluid (CSF) dynamics are thought to play a vital role in central nervous system (CNS) physiology. The objective of this study was to investigate the impact of spinal cord (SC) nerve roots (NR) on CSF dynamics. A subject-specific computational fluid dynamics (CFD) model of the complete spinal subarachnoid space (SSS) with and without anatomically realistic NR and nonuniform moving dura wall deformation was constructed. This CFD model allowed detailed investigation of the impact of NR on CSF velocities that is not possible in vivo using magnetic resonance imaging (MRI) or other noninvasive imaging methods. Results showed that NR altered CSF dynamics in terms of velocity field, steady-streaming, and vortical structures. Vortices occurred in the cervical spine around NR during CSF flow reversal. The magnitude of steady-streaming CSF flow increased with NR, in particular within the cervical spine. This increase was located axially upstream and downstream of NR due to the interface of adjacent vortices that formed around NR.
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Affiliation(s)
- Mohammadreza Khani
- Neurophysiological Imaging and Modeling Laboratory, Department of Biological Engineering, University of Idaho, Moscow, ID 83844 e-mail:
| | - Lucas R Sass
- Neurophysiological Imaging and Modeling Laboratory, Department of Biological Engineering, University of Idaho, Moscow, ID 83844 e-mail:
| | - Tao Xing
- Department of Mechanical Engineering, University of Idaho, Moscow, ID 83844 e-mail:
| | - M Keith Sharp
- Biofluid Mechanics Laboratory, University of Louisville, Louisville, KY 40292 e-mail:
| | - Olivier Balédent
- Bioflow Image, CHU Nord Amiens-Picardie, Amiens 80054, France e-mail:
| | - Bryn A Martin
- Neurophysiological Imaging and Modeling Laboratory, Department of Biological Engineering, University of Idaho, Moscow, ID 83844 e-mail:
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19
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Kurucz P, Meszaros C, Ganslandt O, Buchfelder M, Barany L. The "Valva Cerebri": Morphometry, Topographic Anatomy and Histology of the Rhomboid Membrane at the Craniocervical Junction. Clin Anat 2019; 33:56-65. [PMID: 31444925 DOI: 10.1002/ca.23460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 08/19/2019] [Indexed: 11/09/2022]
Abstract
The arachnoid membranes' anatomy is a controversial topic in the literature, and the rhomboid membrane at the craniovertebral junction is an element of this system that has been described poorly. Hence, the objective of our study was to examine this membrane's anatomy and histology. A total of 45 fresh formalin-fixed human cadaveric heads were examined, and anatomic dissections and histologic examinations using standard staining methods were performed. The membrane was found to be a constant structure. It has a rhomboid shape and is located on the medulla oblongata and upper cervical spine's ventral surface within the subarachnoid space. Its average craniocaudal length is 49 mm and the short axis is 26 mm. The cranial apex is attached to the vertebral arteries' junction, and the caudal apex reaches the level of C4. The lateral apices are attached to the dura mater at the level of the denticulate ligament's second insertion. The C1 spinal nerves perforate the membrane, while the C2 roots are located dorsal to it. The membrane is attached strongly to the underlying pia mater. Histologically, it has a typical arachnoid structure, in which its adhesions to the vertebral arteries as well as to the pia mater could be verified histologically. This is the first detailed examination of the rhomboid membrane. Our results suggest that the membrane serves a valve-like function between the spinal and cranial subarachnoid spaces. Based on our findings, further hydrodynamic studies should clarify the membrane's physiological role. Clin. Anat. 32:56-65, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Peter Kurucz
- Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany.,Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Cintia Meszaros
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
| | - Oliver Ganslandt
- Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Laszlo Barany
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
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20
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Maj E, Wójtowicz K, Aleksandra, Podlecka-Piȩtowska, Prokopienko M, Marchel A, Rowiński O, Bekiesińska-Figatowska M. Intramedullary spinal tumor-like lesions. Acta Radiol 2019; 60:994-1010. [PMID: 30537844 DOI: 10.1177/0284185118809540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The development of magnetic resonance imaging (MRI) has led to an increasingly frequent detection of changes in the spinal cord. The most common intramedullary lesions are: demyelinating; vascular; inflammatory; infectious; and congenital, largely called tumor-like lesions. Spinal cord tumors are relatively rare, as compared with brain tumors. The hardest task is to conclude whether the spinal cord lesion is a tumor or a tumor-like lesion. This review is intended to help evaluate the spinal cord and gives an overview of the tumor-like lesions occurring in the spinal cord along with their characteristic.
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Affiliation(s)
- Edyta Maj
- Second Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Marek Prokopienko
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Olgierd Rowiński
- Second Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
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21
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Bert RJ, Settipalle N, Tiwana E, Muddasani D, Nath R, Wellman B, Mihlon F, Negahdar M, Amini A, Boakye M. The relationships among spinal CSF flows, spinal cord geometry, and vascular correlations: evidence of intrathecal sources and sinks. Am J Physiol Regul Integr Comp Physiol 2019; 317:R470-R484. [PMID: 31242020 DOI: 10.1152/ajpregu.00101.2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We studied relationships of cerebral spinal fluid (CSF) pulsatile flow at cervical, thoracic, and lumbar levels using phase-contrast cine MRI (PCCMRI) to determine the following: 1) instantaneous and average net flows at cervical, thoracic, and lumbar levels, 2) stochastic correlations of CSF flow with major arterial supplies and major draining veins, and 3) whether adjustments of cord-flow curves-using cord cross-sectional areas, caudal lengths, and caudal volumes-would normalize flow curves from different levels. We scanned 15 healthy volunteers without anesthesia, ages 23-46 yr, using external, retrocardiac-gated, two-dimensional PCCMRI at 3T. Transverse scans of the subarachnoid space, arteries, and veins were acquired and analyzed at cervical, thoracic, and lumbar levels. Instantaneous CSF flow decreased craniocaudally along the full time course of a cardiac cycle. Downward net flow generally increased craniocaudally. During diastole, instantaneous CSF flow decreased proportionally to cross-sectional area, caudal residual length, and caudal residual volume of the cord. The proportionalities were less consistent during systole. CSF, internal carotid artery (ICA), vertebral artery, and lower aorta temporal correlations were highest in systole and decreased craniocaudally. CSF flow temporally correlated better with lower aorta flow than with the ICA at T7 and L2 during systole but not diastole. Inferior vena cava temporal correlation increased craniocaudally. We conclude that whereas instantaneous flow is attenuated cranial caudally, net downward flow, per cardiac cycle, increases caudally, becoming statistically significant at T7 and below the conus medullaris. We can explain the results with the assumption of cord CSF production and peripheral-dominated CSF absorption.
