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Boyd ED, Kaur J, Ding G, Chopp M, Jiang Q. Clinical magnetic resonance imaging evaluation of glymphatic function. NMR IN BIOMEDICINE 2024; 37:e5132. [PMID: 38465514 DOI: 10.1002/nbm.5132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 03/12/2024]
Abstract
The glymphatic system is a system of specialized perivascular spaces in the brain that facilitates removal of toxic waste solutes from the brain. Evaluation of glymphatic system function by means of magnetic resonance imaging (MRI) has thus far been largely focused on rodents because of the limitations of intrathecal delivery of gadolinium-based contrast agents to humans. This review discusses MRI methods that can be employed clinically for glymphatic-related measurements intended for early diagnosis, prevention, and the treatment of various neurological conditions. Although glymphatic system-based MRI research is in its early stages, recent studies have identified promising noninvasive MRI markers associated with glymphatic system alterations in neurological diseases. However, further optimization in data acquisition, validation, and modeling are needed to investigate the glymphatic system within the clinical setting.
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Affiliation(s)
- Edward D Boyd
- Department of Neurology, Henry Ford Health System, Detroit, Michigan, USA
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
| | - Jasleen Kaur
- Department of Neurology, Henry Ford Health System, Detroit, Michigan, USA
- Department of Physics, Oakland University, Rochester, Michigan, USA
| | - Guangliang Ding
- Department of Neurology, Henry Ford Health System, Detroit, Michigan, USA
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
| | - Michael Chopp
- Department of Neurology, Henry Ford Health System, Detroit, Michigan, USA
- Department of Physics, Oakland University, Rochester, Michigan, USA
| | - Quan Jiang
- Department of Neurology, Henry Ford Health System, Detroit, Michigan, USA
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
- Department of Physics, Oakland University, Rochester, Michigan, USA
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Sincomb S, Moral-Pulido F, Campos O, Martínez-Bazán C, Haughton V, Sánchez A. An in vitro experimental investigation of oscillatory flow in the cerebral aqueduct. EUROPEAN JOURNAL OF MECHANICS. B, FLUIDS 2024; 105:180-191. [PMID: 38770034 PMCID: PMC11105671 DOI: 10.1016/j.euromechflu.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
This in vitro study aims at clarifying the relation between the oscillatory flow of cerebrospinal fluid (CSF) in the cerebral aqueduct, a narrow conduit connecting the third and fourth ventricles, and the corresponding interventricular pressure difference. Dimensional analysis is used in designing an anatomically correct scaled model of the aqueduct flow, with physical similarity maintained by adjusting the flow frequency and the properties of the working fluid. The time-varying pressure difference across the aqueduct corresponding to a given oscillatory flow rate is measured in parametric ranges covering the range of flow conditions commonly encountered in healthy subjects. Parametric dependences are delineated for the time-averaged pressure fluctuations and for the phase lag between the transaqueductal pressure difference and the flow rate, both having clinical relevance. The results are validated through comparisons with predictions obtained with a previously derived computational model. The parametric quantification in this study enables the derivation of a simple formula for the relation between the transaqueductal pressure and the stroke volume. This relationship can be useful in the quantification of transmantle pressure differences based on non-invasive magnetic-resonance-velocimetry measurements of aqueduct flow for investigation of CSF-related disorders.
