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Edrisnia H, Sharbatdar M. Numerical analysis of the effect of Syringomyelia on cerebrospinal fluid dynamics. Heliyon 2024; 10:e37067. [PMID: 39319127 PMCID: PMC11419872 DOI: 10.1016/j.heliyon.2024.e37067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 08/19/2024] [Accepted: 08/27/2024] [Indexed: 09/26/2024] Open
Abstract
Spinal cord enlargement (SCE) includes conditions such as Syringomyelia, tumors, and tumor-like cases of demyelination, edema, or inflammation. These conditions involve fluid-filled cysts, known as syrinx, or masses of tissue, referred to as tumors, which cause increased pressure within the spinal cord (SC) and obstruct cerebrospinal fluid (CSF) circulation. To assess the impact of SCE location and diameter, we constructed fifteen computational SC models, each featuring a SCE placed in one of five probable locations with 20 %, 40 %, and 60 % stenosis. Our objective was to investigate how the location, diameter, and length of the SCE influence CSF velocity pattern and to identify the most critical location in the SC associated with this condition. The results indicated a velocity increase of 0.5 cm/(s) near models with 60 % stenosis. Importantly, SCE located from T1 to T5 exhibit a more pronounced reduction, exceeding 6.5, in the Womersley number. Our finding suggests that this region is the most vulnerable for SCE formation due to its significant impact on fluid circulation. The identification of specific locations within the SC associated with heightened risk can contribute to an improved understanding, treatment and management of SCE.
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Affiliation(s)
- Hadis Edrisnia
- Faculty of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, 19991-43344, Iran
| | - Mahkame Sharbatdar
- Faculty of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, 19991-43344, Iran
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2
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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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3
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Sadekar SS, Bowen M, Cai H, Jamalian S, Rafidi H, Shatz‐Binder W, Lafrance‐Vanasse J, Chan P, Meilandt WJ, Oldendorp A, Sreedhara A, Daugherty A, Crowell S, Wildsmith KR, Atwal J, Fuji RN, Horvath J. Translational approaches for brain delivery of biologics via cerebrospinal fluid. Clin Pharmacol Ther 2022; 111:826-834. [PMID: 35064573 PMCID: PMC9305158 DOI: 10.1002/cpt.2531] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/04/2022] [Indexed: 11/14/2022]
Abstract
Delivery of biologics via cerebrospinal fluid (CSF) has demonstrated potential to access the tissues of the central nervous system (CNS) by circumventing the blood‐brain barrier and blood‐CSF barrier. Developing an effective CSF drug delivery strategy requires optimization of multiple parameters, including choice of CSF access point, delivery device technology, and delivery kinetics to achieve effective therapeutic concentrations in the target brain region, whereas also considering the biologic modality, mechanism of action, disease indication, and patient population. This review discusses key preclinical and clinical examples of CSF delivery for different biologic modalities (antibodies, nucleic acid‐based therapeutics, and gene therapy) to the brain via CSF or CNS access routes (intracerebroventricular, intrathecal‐cisterna magna, intrathecal‐lumbar, intraparenchymal, and intranasal), including the use of novel device technologies. This review also discusses quantitative models of CSF flow that provide insight into the effect of fluid dynamics in CSF on drug delivery and CNS distribution. Such models can facilitate delivery device design and pharmacokinetic/pharmacodynamic translation from preclinical species to humans in order to optimize CSF drug delivery to brain regions of interest.
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Affiliation(s)
- Shraddha S Sadekar
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Mayumi Bowen
- Pharma Technical Development. Genentech, Inc, a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Hao Cai
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Samira Jamalian
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Hanine Rafidi
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Whitney Shatz‐Binder
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Julien Lafrance‐Vanasse
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Pamela Chan
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - William J. Meilandt
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Amy Oldendorp
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Alavattam Sreedhara
- Pharma Technical Development. Genentech, Inc, a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Ann Daugherty
- Pharma Technical Development. Genentech, Inc, a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Susan Crowell
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Kristin R. Wildsmith
- Clinical pharmacology and translational medicine Neurology business Eisai, Nutley NJ 07110 USA
| | - Jasvinder Atwal
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Reina N. Fuji
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Josh Horvath
- Pharma Technical Development. Genentech, Inc, a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
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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] [MESH Headings] [Grants] [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.