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Affiliation(s)
- Robert J Bert
- Department of Radiology, University of Louisville, Louisville, Kentucky
| | - Neesha Settipalle
- Department of Internal Medicine, St. Michael's Medical Center, Newark, New Jersey
| | - Emily Tiwana
- Department of Radiology, University of Louisville, Louisville, Kentucky
| | - Dheeraj Muddasani
- Department of Radiology, University of Louisville, Louisville, Kentucky
| | - Ruponti Nath
- Speed School of Electrical and Computer Engineering, University of Louisville, Louisville, Kentucky
| | - Brandon Wellman
- Department of Radiology, University of Louisville, Louisville, Kentucky
| | - Frank Mihlon
- Hampton Roads Radiology Associates, PA, Norfolk, Virginia
| | | | - Amir Amini
- Speed School of Electrical and Computer Engineering, University of Louisville, Louisville, Kentucky
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky
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22
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Segmental differences of cervical spinal cord motion: advancing from confounders to a diagnostic tool. Sci Rep 2019; 9:7415. [PMID: 31092891 PMCID: PMC6520379 DOI: 10.1038/s41598-019-43908-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/02/2019] [Indexed: 01/01/2023] Open
Abstract
Increased cranio-caudal spinal cord motion is associated with clinical impairment in degenerative cervical myelopathy. However, whether spinal cord motion holds potential as a neuroimaging biomarker requires further validation. Different confounders (i.e. subject characteristics, methodological problems such as phase drift, etc.) on spinal cord motion readouts have to be considered. Twenty-two healthy subjects underwent phase contrast MRI, a subset of subjects (N = 9) had repeated scans. Parameters of interest included amplitude of velocity signal, maximum cranial respectively maximum caudal velocity, displacement (=area under curve of the velocity signal). The cervical spinal cord showed pulse synchronic oscillatory motions with significant differences in all readouts across cervical segments, with a maximum at C5. The Inter-rater reliability was excellent for all readouts. The test-retest reliability was excellent for all parameters at C2 to C6, but not for maximum cranial velocity at C6 and all readouts at C7. Spinal cord motion was correlated with spinal canal size, heart rate and body size. This is the first study to propose a standardized MRI measurement of spinal cord motion for further clinical implementation based on satisfactory phase drift correction and excellent reliability. Understanding the influence of confounders (e.g. structural conditions of the spine) is essential for introducing cord motion into the diagnostic work up.
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23
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Korbecki A, Zimny A, Podgórski P, Sąsiadek M, Bladowska J. Imaging of cerebrospinal fluid flow: fundamentals, techniques, and clinical applications of phase-contrast magnetic resonance imaging. Pol J Radiol 2019; 84:e240-e250. [PMID: 31481996 PMCID: PMC6717940 DOI: 10.5114/pjr.2019.86881] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/15/2019] [Indexed: 12/28/2022] Open
Abstract
Cerebrospinal fluid (CSF) is a dynamic compartment of the brain, constantly circulating through the ventricles and subarachnoid space. In recent years knowledge about CSF has expended due to numerous applications of phase-contrast magnetic resonance imaging (PC-MRI) in CSF flow evaluation, leading to the revision of former theories and new concepts about pathophysiology of CSF disorders, which are caused either by alterations in CSF production, absorption, or its hydrodynamics. Although alternative non-invasive techniques have emerged in recent years, PC-MRI is still a fundamental sequence that provides both qualitative and quantitative CSF assessment. PC-MRI is widely used to evaluate CSF hydrodynamics in normal pressure hydrocephalus (NPH), Chiari type I malformations (CMI), syringomyelia, and after neurosurgical procedures. In NPH precisely performed PC-MRI provides reliable clinical information useful for differential diagnosis and selection of patients benefiting from surgical operation. Patients with CMI show abnormalities in CSF dynamics within the subarachnoid space, which are pronounced even further if syringomyelia coexists. Another indication for PC-MRI may be assessment of post-surgical CSF flow normalisation. The aim of this review is to highlight the significance of CSF as a multifunctional entity, to outline both the physical and technical background of PC-MRI, and to state current applications of this technique, not only in the diagnosis of central nervous system disorders, but also in the further clinical monitoring and prognosis after treatment.
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24
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Peters K, Weiss K, Maintz D, Giese D. Influence of respiration-induced B 0 variations in real-time phase-contrast echo planar imaging of the cervical cerebrospinal fluid. Magn Reson Med 2019; 82:647-657. [PMID: 30957288 DOI: 10.1002/mrm.27748] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 11/08/2022]
Abstract
PURPOSE Respiration induces temporal variations of the main magnetic field B0 along the spinal cord. These variations are typically not compensated for in velocity quantifications using phase-contrast MRI. The goal of this study was to analyze errors caused by respiration-induced B0 variations in real-time phase-contrast echo planar imaging (PCEPI) of cervical cerebrospinal fluid (CSF) velocity measurements and to evaluate this effect for various sequence parameters using numerical simulations. METHODS Real-time B0 measurements with double gradient echo sequence and PCEPI measurements were acquired in the cervical CSF of 10 healthy subjects. Dynamic phase offsets attributed to respiration-induced B0 variations were analyzed by quantifying amplitudes and comparing the temporal behavior with respiratory signals. In experiments and simulations, the influence of the echo time (TE) and the delay between PCEPI images (Δt) with respect to respiration on the dynamic phase offsets were investigated. RESULTS A good agreement was found between phase offsets extracted from both acquisition types. Furthermore, respiratory signals qualitatively matched the temporal behavior of the measured phase offsets showing a dependency on subject-dependent local B0 distribution and respiration physiology. Simulations revealed residual background phases in PCEPI velocity quantification varying with TE and Δt. CONCLUSION Respiration-induced B0 variations result in dynamic background phases in real-time PCEPI velocity quantifications of the CSF in the cervical spine. The current work underlines that these background phases need to be corrected to avoid confounding effects.
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Affiliation(s)
- Kristina Peters
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany
| | - Kilian Weiss
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany.,Philips GmbH, Hamburg, Germany
| | - David Maintz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany
| | - Daniel Giese
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany
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25
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Vargas MI, Delattre BMA, Boto J, Gariani J, Dhouib A, Fitsiori A, Dietemann JL. Advanced magnetic resonance imaging (MRI) techniques of the spine and spinal cord in children and adults. Insights Imaging 2018; 9:549-557. [PMID: 29858818 PMCID: PMC6108966 DOI: 10.1007/s13244-018-0626-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/19/2018] [Accepted: 04/05/2018] [Indexed: 12/14/2022] Open
Abstract
Abstract In this article, we illustrate the main advanced magnetic resonance imaging (MRI) techniques used for imaging of the spine and spinal cord in children and adults. This work focuses on daily clinical practice and aims to address the most common questions and needs of radiologists. We will also provide tips to solve common problems with which we were confronted. The main clinical indications for each MR technique, possible pitfalls and the challenges faced in spine imaging because of anatomical and physical constraints will be discussed. The major advanced MRI techniques dealt with in this article are CSF, (cerebrosopinal fluid) flow, diffusion, diffusion tensor imaging (DTI), MRA, dynamic contrast-enhanced T1-weighted perfusion, MR angiography, susceptibility-weighted imaging (SWI), functional imaging (fMRI) and spectroscopy. Teaching Points • DWI is essential to diagnose cord ischaemia in the acute stage. • MRA is useful to guide surgical planning or endovascular embolisation of AVMs. • Three Tesla is superior to 1.5 T for spine MR angiography and spectroscopy. • Advanced sequences should only be used together with conventional morphological sequences.