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Affiliation(s)
- S. Sincomb
- Department of Aerospace and Mechanical Engineering, University of California, San Diego, La Jolla, 92093-0411, CA, USA
| | - F. Moral-Pulido
- Department of Mechanical and Mining Engineering, University of Jaen, Jaen, 23071, Spain
- Andalusian Institute for Earth System Research, University of Jaen, Jaen, 23071, Spain
| | - O. Campos
- Department of Aerospace and Mechanical Engineering, University of California, San Diego, La Jolla, 92093-0411, CA, USA
| | - C. Martínez-Bazán
- Department of Mechanics of Structures and Hydraulic Engineering, University of Granada, Granada, 18001, Spain
- Andalusian Institute for Earth System Research, University of Granada, Granada, 18006, Spain
| | - V. Haughton
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, 53706, WI, USA
| | - A.L. Sánchez
- Department of Aerospace and Mechanical Engineering, University of California, San Diego, La Jolla, 92093-0411, CA, USA
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Stöcklein S, Brandlhuber M, Lause S, Pomschar A, Jahn K, Schniepp R, Alperin N, Ertl-Wagner B. Decreased Craniocervical CSF Flow in Patients with Normal Pressure Hydrocephalus: A Pilot Study. AJNR Am J Neuroradiol 2022; 43:230-237. [PMID: 34992125 PMCID: PMC8985674 DOI: 10.3174/ajnr.a7385] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Normal pressure hydrocephalus is characterized by systolic peaks of raised intracranial pressure, possibly due to a reduced compliance of the spinal CSF spaces. This concept of a reduced spinal CSF buffer function may be reflected by a low cervical CSF outflow from the cranium. The aim of this study was to investigate craniospinal CSF flow rates by phase-contrast MR imaging in patients with normal pressure hydrocephalus. MATERIALS AND METHODS A total of 42 participants were included in this prospective study, consisting of 3 study groups: 1) 10 patients with normal pressure hydrocephalus (mean age, 74 [SD, 6] years, with proved normal pressure hydrocephalus according to current scientific criteria); 2) eighteen age-matched healthy controls (mean age, 71 [SD, 5] years); and 3) fourteen young healthy controls (mean age, 21 [SD, 2] years, for investigation of age-related effects). Axial phase-contrast MR imaging was performed, and the maximal systolic CSF and total arterial blood flow rates were measured at the level of the upper second cervical vertebra and compared among all study groups (2-sample unpaired t test). RESULTS The maximal systolic CSF flow rate was significantly decreased in patients with normal pressure hydrocephalus compared with age-matched and young healthy controls (53 [SD, 40] mL/m; 329 [SD, 175] mL/m; 472 [SD, 194] mL/m; each P < .01), whereas there were no significant differences with regard to maximal systolic arterial blood flow (1160 [SD, 404] mL/m; 1470 [SD, 381] mL/m; 1400 [SD, 254] mL/m; each P > .05). CONCLUSIONS The reduced maximal systolic craniospinal CSF flow rate in patients with normal pressure hydrocephalus may be reflective of a reduced compliance of the spinal CSF spaces and an ineffective spinal CSF buffer function. Systolic craniospinal CSF flow rates are an easily obtainable MR imaging-based measure that may support the diagnosis of normal pressure hydrocephalus.
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Affiliation(s)
| | | | - S.S. Lause
- Department of Dermatology (S.S.L.), Bethesda Hospital, Freudenberg, Germany
| | - A. Pomschar
- Radiological Office (A.P.), Centre for Radiology, Munich, Germany
| | - K. Jahn
- Neurology, and Friedrich-Baur-Institute (FBI) of the Department of Neurology (K.J.)