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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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Sass LR, Khani M, Romm J, Schmid Daners M, McCain K, Freeman T, Carter GT, Weeks DL, Petersen B, Aldred J, Wingett D, Martin BA. Non-invasive MRI quantification of cerebrospinal fluid dynamics in amyotrophic lateral sclerosis patients. Fluids Barriers CNS 2020; 17:4. [PMID: 31959193 PMCID: PMC6971921 DOI: 10.1186/s12987-019-0164-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023] Open
Abstract
Background Developing novel therapeutic agents to treat amyotrophic lateral sclerosis (ALS) has been difficult due to multifactorial pathophysiologic processes at work. Intrathecal drug administration shows promise due to close proximity of cerebrospinal fluid (CSF) to affected tissues. Development of effective intrathecal pharmaceuticals will rely on accurate models of how drugs are dispersed in the CSF. Therefore, a method to quantify these dynamics and a characterization of differences across disease states is needed. Methods Complete intrathecal 3D CSF geometry and CSF flow velocities at six axial locations in the spinal canal were collected by T2-weighted and phase-contrast MRI, respectively. Scans were completed for eight people with ALS and ten healthy controls. Manual segmentation of the spinal subarachnoid space was performed and coupled with an interpolated model of CSF flow within the spinal canal. Geometric and hydrodynamic parameters were then generated at 1 mm slice intervals along the entire spine. Temporal analysis of the waveform spectral content and feature points was also completed. Results Comparison of ALS and control groups revealed a reduction in CSF flow magnitude and increased flow propagation velocities in the ALS cohort. Other differences in spectral harmonic content and geometric comparisons may support an overall decrease in intrathecal compliance in the ALS group. Notably, there was a high degree of variability between cases, with one ALS patient displaying nearly zero CSF flow along the entire spinal canal. Conclusion While our sample size limits statistical confidence about the differences observed in this study, it was possible to measure and quantify inter-individual and cohort variability in a non-invasive manner. Our study also shows the potential for MRI based measurements of CSF geometry and flow to provide information about the hydrodynamic environment of the spinal subarachnoid space. These dynamics may be studied further to understand the behavior of CSF solute transport in healthy and diseased states.
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Affiliation(s)
- Lucas R Sass
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Mohammadreza Khani
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Jacob Romm
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA.,University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Kyle McCain
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Tavara Freeman
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Gregory T Carter
- St. Luke's Rehabilitation Institute, 711 South Cowley St., Spokane, WA, 99202, USA
| | - Douglas L Weeks
- St. Luke's Rehabilitation Institute, 711 South Cowley St., Spokane, WA, 99202, USA
| | - Brian Petersen
- Inland Imaging PS and LLC, 801 South Stevens St., Spokane, WA, 99204, USA
| | - Jason Aldred
- Selkirk Neurology, 610 South Sherman St. #201, Spokane, WA, 99202, USA
| | - Dena Wingett
- Inland Imaging LLC, 801 South Stevens St., Spokane, WA, 99204, USA
| | - Bryn A Martin
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA. .,Biological Engineering, University of Idaho, 875 Perimeter Dr. MS0904, Moscow, ID, 83844-0904, USA.
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Luciano MG, Batzdorf U, Kula RW, Rocque BG, Maher CO, Heiss J, Martin BA, Bolognese PA, Ashley-Koch A, Limbrick D, Poppe DJ, Esposito KM, Odenkirchen J, Esterlitz JR, Ala’i S, Joseph K, Feldman RS, Riddle R. Development of Common Data Elements for Use in Chiari Malformation Type I Clinical Research: An NIH/NINDS Project. Neurosurgery 2019; 85:854-860. [PMID: 30690581 PMCID: PMC7054710 DOI: 10.1093/neuros/nyy475] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Indexed: 12/28/2022] Open
Abstract
The management of Chiari I malformation (CMI) is controversial because treatment methods vary and treatment decisions rest on incomplete understanding of its complex symptom patterns, etiologies, and natural history. Validity of studies that attempt to compare treatment of CMI has been limited because of variable terminology and methods used to describe study subjects. The goal of this project was to standardize terminology and methods by developing a comprehensive set of Common Data Elements (CDEs), data definitions, case report forms (CRFs), and outcome measure recommendations for use in CMI clinical research, as part of the CDE project at the National Institute of Neurological Disorders and Stroke (NINDS) of the US National Institutes of Health. A working group, comprising over 30 experts, developed and identified CDEs, template CRFs, data dictionaries, and guidelines to aid investigators starting and conducting CMI clinical research studies. The recommendations were compiled, internally reviewed, and posted online for external public comment. In October 2016, version 1.0 of the CMI CDE recommendations became available on the NINDS CDE website. The recommendations span these domains: Core Demographics/Epidemiology; Presentation/Symptoms; Co-Morbidities/Genetics; Imaging; Treatment; and Outcome. Widespread use of CDEs could facilitate CMI clinical research trial design, data sharing, retrospective analyses, and consistent data sharing between CMI investigators around the world. Updating of CDEs will be necessary to keep them relevant and applicable to evolving research goals for understanding CMI and its treatment.