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Affiliation(s)
- M I Vargas
- Division of Neuroradiology, DISIM, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.
| | - B M A Delattre
- Division of Radiology, DISIM, Geneva University Hospitals, Geneva, Switzerland
| | - J Boto
- Division of Neuroradiology, DISIM, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - J Gariani
- Division of Radiology, DISIM, Geneva University Hospitals, Geneva, Switzerland
| | - A Dhouib
- Division of Radiology, DISIM, Geneva University Hospitals, Geneva, Switzerland
| | - A Fitsiori
- Division of Neuroradiology, DISIM, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - J L Dietemann
- Division of Neuroradiology, Strasbourg University Hospitals, Strasbourg, France
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26
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Dreha-Kulaczewski S, Konopka M, Joseph AA, Kollmeier J, Merboldt KD, Ludwig HC, Gärtner J, Frahm J. Respiration and the watershed of spinal CSF flow in humans. Sci Rep 2018; 8:5594. [PMID: 29618801 PMCID: PMC5884798 DOI: 10.1038/s41598-018-23908-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/15/2018] [Indexed: 11/09/2022] Open
Abstract
The dynamics of human CSF in brain and upper spinal canal are regulated by inspiration and connected to the venous system through associated pressure changes. Upward CSF flow into the head during inspiration counterbalances venous flow out of the brain. Here, we investigated CSF motion along the spinal canal by real-time phase-contrast flow MRI at high spatial and temporal resolution. Results reveal a watershed of spinal CSF dynamics which divides flow behavior at about the level of the heart. While forced inspiration prompts upward surge of CSF flow volumes in the entire spinal canal, ensuing expiration leads to pronounced downward CSF flow, but only in the lower canal. The resulting pattern of net flow volumes during forced respiration yields upward CSF motion in the upper and downward flow in the lower spinal canal. These observations most likely reflect closely coupled CSF and venous systems as both large caval veins and their anastomosing vertebral plexus react to respiration-induced pressure changes.
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Affiliation(s)
- Steffi Dreha-Kulaczewski
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, 37075, Göttingen, Germany.
| | - Mareen Konopka
- School of Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Arun A Joseph
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, 37077, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Jost Kollmeier
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, 37077, Göttingen, Germany
| | - Klaus-Dietmar Merboldt
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, 37077, Göttingen, Germany
| | - Hans-Christoph Ludwig
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Jens Frahm
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, 37077, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
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27
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Wolf K, Hupp M, Friedl S, Sutter R, Klarhöfer M, Grabher P, Freund P, Curt A. In cervical spondylotic myelopathy spinal cord motion is focally increased at the level of stenosis: a controlled cross-sectional study. Spinal Cord 2018; 56:769-776. [PMID: 29497178 DOI: 10.1038/s41393-018-0075-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/22/2018] [Accepted: 02/01/2018] [Indexed: 02/08/2023]
Abstract
STUDY DESIGN Level-, age-, and gender-matched controlled cross-sectional cohort study. OBJECTIVES To investigate alterations of spinal cord (SC) motion within cervical spondylotic myelopathy (CSM) across the cervical spinal segments and its relation to cerebrospinal fluid (CSF)-flow, anatomic conditions, and clinical parameters. SETTING University Hospital Balgrist, Zurich, Switzerland. METHODS Overall, 12 patients suffering from CSM at level C5 and 12 controls underwent cardiac-gated 2D phase-contrast-MRI at level C2 and C5 and standard MRI sequences. Parameters of interest: Velocity measurements of SC and CSF (area under the curve = total displacement (normalization for duration of the heart cycle), total displacement ratio (C5/C2; intraindividual normalization for confounders)), spinal canal diameters, clinical motor- and sensory scores, and performance measures. RESULTS Interrater reliability was excellent for SC motion at both levels and for CSF flow at C2, but not reliable for CSF flow at C5. Within controls, SC motion at C2 positively correlated with SC motion at C5 (p = 0.000); this correlation diminished in patients (p = 0.860). SC total displacement ratio was significantly increased in patients (p = 0.029) and correlated with clinical impairment (p = 0.017). Morphometric measures of the extent of stenosis were not related to SC motion or clinical symptoms. CONCLUSION The findings revealed physiological interactions of CSF flow and SC motion across the cervical spine in healthy controls while being diminished in CSM patients. Findings of focally increased SC motion at the level of stenosis were related to clinical impairment and might be promising as a diagnostic and prognostic marker in CSM. SPONSORSHIP CRPP Neurorehab of the University of Zurich, Switzerland.
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Affiliation(s)
- Katharina Wolf
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland. .,Department of Neurology and Neurophysiology, University Hospital Freiburg, Freiburg, Germany.
| | - Markus Hupp
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland
| | - Susanne Friedl
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, Zürich, Switzerland
| | | | - Patrick Grabher
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland.,Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK.,Wellcome Trust Centre, University College London, London, UK.,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland
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28
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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]
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29
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Yatsushiro S, Sunohara S, Hayashi N, Hirayama A, Matsumae M, Atsumi H, Kuroda K. Cardiac-driven Pulsatile Motion of Intracranial Cerebrospinal Fluid Visualized Based on a Correlation Mapping Technique. Magn Reson Med Sci 2017; 17:151-160. [PMID: 29187679 PMCID: PMC5891341 DOI: 10.2463/mrms.mp.2017-0014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: A correlation mapping technique delineating delay time and maximum correlation for characterizing pulsatile cerebrospinal fluid (CSF) propagation was proposed. After proofing its technical concept, this technique was applied to healthy volunteers and idiopathic normal pressure hydrocephalus (iNPH) patients. Methods: A time-resolved three dimensional-phase contrast (3D-PC) sampled the cardiac-driven CSF velocity at 32 temporal points per cardiac period at each spatial location using retrospective cardiac gating. The proposed technique visualized distributions of propagation delay and correlation coefficient of the PC-based CSF velocity waveform with reference to a waveform at a particular point in the CSF space. The delay time was obtained as the amount of time-shift, giving the maximum correlation for the velocity waveform at an arbitrary location with that at the reference location. The validity and accuracy of the technique were confirmed in a flow phantom equipped with a cardiovascular pump. The technique was then applied to evaluate the intracranial CSF motions in young, healthy (N = 13), and elderly, healthy (N = 13) volunteers and iNPH patients (N = 13). Results: The phantom study demonstrated that root mean square error of the delay time was 2.27%, which was less than the temporal resolution of PC measurement used in this study (3.13% of a cardiac cycle). The human studies showed a significant difference (P < 0.01) in the mean correlation coefficient between the young, healthy group and the other two groups. A significant difference (P < 0.05) was also recognized in standard deviation of the correlation coefficients in intracranial CSF space among all groups. The result suggests that the CSF space compliance of iNPH patients was lower than that of healthy volunteers. Conclusion: The correlation mapping technique allowed us to visualize pulsatile CSF velocity wave propagations as still images. The technique may help to classify diseases related to CSF dynamics, such as iNPH.
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Affiliation(s)
- Satoshi Yatsushiro
- Course of Science and Technology, Graduate School of Science and Technology, Tokai University
| | - Saeko Sunohara
- Course of Electrical and Electronic Engineering, Graduate School of Engineering, Tokai University
| | - Naokazu Hayashi
- Department of Neurosurgery, School of Medicine, Tokai University
| | - Akihiro Hirayama
- Department of Neurosurgery, School of Medicine, Tokai University
| | | | - Hideki Atsumi
- Department of Neurosurgery, School of Medicine, Tokai University
| | - Kagayaki Kuroda
- Course of Science and Technology, Graduate School of Science and Technology, Tokai University.,Course of Electrical and Electronic Engineering, Graduate School of Engineering, Tokai University
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30
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Thyagaraj S, Pahlavian SH, Sass LR, Loth F, Vatani M, Choi JW, Tubbs RS, Giese D, Kroger JR, Bunck AC, Martin BA. An MRI-Compatible Hydrodynamic Simulator of Cerebrospinal Fluid Motion in the Cervical Spine. IEEE Trans Biomed Eng 2017; 65:1516-1523. [PMID: 28961100 DOI: 10.1109/tbme.2017.2756995] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
GOAL Develop and test an MRI-compatible hydrodynamic simulator of cerebrospinal fluid (CSF) motion in the cervical spinal subarachnoid space. Four anatomically realistic subject-specific models were created based on a 22-year-old healthy volunteer and a five-year-old patient diagnosed with Chiari I malformation. METHODS The in vitro models were based on manual segmentation of high-resolution T2-weighted MRI of the cervical spine. Anatomically realistic dorsal and ventral spinal cord nerve rootlets (NR) were added. Models were three dimensional (3-D) printed by stereolithography with 50-μm layer thickness. A computer controlled pump system was used to replicate the shape of the subject specific in vivo CSF flow measured by phase-contrast MRI. Each model was then scanned by T2-weighted and 4-D phase contrast MRI (4D flow). RESULTS Cross-sectional area, wetted perimeter, and hydraulic diameter were quantified for each model. The oscillatory CSF velocity field (flow jets near NR, velocity profile shape, and magnitude) had similar characteristics to previously reported studies in the literature measured by in vivo MRI. CONCLUSION This study describes the first MRI-compatible hydrodynamic simulator of CSF motion in the cervical spine with anatomically realistic NR. NR were found to impact CSF velocity profiles to a great degree. SIGNIFICANCE CSF hydrodynamics are thought to be altered in craniospinal disorders such as Chiari I malformation. MRI scanning techniques and protocols can be used to quantify CSF flow alterations in disease states. The provided in vitro models can be used to test the reliability of these protocols across MRI scanner manufacturers and machines.