| | - R. Schniepp
- Neurology (R.S.), Ludwig-Maximilians-University Munich, Munich, Germany
| | - N. Alperin
- Department of Radiology (N.A.), University of Miami, Coral Gables, Florida
| | - B. Ertl-Wagner
- Department of Medical Imaging (B.E.-W.), The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Wu X, Richard SA, Xiangdong X, Lirong Z, Min W. Intracranial Cerebrospinal Fluid Volume Evaluation in Healthy People and Hydrocephalus Patients using SPACE Sequence. Curr Med Imaging 2021; 17:878-883. [PMID: 33949937 PMCID: PMC8811619 DOI: 10.2174/1573405617666210504093557] [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: 01/01/2021] [Revised: 03/12/2021] [Accepted: 03/29/2021] [Indexed: 12/02/2022]
Abstract
Introduction Cerebrospinal Fluid (CSF) is produced mainly by the choroid plexus but with a substantial influence by the ependymal lining of the ventricles in the brain. Hydrocephalus occurs as a result of discrepancy in the production as well as circulation of CSF as a result of congenital and acquired conditions. Nevertheless, studies on the differences between CSF dynamics according to age and gender are still insufficient. Thus, this study evaluated the volume of intracranial CSF in healthy people and hydrocephalus patients taking into account the differences between CSF dynamics according to age and gender using Sampling Perfection with Application optimised Contrast using different flip-angle Evolution (SPACE) sequence. Methods 120 healthy volunteers and 60 patients with hydrocephalus were included in this study. SPACE sequence was used to evaluate intracranial CSF with a 3.0T magnetic resonance machine. The total volume of intracranial CSF and the amount of CSF in the ventricle were obtained using a software, and the volume ratio of CSF in the subarachnoid space, the ventricle and the subarachnoid space were calculated. Results The mean volume of intracranial CSF, ventricular CSF, and subarachnoid CSF of male volunteers were (206.9±47.7) cm3, (33.0±10.7) cm3, (173.9±37.9) cm3 respectively. The average volume of intracranial CSF, ventricular CSF, and subarachnoid CSF of female volunteers were (199.7±44.9) cm3, (30.8±9.4) cm3, and (168.9±37.0) cm3, respectively. Thus, no significant statistically (P>0.05) difference between males and females was found. (3) The mean values of intracranial CSF, ventricle CSF and subarachnoid CSF, ventricle and subarachnoid CSF volume ratio in patients with hydrocephalus were significantly greater than health volunteers. Thus, the difference between the two groups was statistically significant (P<0.05). Conclusion SPACE sequence can quantitatively determine the content of CSF. The change of CSF volume has nothing to do with gender but with age. It is feasible to use SPACE sequence to evaluate the spatial distribution and volume of intracranial CSF.
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Affiliation(s)
- Xiaofeng Wu
- Department of Neurosurgery, Jiangyin Hospital, Southeast University, Jiangyin, 214400, Jiangsu province, China
| | - Seidu A Richard
- Department of Neurosurgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu Province, China
| | - Xu Xiangdong
- Department of Neurosurgery, Jiangyin Hospital, Southeast University, Jiangyin, 214400, Jiangsu province, China
| | - Zhang Lirong
- Department of Radiology, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu Province, China
| | - Wu Min
- Department of Neurosurgery, Jiangyin Hospital, Southeast University, Jiangyin, 214400, Jiangsu province, China
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Using deep learning convolutional neural networks to automatically perform cerebral aqueduct CSF flow analysis. J Clin Neurosci 2021; 90:60-67. [PMID: 34275582 DOI: 10.1016/j.jocn.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/11/2021] [Accepted: 05/01/2021] [Indexed: 11/22/2022]
Abstract
Since the development of phase-contrast magnetic resonance imaging (PC-MRI), quantification of cerebrospinal fluid (CSF) flow across the cerebral aqueduct has been utilized for diagnosis of conditions such as normal pressure hydrocephalus (NPH). This study aims to develop an automated method of aqueduct CSF flow analysis using convolution neural networks (CNNs), which can replace the current standard involving manual segmentation of aqueduct region of interest (ROI). Retrospective analysis was performed on 333 patients who underwent PC-MRI, totaling 353 imaging studies. Aqueduct flow measurements using manual ROI placement was performed independently by two radiologists. Two types of CNNs, MultiResUNet and UNet, were trained using ROI data from the senior radiologist, with PC-MRI studies being randomly divided into training (80%) and validation (20%) datasets. Segmentation performance was assessed using Dice similarity coefficient (DSC), and CSF flow parameters were calculated from both manual and CNN-derived ROIs. MultiResUNet, UNet and second radiologist (Rater 2) had DSCs of 0.933, 0.928, and 0.867, respectively, with p < 0.001 between CNNs and Rater 2. Comparison of CSF flow parameters showed excellent intraclass correlation coefficients (ICCs) for MultiResUNet, with lowest correlation being 0.67. For UNet, lower ICCs of -0.01 to 0.56 were observed. Only 3/353 (0.8%) studies failed to have appropriate ROIs placed by MultiResUNet, compared to 12/353 (3.4%) failed cases for UNet. In conclusion, CNNs were able to measure aqueductal CSF flow with similar performance to a senior neuroradiologist. MultiResUNet demonstrated fewer cases of segmentation failure and more consistent flow measurements compared to the widely adopted UNet.