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Affiliation(s)
- Mark G Luciano
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Ulrich Batzdorf
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California
| | - Roger W Kula
- Chiari Neurosurgical Center at Neurological Surgery, P.C., Lake Success, New York
| | - Brandon G Rocque
- Department of Neurosurgery, University of Alabama, Birmingham, Alabama
| | - Cormac O Maher
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - John Heiss
- Division of Intramural Research, National Institutes of Health/National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Bryn A Martin
- Department of Biological Engineering, University of Idaho, Moscow, Idaho
| | - Paolo A Bolognese
- Chiari Neurosurgical Center at Neurological Surgery, P.C., Lake Success, New York
| | | | - David Limbrick
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Joanne Odenkirchen
- Division of Neuroscience, National Institutes of Health/National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | | | | | | | | | - Robert Riddle
- Division of Neuroscience, National Institutes of Health/National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
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Khani M, Lawrence BJ, Sass LR, Gibbs CP, Pluid JJ, Oshinski JN, Stewart GR, Zeller JR, Martin BA. Characterization of intrathecal cerebrospinal fluid geometry and dynamics in cynomolgus monkeys (macaca fascicularis) by magnetic resonance imaging. PLoS One 2019; 14:e0212239. [PMID: 30811449 PMCID: PMC6392269 DOI: 10.1371/journal.pone.0212239] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/29/2019] [Indexed: 02/08/2023] Open
Abstract
Recent advancements have been made toward understanding the diagnostic and therapeutic potential of cerebrospinal fluid (CSF) and related hydrodynamics. Increased understanding of CSF dynamics may lead to improved detection of central nervous system (CNS) diseases and optimized delivery of CSF based CNS therapeutics, with many proposed therapeutics hoping to successfully treat or cure debilitating neurological conditions. Before significant strides can be made toward the research and development of interventions designed for human use, additional research must be carried out with representative subjects such as non-human primates (NHP). This study presents a geometric and hydrodynamic characterization of CSF in eight cynomolgus monkeys (Macaca fascicularis) at baseline and two-week follow-up. Results showed that CSF flow along the entire spine was laminar with a Reynolds number ranging up to 80 and average Womersley number ranging from 4.1–7.7. Maximum CSF flow rate occurred ~25 mm caudal to the foramen magnum. Peak CSF flow rate ranged from 0.3–0.6 ml/s at the C3-C4 level. Geometric analysis indicated that average intrathecal CSF volume below the foramen magnum was 7.4 ml. The average surface area of the spinal cord and dura was 44.7 and 66.7 cm2 respectively. Subarachnoid space cross-sectional area and hydraulic diameter ranged from 7–75 mm2 and 2–3.7 mm, respectively. Stroke volume had the greatest value of 0.14 ml at an axial location corresponding to C3-C4.