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31
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Choroidal fissure acts as an overflow device in cerebrospinal fluid drainage: morphological comparison between idiopathic and secondary normal-pressure hydrocephalus. Sci Rep 2016; 6:39070. [PMID: 27941913 PMCID: PMC5150242 DOI: 10.1038/srep39070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 11/17/2016] [Indexed: 12/21/2022] Open
Abstract
To clarify the pathogenesis of two different types of adult-onset normal-pressure hydrocephalus (NPH), we investigated cerebrospinal fluid distribution on the high-field three-dimensional MRI. The subarachnoid spaces in secondary NPH were smaller than those in the controls, whereas those in idiopathic NPH were of similar size to the controls. In idiopathic NPH, however, the basal cistern and Sylvian fissure were enlarged in concurrence with ventricular enlargement towards the z-direction, but the convexity subarachnoid space was severely diminished. In this article, we provide evidence that the key cause of the disproportionate cerebrospinal fluid distribution in idiopathic NPH is the compensatory direct CSF communication between the inferior horn of the lateral ventricles and the ambient cistern at the choroidal fissure. In contrast, all parts of the subarachnoid spaces were equally and severely decreased in secondary NPH. Blockage of CSF drainage from the subarachnoid spaces could cause the omnidirectional ventricular enlargement in secondary NPH.
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32
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Heidari Pahlavian S, Bunck AC, Thyagaraj S, Giese D, Loth F, Hedderich DM, Kröger JR, Martin BA. Accuracy of 4D Flow Measurement of Cerebrospinal Fluid Dynamics in the Cervical Spine: An In Vitro Verification Against Numerical Simulation. Ann Biomed Eng 2016; 44:3202-3214. [PMID: 27043214 PMCID: PMC5050060 DOI: 10.1007/s10439-016-1602-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/29/2016] [Indexed: 11/30/2022]
Abstract
Abnormal alterations in cerebrospinal fluid (CSF) flow are thought to play an important role in pathophysiology of various craniospinal disorders such as hydrocephalus and Chiari malformation. Three directional phase contrast MRI (4D Flow) has been proposed as one method for quantification of the CSF dynamics in healthy and disease states, but prior to further implementation of this technique, its accuracy in measuring CSF velocity magnitude and distribution must be evaluated. In this study, an MR-compatible experimental platform was developed based on an anatomically detailed 3D printed model of the cervical subarachnoid space and subject specific flow boundary conditions. Accuracy of 4D Flow measurements was assessed by comparison of CSF velocities obtained within the in vitro model with the numerically predicted velocities calculated from a spatially averaged computational fluid dynamics (CFD) model based on the same geometry and flow boundary conditions. Good agreement was observed between CFD and 4D Flow in terms of spatial distribution and peak magnitude of through-plane velocities with an average difference of 7.5 and 10.6% for peak systolic and diastolic velocities, respectively. Regression analysis showed lower accuracy of 4D Flow measurement at the timeframes corresponding to low CSF flow rate and poor correlation between CFD and 4D Flow in-plane velocities.
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Affiliation(s)
- Soroush Heidari Pahlavian
- Conquer Chiari Research Center, The University of Akron, Akron, OH, USA
- Department of Mechanical Engineering, The University of Akron, Akron, OH, USA
| | - Alexander C Bunck
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
- Department of Radiology, University Hospital of Muenster, Muenster, Germany
| | - Suraj Thyagaraj
- Conquer Chiari Research Center, The University of Akron, Akron, OH, USA
- Department of Mechanical Engineering, The University of Akron, Akron, OH, USA
| | - Daniel Giese
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Francis Loth
- Conquer Chiari Research Center, The University of Akron, Akron, OH, USA
- Department of Mechanical Engineering, The University of Akron, Akron, OH, USA
| | - Dennis M Hedderich
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Jan Robert Kröger
- Department of Radiology, University Hospital of Muenster, Muenster, Germany
| | - Bryn A Martin
- Department of Biological Engineering, The University of Idaho, 875 Perimeter Drive MS 0904, Moscow, ID, 83844-0904, USA.
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Støverud KH, Langtangen HP, Ringstad GA, Eide PK, Mardal KA. Computational Investigation of Cerebrospinal Fluid Dynamics in the Posterior Cranial Fossa and Cervical Subarachnoid Space in Patients with Chiari I Malformation. PLoS One 2016; 11:e0162938. [PMID: 27727298 PMCID: PMC5058550 DOI: 10.1371/journal.pone.0162938] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 08/31/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose Previous computational fluid dynamics (CFD) studies have demonstrated that the Chiari malformation is associated with abnormal cerebrospinal fluid (CSF) flow in the cervical part of the subarachnoid space (SAS), but the flow in the SAS of the posterior cranial fossa has received little attention. This study extends previous modelling efforts by including the cerebellomedullary cistern, pontine cistern, and 4th ventricle in addition to the cervical subarachnoid space. Methods The study included one healthy control, Con1, and two patients with Chiari I malformation, P1 and P2. Meshes were constructed by segmenting images obtained from T2-weighted turbo spin-echo sequences. CFD simulations were performed with a previously verified and validated code. Patient-specific flow conditions in the aqueduct and the cervical SAS were used. Two patients with the Chiari malformation and one control were modelled. Results The results demonstrated increased maximal flow velocities in the Chiari patients, ranging from factor 5 in P1 to 14.8 in P2, when compared to Con1 at the level of Foramen Magnum (FM). Maximal velocities in the cervical SAS varied by a factor 2.3, while the maximal flow in the aqueduct varied by a factor 3.5. The pressure drop from the pontine cistern to the cervical SAS was similar in Con1 and P1, but a factor two higher in P2. The pressure drop between the aqueduct and the cervical SAS varied by a factor 9.4 where P1 was the one with the lowest pressure jump and P2 and Con1 differed only by a factor 1.6. Conclusion This pilot study demonstrates that including the posterior cranial fossa is feasible and suggests that previously found flow differences between Chiari I patients and healthy individuals in the cervical SAS may be present also in the SAS of the posterior cranial fossa.