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Nakajima M, Yamada S, Miyajima M, Ishii K, Kuriyama N, Kazui H, Kanemoto H, Suehiro T, Yoshiyama K, Kameda M, Kajimoto Y, Mase M, Murai H, Kita D, Kimura T, Samejima N, Tokuda T, Kaijima M, Akiba C, Kawamura K, Atsuchi M, Hirata Y, Matsumae M, Sasaki M, Yamashita F, Aoki S, Irie R, Miyake H, Kato T, Mori E, Ishikawa M, Date I, Arai H. Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus (Third Edition): Endorsed by the Japanese Society of Normal Pressure Hydrocephalus. Neurol Med Chir (Tokyo) 2021; 61:63-97. [PMID: 33455998 PMCID: PMC7905302 DOI: 10.2176/nmc.st.2020-0292] [Citation(s) in RCA: 190] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Among the various disorders that manifest with gait disturbance, cognitive impairment, and urinary incontinence in the elderly population, idiopathic normal pressure hydrocephalus (iNPH) is becoming of great importance. The first edition of these guidelines for management of iNPH was published in 2004, and the second edition in 2012, to provide a series of timely, evidence-based recommendations related to iNPH. Since the last edition, clinical awareness of iNPH has risen dramatically, and clinical and basic research efforts on iNPH have increased significantly. This third edition of the guidelines was made to share these ideas with the international community and to promote international research on iNPH. The revision of the guidelines was undertaken by a multidisciplinary expert working group of the Japanese Society of Normal Pressure Hydrocephalus in conjunction with the Japanese Ministry of Health, Labour and Welfare research project. This revision proposes a new classification for NPH. The category of iNPH is clearly distinguished from NPH with congenital/developmental and acquired etiologies. Additionally, the essential role of disproportionately enlarged subarachnoid-space hydrocephalus (DESH) in the imaging diagnosis and decision for further management of iNPH is discussed in this edition. We created an algorithm for diagnosis and decision for shunt management. Diagnosis by biomarkers that distinguish prognosis has been also initiated. Therefore, diagnosis and treatment of iNPH have entered a new phase. We hope that this third edition of the guidelines will help patients, their families, and healthcare professionals involved in treating iNPH.
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Affiliation(s)
- Madoka Nakajima
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shigeki Yamada
- Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Shiga, Japan
| | - Masakazu Miyajima
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Kazunari Ishii
- Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Nagato Kuriyama
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Kyoto, Japan
| | - Hiroaki Kazui
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Suehiro
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masahiro Kameda
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Yoshinaga Kajimoto
- Department of Neurosurgery, Division of Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Mitsuhito Mase
- Department of Neurosurgery, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Hisayuki Murai
- Department of Neurosurgery, Chibaken Saiseikai Narashino Hospital, Narashino, Chiba, Japan
| | - Daisuke Kita
- Department of Neurosurgery, Noto General Hospital, Nanao, Ishikawa, Japan
| | - Teruo Kimura
- Department of Neurosurgery, Kitami Red Cross Hospital, Kitami, Hokkaido, Japan
| | - Naoyuki Samejima
- Department of Neurosurgery, Tokyo Kyosai Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan
| | - Takahiko Tokuda
- Department of Functional Brain Imaging Research, National Institute of Radiological Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Chiba, Japan
| | - Mitsunobu Kaijima
- Department of Neurosurgery, Hokushinkai Megumino Hospital, Eniwa, Hokkaido, Japan
| | - Chihiro Akiba