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Affiliation(s)
- Mohammadreza Khani
- Department of Biological Engineering, University of Idaho, Moscow, ID, United States of America
| | - Braden J. Lawrence
- Department of Biological Engineering, University of Idaho, Moscow, ID, United States of America
- School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Lucas R. Sass
- Department of Biological Engineering, University of Idaho, Moscow, ID, United States of America
| | - Christina P. Gibbs
- Department of Biological Engineering, University of Idaho, Moscow, ID, United States of America
| | - Joshua J. Pluid
- Department of Biological Engineering, University of Idaho, Moscow, ID, United States of America
| | - John N. Oshinski
- Department of Radiology, Emory University, Atlanta, GA, United States of America
| | - Gregory R. Stewart
- Axovant, New York, NY, United States of America
- Voyager Therapeutics, Cambridge, MA, United States of America
| | | | - Bryn A. Martin
- Department of Biological Engineering, University of Idaho, Moscow, ID, United States of America
- * E-mail:
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Lawrence BJ, Luciano M, Tew J, Ellenbogen RG, Oshinski JN, Loth F, Culley AP, Martin BA. Cardiac-Related Spinal Cord Tissue Motion at the Foramen Magnum is Increased in Patients with Type I Chiari Malformation and Decreases Postdecompression Surgery. World Neurosurg 2018; 116:e298-e307. [PMID: 29733988 DOI: 10.1016/j.wneu.2018.04.191] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Type 1 Chiari malformation (CM-I) is a craniospinal disorder historically defined by cerebellar tonsillar position greater than 3-5 mm below the foramen magnum (FM). This definition has come under question because quantitative measurements of cerebellar herniation do not always correspond with symptom severity. Researchers have proposed several additional radiographic diagnostic criteria based on dynamic motion of fluids and/or tissues. The present study objective was to determine if cardiac-related craniocaudal spinal cord tissue displacement is an accurate indicator of the presence of CM-I and if tissue displacement is altered with decompression. METHODS A cohort of 20 symptomatic patients underwent decompression surgery. Fifteen healthy volunteers were recruited for comparison with the CM-I group. Axial phase-contrast magnetic resonance imaging (PC-MRI) measurements were collected before and after surgery at the FM with cranial-caudal velocity encoding and 20 frames per cardiac cycle with retrospective reconstruction. Spinal cord motion (SCM) at the FM was quantified based on the peak-to-peak integral of average spinal cord velocity. RESULTS Tissue motion for the presurgical group was significantly greater than controls (P = 0.0009). Motion decreased after surgery (P = 0.058) with an effect size of -0.151 mm and a standard error of 0.066 mm. Postoperatively, no statistical difference from controls in bulk displacement at the FM was found (P = 0.200) after post hoc testing using the Tukey adjustment for multiple comparisons. CONCLUSIONS These results support SCM measurement by PC-MRI as a possible noninvasive radiographic diagnostic for CM-I. Dynamic measurement of SCM provides unique diagnostic information about CM-I alongside static quantification of tonsillar position and other intracranial morphometrics.
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Affiliation(s)
- Braden J Lawrence
- School of Medicine, University of Washington, Seattle, Washington, USA; Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Department of Biological Engineering, University of Idaho, Moscow, Idaho, USA
| | - Mark Luciano
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - John Tew
- Department of Neurosurgery, University of Cincinnati Neuroscience Institute and University of Cincinnati College of Medicine, and Mayfield Clinic, Cincinnati, Ohio, USA
| | - Richard G Ellenbogen
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - John N Oshinski
- Department of Radiology & Imaging Science and Biomedical Engineering, Emory University, Atlanta, Georgia
| | - Francis Loth
- Conquer Chiari Research Center, Department of Mechanical Engineering, University of Akron, Ohio, USA
| | - Amanda P Culley
- Department of Statistical Science, University of Idaho, Moscow, Idaho, USA
| | - Bryn A Martin
- Department of Biological Engineering, University of Idaho, Moscow, Idaho, USA.
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9
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Khani M, Xing T, Gibbs C, Oshinski JN, Stewart GR, Zeller JR, Martin BA. Nonuniform Moving Boundary Method for Computational Fluid Dynamics Simulation of Intrathecal Cerebrospinal Flow Distribution in a Cynomolgus Monkey. J Biomech Eng 2018; 139:2625663. [PMID: 28462417 DOI: 10.1115/1.4036608] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Indexed: 11/08/2022]
Abstract
A detailed quantification and understanding of cerebrospinal fluid (CSF) dynamics may improve detection and treatment of central nervous system (CNS) diseases and help optimize CSF system-based delivery of CNS therapeutics. This study presents a computational fluid dynamics (CFD) model that utilizes a nonuniform moving boundary approach to accurately reproduce the nonuniform distribution of CSF flow along the spinal subarachnoid space (SAS) of a single cynomolgus monkey. A magnetic resonance imaging (MRI) protocol was developed and applied to quantify subject-specific CSF space geometry and flow and define the CFD domain and boundary conditions. An algorithm was implemented to reproduce the axial distribution of unsteady CSF flow by nonuniform deformation of the dura surface. Results showed that maximum difference between the MRI measurements and CFD simulation of CSF flow rates was <3.6%. CSF flow along the entire spine was laminar with a peak Reynolds number of ∼150 and average Womersley number of ∼5.4. Maximum CSF flow rate was present at the C4-C5 vertebral level. Deformation of the dura ranged up to a maximum of 134 μm. Geometric analysis indicated that total spinal CSF space volume was ∼8.7 ml. Average hydraulic diameter, wetted perimeter, and SAS area were 2.9 mm, 37.3 mm and 27.24 mm2, respectively. CSF pulse wave velocity (PWV) along the spine was quantified to be 1.2 m/s.