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Affiliation(s)
- Karen-Helene Støverud
- Center for Biomedical Computing, Simula Research Laboratory and Department of Informatics, University of Oslo, Oslo, Norway
| | - Hans Petter Langtangen
- Center for Biomedical Computing, Simula Research Laboratory and Department of Informatics, University of Oslo, Oslo, Norway
| | - Geir Andre Ringstad
- Department of Radiology and Nuclear Medicine, Oslo University Hospital- Rikshospitalet, University of Oslo, Oslo, Norway
| | - Per Kristian Eide
- Department of Neurosurgery, Oslo University Hospital- Rikshospitalet, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kent-Andre Mardal
- Center for Biomedical Computing, Simula Research Laboratory and Department of Informatics, University of Oslo, Oslo, Norway
- Department of Mathematics, University of Oslo, Oslo, Norway
- * E-mail:
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Leung V, Magnussen JS, Stoodley MA, Bilston LE. Cerebellar and hindbrain motion in Chiari malformation with and without syringomyelia. J Neurosurg Spine 2016; 24:546-55. [PMID: 26722953 DOI: 10.3171/2015.8.spine15325] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The pathogenesis of syringomyelia associated with Chiari malformation type I (CM-I) is unclear. Theories of pathogenesis suggest the cerebellar tonsils may obstruct CSF flow or alter pressure gradients, or their motion might act as a piston to increase CSF pressure in the spinal subarachnoid space. This study was performed to measure cerebellar tonsillar and hindbrain motion in CM-I and assess the potential contributions to syrinx formation. METHODS Sixty-four CM-I patients and 25 controls were retrospectively selected from a clinical database, and all subjects had undergone cardiac-gated cine balanced fast-field echo MRI. There were a total of 36 preoperative CM-I scans, which consisted of 15 patients with and 21 patients without syringomyelia. Nineteen patients underwent paired pre- and postoperative imaging. Anteroposterior (AP) and superoinferior (SI) movements of the tip of the cerebellar tonsils, obex, fastigium of the fourth ventricle, pontomedullary junction, and cervicomedullary junction were measured. The distance between the fastigium and tip of the tonsils was used to calculate tonsillar tissue strain (Δi/i0). RESULTS CM-I patients had significantly greater cerebellar tonsillar motion in both the AP and SI directions than controls (AP +0.34 mm [+136%], p < 0.001; SI +0.49 mm [+163%], p < 0.001). This motion decreased after posterior fossa decompression (AP -0.20 mm [-33%], p = 0.001; SI -0.29 mm [-36%]; p < 0.001), but remained elevated above control levels (AP +56%, p = 0.021; SI +67%, p = 0.015). Similar trends were seen for all other tracked landmarks. There were no significant differences in the magnitude or timing of motion throughout the hindbrain between CM-I patients with and without syringomyelia. Increased tonsillar tissue strain correlated with Valsalva headaches (p = 0.03). CONCLUSIONS Cerebellar tonsillar motion may be a potential marker of CM-I and may have use in tailoring surgical procedures. The lack of association with syringomyelia suggests that tonsillar motion alone is not the driver of syrinx formation. Tonsillar tissue strain may play a part in the pathophysiology of Valsalva headaches.
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Affiliation(s)
| | - John S Magnussen
- Faculty of Medicine and Health Sciences, Macquarie University; and
| | | | - Lynne E Bilston
- Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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Martin BA, Yiallourou TI, Pahlavian SH, Thyagaraj S, Bunck AC, Loth F, Sheffer DB, Kröger JR, Stergiopulos N. Inter-operator Reliability of Magnetic Resonance Image-Based Computational Fluid Dynamics Prediction of Cerebrospinal Fluid Motion in the Cervical Spine. Ann Biomed Eng 2015; 44:1524-37. [PMID: 26446009 DOI: 10.1007/s10439-015-1449-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 09/03/2015] [Indexed: 11/30/2022]
Abstract
For the first time, inter-operator dependence of MRI based computational fluid dynamics (CFD) modeling of cerebrospinal fluid (CSF) in the cervical spinal subarachnoid space (SSS) is evaluated. In vivo MRI flow measurements and anatomy MRI images were obtained at the cervico-medullary junction of a healthy subject and a Chiari I malformation patient. 3D anatomies of the SSS were reconstructed by manual segmentation by four independent operators for both cases. CFD results were compared at nine axial locations along the SSS in terms of hydrodynamic and geometric parameters. Intraclass correlation (ICC) assessed the inter-operator agreement for each parameter over the axial locations and coefficient of variance (CV) compared the percentage of variance for each parameter between the operators. Greater operator dependence was found for the patient (0.19 < ICC < 0.99) near the craniovertebral junction compared to the healthy subject (ICC > 0.78). For the healthy subject, hydraulic diameter and Womersley number had the least variance (CV = ~2%). For the patient, peak diastolic velocity and Reynolds number had the smallest variance (CV = ~3%). These results show a high degree of inter-operator reliability for MRI-based CFD simulations of CSF flow in the cervical spine for healthy subjects and a lower degree of reliability for patients with Type I Chiari malformation.
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Affiliation(s)
- Bryn A Martin
- Neurophysiological Imaging and Modeling Laboratory, Department of Biological Engineering, The University of Idaho, 875 Perimeter Drive MS 0904, Moscow, ID, 83844-0904, USA.
| | - Theresia I Yiallourou
- Laboratory of Hemodynamics and Cardiovascular Technology, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Soroush Heidari Pahlavian
- Department of Mechanical Engineering, Conquer Chiari Research Center, The University of Akron, Akron, OH, USA
| | - Suraj Thyagaraj
- Department of Mechanical Engineering, Conquer Chiari Research Center, The University of Akron, Akron, OH, USA
| | - Alexander C Bunck
- Department of Radiology, University Hospital of Cologne, Cologne, Germany.,Department of Clinical Radiology, University of Muenster, Münster, Germany
| | - Francis Loth
- Department of Mechanical Engineering, Conquer Chiari Research Center, The University of Akron, Akron, OH, USA
| | - Daniel B Sheffer
- Department of Biomedical Engineering, The University of Akron, Akron, OH, USA
| | - Jan Robert Kröger
- Department of Radiology, University Hospital of Cologne, Cologne, Germany.,Department of Clinical Radiology, University of Muenster, Münster, Germany
| | - Nikolaos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Heidari Pahlavian S, Bunck AC, Loth F, Shane Tubbs R, Yiallourou T, Kroeger JR, Heindel W, Martin BA. Characterization of the discrepancies between four-dimensional phase-contrast magnetic resonance imaging and in-silico simulations of cerebrospinal fluid dynamics. J Biomech Eng 2015; 137:051002. [PMID: 25647090 DOI: 10.1115/1.4029699] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Indexed: 02/05/2023]
Abstract
The purpose of the present study was to compare subject-specific magnetic resonance imaging (MRI)-based computational fluid dynamics (CFD) simulations with time-resolved three-directional (3D) velocity-encoded phase-contrast MRI (4D PCMRI) measurements of the cerebrospinal fluid (CSF) velocity field in the cervical spinal subarachnoid space (SSS). Three-dimensional models of the cervical SSS were constructed based on MRI image segmentation and anatomical measurements for a healthy subject and patient with Chiari I malformation. CFD was used to simulate the CSF motion and compared to the 4D PCMRI measurements. Four-dimensional PCMRI measurements had much greater CSF velocities compared to CFD simulations (1.4 to 5.6× greater). Four-dimensional PCMRI and CFD both showed anterior and anterolateral dominance of CSF velocities, although this flow feature was more pronounced in 4D PCMRI measurements compared to CFD. CSF flow jets were present near the nerve rootlets and denticulate ligaments (NRDL) in the CFD simulation. Flow jets were visible in the 4D PCMRI measurements, although they were not clearly attributable to nerve rootlets. Inclusion of spinal cord NRDL in the cervical SSS does not fully explain the differences between velocities obtained from 4D PCMRI measurements and CFD simulations.