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Kaito Kawamura
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masamichi Atsuchi
- Normal Pressure Hydrocephalus Center, Jifukai Atsuchi Neurosurgical Hospital, Kagoshima, Kagoshima, Japan
| | - Yoshihumi Hirata
- Department of Neurosurgery, Kumamoto Takumadai Hospital, Kumamoto, Kumamoto, Japan
| | - Mitsunori Matsumae
- Department of Neurosurgery at Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Makoto Sasaki
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Iwate, Japan
| | - Fumio Yamashita
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Iwate, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryusuke Irie
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroji Miyake
- Nishinomiya Kyoritsu Rehabilitation Hospital, Nishinomiya, Hyogo, Japan
| | - Takeo Kato
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata, Yamagata, Japan
| | - Etsuro Mori
- Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Suita, Osaka, Japan
| | - Masatsune Ishikawa
- Department of Neurosurgery and Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Kyoto, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
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Tripathi M, Vibha D. Normal-Pressure Hydrocephalus - Patient Evaluation and Decision-Making. Neurol India 2021; 69:S406-S412. [DOI: 10.4103/0028-3886.332267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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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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Osawa T, Ohno N, Mase M, Miyati T, Omasa R, Ishida S, Kan H, Arai N, Kasai H, Shibamoto Y, Kobayashi S, Gabata T. Changes in Apparent Diffusion Coefficient (ADC) during Cardiac Cycle of the Brain in Idiopathic Normal Pressure Hydrocephalus Before and After Cerebrospinal Fluid Drainage. J Magn Reson Imaging 2020; 53:1200-1207. [PMID: 33112007 DOI: 10.1002/jmri.27412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The causative mechanisms of idiopathic normal-pressure hydrocephalus (iNPH) symptoms are currently unknown. PURPOSE To assess the dynamic changes in the apparent diffusion coefficient (ADC) during the cardiac cycle (ΔADC) of the brain before and after the lumbar tap and shunt surgery for the purpose of determining changes in hydrodynamic and biomechanical properties in the brain after cerebrospinal fluid (CSF) drainage for iNPH. STUDY TYPE Retrospective. SUBJECTS Overall, 22 patients suspected to have iNPH were examined before and after the lumbar tap and were divided into patients who showed symptomatic improvements (positive group, n = 17) and those without improvement (negative group, n = 5) after the lumbar tap. Seven patients in the positive group were examined after the shunt surgery. FIELD STRENGTH/SEQUENCE 1.5T, electrocardiographically synchronized single-shot diffusion echo-planar imaging. ASSESSMENT The frontal white matter ΔADC and mean ADC (ADCmean ) were compared between before and 24 hours after lumbar tap and from 1 week to 1 month after the shunt surgery. STATISTICAL TESTS Wilcoxon signed-rank test was used. P < 0.05 was considered statistically significant. RESULTS The ΔADC after the lumbar tap in the positive group was significantly lower than that before (P < 0.05), whereas no significant difference was found in the negative group (P = 0.23). After the lumbar tap, ΔADC decreased in 16 of 17 patients in the positive group, whereas ADCmean did not significantly change (P = 0.96). After the shunt surgery, ΔADC decreased in all seven patients (P < 0.05), whereas ADCmean did not significantly change (P = 0.87). DATA CONCLUSION The frontal white matter ΔADC in iNPH decreased after the lumbar tap and shunt surgery. ΔADC analysis may provide detailed information regarding changes in the hydrodynamic and biomechanical properties through CSF drainage. LEVEL OF EVIDENCE 4. TECHNICAL EFFICACY STAGE 4.