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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:
| | - Tao Xing
- Department of Mechanical Engineering, University of Idaho, Moscow, ID 83844 e-mail:
| | - Christina Gibbs
- Neurophysiological Imaging and Modeling Laboratory, Department of Biological Engineering, University of Idaho, Moscow, ID 83844 e-mail:
| | - John N Oshinski
- Department of Radiology, Emory University, Atlanta, GA 30322 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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Chang HH, Li CY, Gallogly AH. Brain MR Image Restoration Using an Automatic Trilateral Filter With GPU-Based Acceleration. IEEE Trans Biomed Eng 2018; 65:400-413. [DOI: 10.1109/tbme.2017.2772853] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sass LR, Khani M, Natividad GC, Tubbs RS, Baledent O, Martin BA. A 3D subject-specific model of the spinal subarachnoid space with anatomically realistic ventral and dorsal spinal cord nerve rootlets. Fluids Barriers CNS 2017; 14:36. [PMID: 29258534 PMCID: PMC5738087 DOI: 10.1186/s12987-017-0085-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/01/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The spinal subarachnoid space (SSS) has a complex 3D fluid-filled geometry with multiple levels of anatomic complexity, the most salient features being the spinal cord and dorsal and ventral nerve rootlets. An accurate anthropomorphic representation of these features is needed for development of in vitro and numerical models of cerebrospinal fluid (CSF) dynamics that can be used to inform and optimize CSF-based therapeutics. METHODS A subject-specific 3D model of the SSS was constructed based on high-resolution anatomic MRI. An expert operator completed manual segmentation of the CSF space with detailed consideration of the anatomy. 31 pairs of semi-idealized dorsal and ventral nerve rootlets (NR) were added to the model based on anatomic reference to the magnetic resonance (MR) imaging and cadaveric measurements in the literature. Key design criteria for each NR pair included the radicular line, descending angle, number of NR, attachment location along the spinal cord and exit through the dura mater. Model simplification and smoothing was performed to produce a final model with minimum vertices while maintaining minimum error between the original segmentation and final design. Final model geometry and hydrodynamics were characterized in terms of axial distribution of Reynolds number, Womersley number, hydraulic diameter, cross-sectional area and perimeter. RESULTS The final model had a total of 139,901 vertices with a total CSF volume within the SSS of 97.3 cm3. Volume of the dura mater, spinal cord and NR was 123.1, 19.9 and 5.8 cm3. Surface area of these features was 318.52, 112.2 and 232.1 cm2 respectively. Maximum Reynolds number was 174.9 and average Womersley number was 9.6, likely indicating presence of a laminar inertia-dominated oscillatory CSF flow field. CONCLUSIONS This study details an anatomically realistic anthropomorphic 3D model of the SSS based on high-resolution MR imaging of a healthy human adult female. The model is provided for re-use under the Creative Commons Attribution-ShareAlike 4.0 International license (CC BY-SA 4.0) and can be used as a tool for development of in vitro and numerical models of CSF dynamics for design and optimization of intrathecal therapeutics.
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Affiliation(s)
- Lucas R Sass
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MC1122, Moscow, ID, 83844-1122, USA
| | - Mohammadreza Khani
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MC1122, Moscow, ID, 83844-1122, USA
| | - Gabryel Connely Natividad
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MC1122, Moscow, ID, 83844-1122, USA
| | - R Shane Tubbs
- Seattle Science Foundation, 200 2nd Ave N, Seattle, WA, 98109, USA
| | - Olivier Baledent
- Bioflow Image, Service de Biophysique et de Traitement de l'Image médicale, Bâtiment des écoles, CHU Nord Amiens-Picardie, Place Victor Pauchet, 80054, Amiens Cedex 1, France
| | - Bryn A Martin
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MC1122, Moscow, ID, 83844-1122, USA. .,Department of Biological Engineering, University of Idaho, 875 Perimeter Dr. MC0904, Moscow, ID, 83844-0904, USA.
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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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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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