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HIRAYAMA A, MATSUMAE M, YATSUSHIRO S, ABDULLA A, ATSUMI H, KURODA K. Visualization of Pulsatile CSF Motion Around Membrane-like Structures with both 4D Velocity Mapping and Time-SLIP Technique. Magn Reson Med Sci 2015; 14:263-73. [DOI: 10.2463/mrms.2014-0089] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | | | - Satoshi YATSUSHIRO
- Course of Information Science and Engineering, Tokai University Graduate School of Engineering
| | | | - Hideki ATSUMI
- Department of Neurosurgery, Tokai University School of Medicine
| | - Kagayaki KURODA
- Course of Information Science and Engineering, Tokai University Graduate School of Engineering
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Detection of the communicating hole(s) of spinal extradural arachnoid cysts using time-spatial labeling inversion pulse magnetic resonance imaging. Spine (Phila Pa 1976) 2014; 39:E1394-7. [PMID: 25202934 DOI: 10.1097/brs.0000000000000591] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Report of 2 cases. OBJECTIVE To report the usefulness of time-spatial labeling inversion pulse magnetic resonance imaging (T-SLIP MRI) for detection of the communicating hole(s) of spinal extradural arachnoid cysts (SEACs). SUMMARY OF BACKGROUND DATA SEACs normally communicate with the subarachnoid space via small communicating hole(s) in the dura. It is necessary to identify the accurate locations of these communicating hole(s) before attempting to close them through limited laminotomy/laminectomy. Myelocomputed tomography or conventional MRI may fail to detect the locations of the hole(s) because they comprise small dural defects. METHODS Case 1: A 33-year-old female presented with an SEAC at the T11–L2 vertebral level. Case 2: An 82-year-old female presented with an SEAC at T12–L4 vertebral level. RESULTS Case 1: T-SLIP MR image of the left parasagittal plane (not the midsagittal or right parasagittal plane) revealed cerebrospinal fluid flow from the subarachnoid space into the cyst at L1. After limited laminotomy at T12–L1 and partial cyst resection, we identified 2 contiguous dural holes immediately medial to the left L1 pedicle; this corroborated the preoperative T-SLIP MRI findings. The holes were sutured. Postoperative conventional MR image confirmed significant cyst shrinkage. Case 2: T-SLIP MR image revealed a curved line at the L1 pedicle in the right parasagittal plane. After L1 laminectomy and partial cyst resection, a dural hole was identified L1 pedicle, which was in agreement with the preoperative T-SLIP MRI findings. After surgery, the lower extremity pain disappeared. Postoperative conventional MR image revealed significant cyst shrinkage. CONCLUSION T-SLIP MRI is useful for detection of the communicating hole(s) of SEACs. LEVEL OF EVIDENCE N/A.
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An approach to objective analysis of cerebrospinal fluid flow dynamics with phase-contrast magnetic resonance imaging. Acta Neurochir (Wien) 2014; 156:2207-8. [PMID: 24817174 DOI: 10.1007/s00701-014-2109-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 04/19/2014] [Indexed: 10/25/2022]
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Heidari Pahlavian S, Yiallourou T, Tubbs RS, Bunck AC, Loth F, Goodin M, Raisee M, Martin BA. The impact of spinal cord nerve roots and denticulate ligaments on cerebrospinal fluid dynamics in the cervical spine. PLoS One 2014; 9:e91888. [PMID: 24710111 PMCID: PMC3977950 DOI: 10.1371/journal.pone.0091888] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 02/17/2014] [Indexed: 12/29/2022] Open
Abstract
Cerebrospinal fluid (CSF) dynamics in the spinal subarachnoid space (SSS) have been thought to play an important pathophysiological role in syringomyelia, Chiari I malformation (CM), and a role in intrathecal drug delivery. Yet, the impact that fine anatomical structures, including nerve roots and denticulate ligaments (NRDL), have on SSS CSF dynamics is not clear. In the present study we assessed the impact of NRDL on CSF dynamics in the cervical SSS. The 3D geometry of the cervical SSS was reconstructed based on manual segmentation of MRI images of a healthy volunteer and a patient with CM. Idealized NRDL were designed and added to each of the geometries based on in vivo measurments in the literature and confirmation by a neuroanatomist. CFD simulations were performed for the healthy and patient case with and without NRDL included. Our results showed that the NRDL had an important impact on CSF dynamics in terms of velocity field and flow patterns. However, pressure distribution was not altered greatly although the NRDL cases required a larger pressure gradient to maintain the same flow. Also, the NRDL did not alter CSF dynamics to a great degree in the SSS from the foramen magnum to the C1 level for the healthy subject and CM patient with mild tonsillar herniation (∼6 mm). Overall, the NRDL increased fluid mixing phenomena and resulted in a more complex flow field. Comparison of the streamlines of CSF flow revealed that the presence of NRDL lead to the formation of vortical structures and remarkably increased the local mixing of the CSF throughout the SSS.
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Affiliation(s)
- Soroush Heidari Pahlavian
- Center of Excellence in Design and Optimization of Energy Systems (CEDOES), School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Theresia Yiallourou
- Laboratory of Hemodynamics and Cardiovascular Technology, EPFL, Lausanne, Switzerland
| | - R. Shane Tubbs
- Children's of Alabama, Birmingham, Alabama, United States of America
| | - Alexander C. Bunck
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Francis Loth
- Conquer Chiari Research Center, Dept. of Mech. Engineering, University of Akron, Akron, Ohio, United States of America
| | - Mark Goodin
- SimuTech Group, Hudson, Ohio, United States of America
| | - Mehrdad Raisee
- Center of Excellence in Design and Optimization of Energy Systems (CEDOES), School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
- Hydraulic Machinery Research Institute, School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Bryn A. Martin
- Conquer Chiari Research Center, Dept. of Mech. Engineering, University of Akron, Akron, Ohio, United States of America
- * E-mail:
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Shaffer N, Martin BA, Rocque B, Madura C, Wieben O, Iskandar BJ, Dombrowski S, Luciano M, Oshinski JN, Loth F. Cerebrospinal fluid flow impedance is elevated in Type I Chiari malformation. J Biomech Eng 2014; 136:021012. [PMID: 24362680 PMCID: PMC4023655 DOI: 10.1115/1.4026316] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 12/16/2013] [Accepted: 12/23/2013] [Indexed: 12/26/2022]
Abstract
Diagnosis of Type I Chiari malformation (CMI) is difficult because the most commonly used diagnostic criterion, cerebellar tonsillar herniation (CTH) greater than 3-5 mm past the foramen magnum, has been found to have little correlation with patient symptom severity. Thus, there is a need to identify new objective measurement(s) to help quantify CMI severity. This study investigated longitudinal impedance (LI) as a parameter to assess CMI in terms of impedance to cerebrospinal fluid motion near the craniovertebral junction. LI was assessed in CMI patients (N = 15) and age-matched healthy controls (N = 8) using computational fluid dynamics based on subject-specific magnetic resonance imaging (MRI) measurements of the cervical spinal subarachnoid space. In addition, CTH was measured for each subject. Mean LI in the CMI group (551 ± 66 dyn/cm5) was significantly higher than in controls (220 ± 17 dyn/cm5, p < 0.001). Mean CTH in the CMI group was 9.0 ± 1.1 mm compared to -0.4 ± 0.5 mm in controls. Regression analysis of LI versus CTH found a weak relationship (R2 = 0.46, p < 0.001), demonstrating that CTH was not a good indicator of the impedance to CSF motion caused by cerebellar herniation. These results showed that CSF flow impedance was elevated in CMI patients and that LI provides different information than a standard CTH measurement. Further research is necessary to determine if LI can be useful in CMI patient diagnosis.