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Affiliation(s)
- Tomoshi Osawa
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Naoki Ohno
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Mitsuhito Mase
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tosiaki Miyati
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Ryoko Omasa
- Department of Medical Technology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Shota Ishida
- Radiological Center, University of Fukui Hospital, Fukui, Japan
| | - Hirohito Kan
- Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Arai
- Department of Radiological Technology, Suzuka University of Medical Science, Suzuka, Japan
| | - Harumasa Kasai
- Department of Radiology, Nagoya City University Hospital, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Hospital, Nagoya, Japan
| | - Satoshi Kobayashi
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.,Department of Radiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Japan
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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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11
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Skalický P, Mládek A, Vlasák A, De Lacy P, Beneš V, Bradáč O. Normal pressure hydrocephalus—an overview of pathophysiological mechanisms and diagnostic procedures. Neurosurg Rev 2019; 43:1451-1464. [DOI: 10.1007/s10143-019-01201-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/27/2019] [Accepted: 10/25/2019] [Indexed: 01/25/2023]
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12
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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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13
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Zhang L, Hussain Z, Ren Z. Recent Advances in Rational Diagnosis and Treatment of Normal Pressure Hydrocephalus: A Critical Appraisal on Novel Diagnostic, Therapy Monitoring and Treatment Modalities. Curr Drug Targets 2019; 20:1041-1057. [PMID: 30767741 DOI: 10.2174/1389450120666190214121342] [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] [Received: 12/05/2018] [Revised: 02/02/2019] [Accepted: 02/06/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Normal pressure hydrocephalus (NPH) is a critical brain disorder in which excess Cerebrospinal Fluid (CSF) is accumulated in the brain's ventricles causing damage or disruption of the brain tissues. Amongst various signs and symptoms, difficulty in walking, slurred speech, impaired decision making and critical thinking, and loss of bladder and bowl control are considered the hallmark features of NPH. OBJECTIVE The current review was aimed to present a comprehensive overview and critical appraisal of majorly employed neuroimaging techniques for rational diagnosis and effective monitoring of the effectiveness of the employed therapeutic intervention for NPH. Moreover, a critical overview of recent developments and utilization of pharmacological agents for the treatment of hydrocephalus has also been appraised. RESULTS Considering the complications associated with the shunt-based surgical operations, consistent monitoring of shunting via neuroimaging techniques hold greater clinical significance. Despite having extensive applicability of MRI and CT scan, these conventional neuroimaging techniques are associated with misdiagnosis or several health risks to patients. Recent advances in MRI (i.e., Sagittal-MRI, coronal-MRI, Time-SLIP (time-spatial-labeling-inversion-pulse), PC-MRI and diffusion-tensor-imaging (DTI)) have shown promising applicability in the diagnosis of NPH. Having associated with several adverse effects with surgical interventions, non-invasive approaches (pharmacological agents) have earned greater interest of scientists, medical professional, and healthcare providers. Amongst pharmacological agents, diuretics, isosorbide, osmotic agents, carbonic anhydrase inhibitors, glucocorticoids, NSAIDs, digoxin, and gold-198 have been employed for the management of NPH and prevention of secondary sensory/intellectual complications. CONCLUSION Employment of rational diagnostic tool and therapeutic modalities avoids misleading diagnosis and sophisticated management of hydrocephalus by efficient reduction of Cerebrospinal Fluid (CSF) production, reduction of fibrotic and inflammatory cascades secondary to meningitis and hemorrhage, and protection of brain from further deterioration.
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Affiliation(s)
- Lei Zhang
- Department of Radiology, Baoji Center Hospital, Baoji, Shaanxi, China
| | - Zahid Hussain
- Department of Pharmaceutics, Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Selangor, Puncak Alam Campus, Bandar Puncak Alam 42300, Selangor, Malaysia
| | - Zhuanqin Ren
- Department of Radiology, Baoji Center Hospital, No. 8 Jiang Tan Road, Baoji 721008, Shaanxi, China
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14
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Gokul UR, Ramakrishnan KG. Change in average peak cerebrospinal fluid velocity at the cerebral aqueduct, before and after lumbar CSF tapping by the use of phase contrast MRI, and its effect on gait improvement in patients with normal pressure hydrocephalus. Neurol India 2018; 66:1407-1412. [PMID: 30233015 DOI: 10.4103/0028-3886.241406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives To compare the change in peak cerebrospinal (CSF) flow velocity at the cerebral aqueduct in patients with normal pressure hydrocephalus (NPH) before and after CSF tapping with clinical outcome of the patients, i.e., gait improvement. Materials and Methods Forty patients with NPH were evaluated before and after CSF tapping on 3 consecutive days at our institution. Gait improvement was compared with the average peak velocity at the cerebral aqueduct. The average peak velocity was also compared before and after lumbar CSF tapping using phase contrast magnetic resonance imaging (PC-MRI). The different flow parameters were compared using paired t-test. Results The average peak velocity before and after lumbar CSF tapping was 5.8196 ± 1.420 cm/s and 4.1411 ± 1.0638 cm/s, respectively. The peak positive, negative, and average velocity decreased in the post-tap group. In our study, 70% of the patients showed gait improvement, and a comparison of the gait improvement with the change in average peak velocity was statistically significant (P = 0.001). Comparison of the change in peak positive and negative velocity with gait improvement was also statistically significant, with a P value of 0.004 and <0.001, respectively. Rest of the CSF flow parameters were statistically insignificant. Conclusion PC-MRI is a sensitive method to support the diagnosis of NPH. Different flow parameters were comparable before and after CSF tapping. The parameters which might be useful for assessing clinical improvement include a change in the peak average, as well as positive, and negative velocity.