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Affiliation(s)
- Nicholas Shaffer
- Conquer Chiari Research Center,Department of Mechanical Engineering,University of Akron,Akron, OH 44325-0406
| | - Bryn A. Martin
- Conquer Chiari Research Center,Department of Mechanical Engineering,University of Akron,Akron, OH 44325-0406
| | - Brandon Rocque
- Department of Neurological Surgery,University of Wisconsin,Madison, WI 53792-8660
| | - Casey Madura
- Department of Neurological Surgery,University of Wisconsin,Madison, WI 53792-8660
| | - Oliver Wieben
- Departments of Radiology and Medical Physics,University of Wisconsin,Madison, WI 53705-2275
| | - Bermans J. Iskandar
- Department of Neurological Surgery,University of Wisconsin,Madison, WI 53792-8660
| | - Stephen Dombrowski
- Department of Neurological Surgery,Cleveland Clinic Foundation,Cleveland, OH 44195
| | - Mark Luciano
- Department of Neurological Surgery,Cleveland Clinic Foundation,Cleveland, OH 44195
| | - John N. Oshinski
- Department of Radiology and Imaging Sciences,Emory University School of Medicine,Atlanta, GA 30322
| | - Francis Loth
- Conquer Chiari Research Center,Department of Mechanical Engineering,University of Akron,Akron, OH 44325-0406
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Yatsushiro S, Hirayama A, Matsumae M, Kajiwara N, Abdullah A, Kuroda K. Correlation mapping for visualizing propagation of pulsatile CSF motion in intracranial space based on magnetic resonance phase contrast velocity images: preliminary results. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2014; 2014:3300-3303. [PMID: 25570696 DOI: 10.1109/embc.2014.6944328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Correlation time mapping based on magnetic resonance (MR) velocimetry has been applied to pulsatile cerebrospinal fluid (CSF) motion to visualize the pressure transmission between CSF at different locations and/or between CSF and arterial blood flow. Healthy volunteer experiments demonstrated that the technique exhibited transmitting pulsatile CSF motion from CSF space in the vicinity of blood vessels with short delay and relatively high correlation coefficients. Patient and healthy volunteer experiments indicated that the properties of CSF motion were different from the healthy volunteers. Resultant images in healthy volunteers implied that there were slight individual difference in the CSF driving source locations. Clinical interpretation for these preliminary results is required to apply the present technique for classifying status of hydrocephalus.
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Martin BA, Kalata W, Shaffer N, Fischer P, Luciano M, Loth F. Hydrodynamic and longitudinal impedance analysis of cerebrospinal fluid dynamics at the craniovertebral junction in type I Chiari malformation. PLoS One 2013; 8:e75335. [PMID: 24130704 PMCID: PMC3794956 DOI: 10.1371/journal.pone.0075335] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/11/2013] [Indexed: 02/02/2023] Open
Abstract
Elevated or reduced velocity of cerebrospinal fluid (CSF) at the craniovertebral junction (CVJ) has been associated with type I Chiari malformation (CMI). Thus, quantification of hydrodynamic parameters that describe the CSF dynamics could help assess disease severity and surgical outcome. In this study, we describe the methodology to quantify CSF hydrodynamic parameters near the CVJ and upper cervical spine utilizing subject-specific computational fluid dynamics (CFD) simulations based on in vivo MRI measurements of flow and geometry. Hydrodynamic parameters were computed for a healthy subject and two CMI patients both pre- and post-decompression surgery to determine the differences between cases. For the first time, we present the methods to quantify longitudinal impedance (LI) to CSF motion, a subject-specific hydrodynamic parameter that may have value to help quantify the CSF flow blockage severity in CMI. In addition, the following hydrodynamic parameters were quantified for each case: maximum velocity in systole and diastole, Reynolds and Womersley number, and peak pressure drop during the CSF cardiac flow cycle. The following geometric parameters were quantified: cross-sectional area and hydraulic diameter of the spinal subarachnoid space (SAS). The mean values of the geometric parameters increased post-surgically for the CMI models, but remained smaller than the healthy volunteer. All hydrodynamic parameters, except pressure drop, decreased post-surgically for the CMI patients, but remained greater than in the healthy case. Peak pressure drop alterations were mixed. To our knowledge this study represents the first subject-specific CFD simulation of CMI decompression surgery and quantification of LI in the CSF space. Further study in a larger patient and control group is needed to determine if the presented geometric and/or hydrodynamic parameters are helpful for surgical planning.
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Affiliation(s)
- Bryn A. Martin
- Conquer Chiari Research Center, University of Akron, Ohio, United States of America
- Department of Mechanical Engineering, University of Akron, Ohio, United States of America
- * E-mail:
| | - Wojciech Kalata
- Spraying Systems Inc., Wheaton, Illinois, United States of America
| | - Nicholas Shaffer
- Conquer Chiari Research Center, University of Akron, Ohio, United States of America
- Department of Mechanical Engineering, University of Akron, Ohio, United States of America
| | - Paul Fischer
- Mathematics and Computer Science Division, Argonne National Laboratory, Illinois, United States of America
| | - Mark Luciano
- Department of Neurosurgery, Cleveland Clinic Foundation, Ohio, United States of America
| | - Francis Loth
- Conquer Chiari Research Center, University of Akron, Ohio, United States of America
- Department of Mechanical Engineering, University of Akron, Ohio, United States of America
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Støverud KH, Langtangen HP, Haughton V, Mardal KA. CSF pressure and velocity in obstructions of the subarachnoid spaces. Neuroradiol J 2013; 26:218-26. [PMID: 23859246 DOI: 10.1177/197140091302600213] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 03/02/2013] [Indexed: 01/29/2023] Open
Abstract
According to some theories, obstruction of CSF flow produces a pressure drop in the subarachnoid space in accordance with the Bernoulli theorem that explains the development of syringomyelia below the obstruction. However, Bernoulli's principle applies to inviscid stationary flow unlike CSF flow. Therefore, we performed a series of computational experiments to investigate the relationship between pressure drop, flow velocities, and obstructions under physiologic conditions. We created geometric models with dimensions approximating the spinal subarachnoid space with varying degrees of obstruction. Pressures and velocities for constant and oscillatory flow of a viscid fluid were calculated with the Navier-Stokes equations. Pressure and velocity along the length of the models were also calculated by the Bernoulli equation and compared with the results from the Navier-Stokes equations. In the models, fluid velocities and pressure gradients were approximately inversely proportional to the percentage of the channel that remained open. Pressure gradients increased minimally with 35% obstruction and with factors 1.4, 2.2 and 5.0 respectively with 60, 75 and 85% obstruction. Bernoulli's law underestimated pressure changes by at least a factor 2 and predicted a pressure increase downstream of the obstruction, which does not occur. For oscillatory flow the phase difference between pressure maxima and velocity maxima changed with the degree of obstruction. Inertia and viscosity which are not factored into the Bernoulli equation affect CSF flow. Obstruction of CSF flow in the cervical spinal canal increases pressure gradients and velocities and decreases the phase lag between pressure and velocity.
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Affiliation(s)
- K H Støverud
- Center for Biomedical Computing, Simula Research Laboratory, Department of Informatics, University of Oslo, Oslo, Norway.
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Abstract
Spinal cord injuries often occur in cases of multiple trauma, can occur alone or in combination with concomitant injuries and are mostly associated with high morbidity and mortality. They often result in lifelong impairment and need for medical care. Radiologic diagnostics are crucial in the acute setting as well as in the long-term treatment of spinal cord injuries. Besides an overview of diagnostic and therapeutic management, typical magnetic resonance imaging (MRI) findings in the acute and chronic stages of spinal cord injuries are presented in this article. Post-traumatic syringomyelia can even develop years after the initial injury of the spine or spinal cord. As syringomyelia can also occur in association with tumors, developmental anomalies and also idiopathically, a thorough MRI diagnostic is essential especially in any case of newly diagnosed syringomyelia.
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Mardal KA, Rutkowska G, Linge S, Haughton V. Estimation of CSF flow resistance in the upper cervical spine. Neuroradiol J 2013; 26:106-10. [PMID: 23859177 DOI: 10.1177/197140091302600118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 11/20/2012] [Indexed: 11/15/2022] Open
Abstract
Chiari I patients have increased CSF velocities in the foramen magnum due hypothetically to increased pressure gradients or reduced flow resistance. We calculated flow resistance in the cervical spinal canal in a group of subjects with and without the Chiari malformation. Eight subjects including healthy volunteers and Chiari I patients were studied. From 3D high resolution MR images of the cervical spine mathematical models of the subarachnoid spaces were created by means of standard programs for segmentation and discretization. Oscillatory flow through the subarachnoid space was simulated. Cross-sectional area of the subarachnoid space was computed at each level from C1 through C4 and the length of this spinal canal segment was measured. Peak caudad CSF flow velocity at each level was plotted against cross-section area. CSF volumetric flux and resistance were calculated for each subject. The correlation between velocity and resistance was calculated. In all subjects, peak velocities increased progressively from C1 to C4 by 0.6 to 0.7 cm/s per level. Spinal canal areas diminished from C1 to C5 in each subject at a rate of -0.25 to -0.29 cm(2) per level. Resistance averaged 4.3 pascal/ml/s in the eight subjects; 3.8 pascal/ml/s in patients with tonsilar herniation and 6.0 pascal/ml/s in volunteers. Velocity correlated inversely with resistance (R(2) = 0.6). CSF velocities correlated inversely with the flow resistance in the upper cervical spinal canal. Resistance tends to be lower in Chiari I patients than in healthy volunteers.
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Affiliation(s)
- K-A Mardal
- Center for Biomedical Computing, Simula Research Laboratory, Lysaker, Norway
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Yiallourou TI, Kröger JR, Stergiopulos N, Maintz D, Martin BA, Bunck AC. Comparison of 4D phase-contrast MRI flow measurements to computational fluid dynamics simulations of cerebrospinal fluid motion in the cervical spine. PLoS One 2012; 7:e52284. [PMID: 23284970 PMCID: PMC3528759 DOI: 10.1371/journal.pone.0052284] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 11/12/2012] [Indexed: 11/30/2022] Open
Abstract
Cerebrospinal fluid (CSF) dynamics in the cervical spinal subarachnoid space (SSS) have been thought to be important to help diagnose and assess craniospinal disorders such as Chiari I malformation (CM). In this study we obtained time-resolved three directional velocity encoded phase-contrast MRI (4D PC MRI) in three healthy volunteers and four CM patients and compared the 4D PC MRI measurements to subject-specific 3D computational fluid dynamics (CFD) simulations. The CFD simulations considered the geometry to be rigid-walled and did not include small anatomical structures such as nerve roots, denticulate ligaments and arachnoid trabeculae. Results were compared at nine axial planes along the cervical SSS in terms of peak CSF velocities in both the cranial and caudal direction and visual interpretation of thru-plane velocity profiles. 4D PC MRI peak CSF velocities were consistently greater than the CFD peak velocities and these differences were more pronounced in CM patients than in healthy subjects. In the upper cervical SSS of CM patients the 4D PC MRI quantified stronger fluid jets than the CFD. Visual interpretation of the 4D PC MRI thru-plane velocity profiles showed greater pulsatile movement of CSF in the anterior SSS in comparison to the posterior and reduction in local CSF velocities near nerve roots. CFD velocity profiles were relatively uniform around the spinal cord for all subjects. This study represents the first comparison of 4D PC MRI measurements to CFD of CSF flow in the cervical SSS. The results highlight the utility of 4D PC MRI for evaluation of complex CSF dynamics and the need for improvement of CFD methodology. Future studies are needed to investigate whether integration of fine anatomical structures and gross motion of the brain and/or spinal cord into the computational model will lead to a better agreement between the two techniques.
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Affiliation(s)
- Theresia I. Yiallourou
- Laboratory of Hemodynamics and Cardiovascular Technology, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Jan Robert Kröger
- Department of Clinical Radiology, University Hospital of Münster, Münster, Germany
| | - Nikolaos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - David Maintz
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Bryn A. Martin
- Laboratory of Hemodynamics and Cardiovascular Technology, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Conquer Chiari Research Center, University of Akron, Akron, Ohio, United States of America
- * E-mail:
| | - Alexander C. Bunck
- Department of Clinical Radiology, University Hospital of Münster, Münster, Germany
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
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Bibliography. Cardiovascular medicine (CM). Current world literature. Curr Opin Pediatr 2012; 24:656-60. [PMID: 22954957 DOI: 10.1097/mop.0b013e328358bc78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bunck AC, Kroeger JR, Juettner A, Brentrup A, Fiedler B, Crelier GR, Martin BA, Heindel W, Maintz D, Schwindt W, Niederstadt T. Magnetic resonance 4D flow analysis of cerebrospinal fluid dynamics in Chiari I malformation with and without syringomyelia. Eur Radiol 2012; 22:1860-70. [PMID: 22569996 DOI: 10.1007/s00330-012-2457-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/15/2012] [Accepted: 02/27/2012] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To analyse cerebrospinal fluid (CSF) hydrodynamics in patients with Chiari type I malformation (CM) with and without syringomyelia using 4D magnetic resonance (MR) phase contrast (PC) flow imaging. METHODS 4D-PC CSF flow data were acquired in 20 patients with CM (12 patients with presyrinx/syrinx). Characteristic 4D-CSF flow patterns were identified. Quantitative CSF flow parameters were assessed at the craniocervical junction and the cervical spinal canal and compared with healthy volunteers and between patients with and without syringomyelia. RESULTS Compared with healthy volunteers, 17 CM patients showed flow abnormalities at the craniocervical junction in the form of heterogeneous flow (n = 3), anterolateral flow jets (n = 14) and flow vortex formation (n = 5), most prevalent in patients with syringomyelia. Peak flow velocities at the craniocervical junction were significantly increased in patients (-15.5 ± 11.3 vs. -4.7 ± 0.7 cm/s in healthy volunteers, P < 0.001). At the level of C1, maximum systolic flow was found to be significantly later in the cardiac cycle in patients (30.8 ± 10.3 vs. 22.7 ± 4.1%, P < 0.05). CONCLUSIONS 4D-PC flow imaging allowed comprehensive analysis of CSF flow in patients with Chiari I malformation. Alterations of CSF hydrodynamics were most pronounced in patients with syringomyelia.
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Affiliation(s)
- Alexander C Bunck
- Department of Clinical Radiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, building A1, 48149 Muenster, Germany.
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