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Affiliation(s)
- Uthamanthil R Gokul
- Department of Radiology and Imaging Sciences, Malabar Institute of Medical Sciences, Calicut, Kerala, India
| | - Kollengode G Ramakrishnan
- Department of Radiology and Imaging Sciences, Malabar Institute of Medical Sciences, Calicut, Kerala, India
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15
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Borzage M, Ponrartana S, Tamrazi B, Gibbs W, Nelson MD, McComb JG, Blüml S. A new MRI tag-based method to non-invasively visualize cerebrospinal fluid flow. Childs Nerv Syst 2018; 34:1677-1682. [PMID: 29876643 DOI: 10.1007/s00381-018-3845-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/17/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Abnormal cerebrospinal fluid (CSF) dynamics can produce a number of significant clinical problems to include hydrocephalus, loculated areas within the ventricles or subarachnoid spaces as well as impairment of normal CSF movement between the cranial and spinal compartments that can result in a cerebellar ectopia and hydrosyringomyelia. Thus, assessing the patency of fluid flow between adjacent CSF compartments non-invasively by magnetic resonance imaging (MRI) has definite clinical value. Our objective was to demonstrate that a novel tag-based CSF imaging methodology offers improved contrast when compared with a commercially available application. METHODS In a prospective study, ten normal healthy adult subjects were examined on 3T magnets with time-spatial labeling inversion pulse (Time-SLIP) and a new tag-based flow technique-time static tagging and mono-contrast preservation (Time-STAMP). The image contrast was calculated for dark-untagged CSF and bright-flowing CSF. We tested the results with the D'Agostino and Pearson normality test and Friedman's test with Dunn's multiple comparison correction for significance. Separately 96 pediatric patients were evaluated using the Time-STAMP method. RESULTS In healthy adults, contrasts were consistently higher with Time-STAMP than Time-SLIP (p < 0.0001, in all ROI comparisons). The contrast between untagged CSF and flowing tagged CSF improved by 15 to 34%. In both healthy adults and pediatric patients, CSF flow between adjacent fluid compartments was demonstrated. CONCLUSIONS Time-STAMP provided images with higher contrast than Time-SLIP, without diminishing the ability to visualize qualitative CSF movement and between adjacent fluid compartments.
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Affiliation(s)
- Matthew Borzage
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA. .,Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, USA. .,Rudi Schulte Research Institute, Santa Barbara, CA, USA.
| | - Skorn Ponrartana
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Rudi Schulte Research Institute, Santa Barbara, CA, USA.,Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Benita Tamrazi
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wende Gibbs
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Marvin D Nelson
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - J Gordon McComb
- Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stefan Blüml
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Rudi Schulte Research Institute, Santa Barbara, CA, USA
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Khachatryan T, Robinson JS. The possible impact of cervical stenosis on cephalad neuronal dysfunction. Med Hypotheses 2018; 118:13-18. [PMID: 30037601 DOI: 10.1016/j.mehy.2018.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/07/2018] [Indexed: 12/25/2022]
Abstract
Earlier observers have speculated on the causal relationships between abnormal CSF circulation and a variety of neurological dysfunctions. Such speculations have been at least partially validated by recent evidence and inquiries contravening the traditional static viewpoint of CSF circulation. More contemporary inquiries establish a number of factors which influence both CSF production and absorption (sleep disturbance, neck position, cerebral metabolism, brain atrophy, medications, etc.). Thus, transient periods of abnormality are possibly mingled with periods of normality. Such episodic alterations suggest that the physiological arrangements which underpin CSF circulation may be in some ways likened to blood pressure alterations, in that long-standing CSF abnormalities may be both unappreciated and gradual, though virulent enough to cause substantial neurological injury. We suggest that cervical stenosis (blocking an important CSF decompressive pathway into the vertebral canal) is among the largely unappreciated causes of abnormal CSF circulation and may play a role in cephalad neuronal dysfunction. Such a blockage is correlated with age and easily assessed by cine MRI study. Indeed, episodic disturbances can diminish CSF cerebral flow circulation increasing deposition in cerebral parenchyma of contrary metabolic products (e.g. beta Amyloid), possibly having a causal influence on senile dementia. Additionally, cervical stenosis, by increasing posterior fossa cerebral pressure, could play a causal role in a number of afflictions, among them sleep apnea, concomitant respiratory and circulatory dysfunction, hypertension, chronic occipital headaches, tinnitus, etc. We further suggest that among those patients with substantial cervical stenosis (extensive enough to block CSF circulation in the cervical area as identified by cine MRI) appropriate comparative clinical studies could be undertaken to demarcate associations with presenile dementia, sleep disturbance and posterior fossa dysfunction. Additionally, we suggest that an intracranial monitoring implant be perfected to chronically monitor both intracranial pressure and CSF flow - a monitoring device comparable to the rather less invasive sphygmometric evaluation of blood pressure. If such speculations prove correct, different therapeutic regimens which might improve outcome could be imagined. Among them better sleep hygiene (to by position maximize CSF flow) and possibly more aggressive operative decompressive intervention to diminish cervical obstruction.
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Affiliation(s)
- Tigran Khachatryan
- Georgia Neurosurgical Institute, 840 Pine Street, Suite 880, Macon, GA 31210, United States.
| | - Joe Sam Robinson
- Georgia Neurosurgical Institute, 840 Pine Street, Suite 880, Macon, GA 31210, United States
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Nowosławska E, Gwizdała D, Barańska D, Grzelak P, Podgórski M, Zakrzewski K, Polis B, Stasiołek M, Polis L. The oscillatory flow of the cerebrospinal fluid in the Sylvian aqueduct and the prepontine cistern measured with phase contrast MRI in children with hydrocephalus-a preliminary report. Childs Nerv Syst 2018; 34:845-851. [PMID: 29322338 PMCID: PMC5895674 DOI: 10.1007/s00381-017-3699-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 12/12/2017] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Recognizing patients with ventriculomegaly who are at risk of developing acute hydrocephalus presents a challenge for the clinician. The association between disturbed cerebrospinal fluid flow (CSF) and impaired brain compliance may play a role in the pathogenesis of hydrocephalus. Phase contrast MRI is a noninvasive technique which can be used to assess CSF parameters. The aim of the work is to evaluate the effectiveness of phase contrast MRI in recognizing patients at risk of acute hydrocephalus, based on measuring the pulsatile CSF flow parameters in the Sylvian aqueduct and prepontine cistern in children with ventriculomegaly. AIM The aim of the work is to characterize the parameters of cerebrospinal fluid (CSF) flow in the Sylvian aqueduct and prepontine cistern in children with ventriculomegaly with regard to patient age and symptoms. We hypothesize that the relationship between CSF flow parameters in these two regions will vary according to analyzed factors and it will allow to recognize children at risk of hydrocephalus. MATERIALS AND METHODS A group of 26 children with ventriculomegaly (five girls and 21 boys) underwent phase contrast MRI examinations (Philips 3T Achieva with Q-flow integral application). Amplitudes of average and peak velocities of the CSF flow through the Sylvian aqueduct and prepontine cistern were used to calculate ratios of oscillation and peak velocities, respectively. The relationship between the oscillation coefficient, the peak velocity coefficient, and stroke volume was then assessed in accordance with age and clinical symptoms. RESULTS The peak velocity coefficient was significantly higher in patients with hyper-oscillating flow through the Sylvian aqueduct (3.04 ± 3.37 vs. 0.54 ± 0.28; p = 0.0094). Moreover, these patients tended to develop symptoms more often (p = 0.0612). No significant age-related changes were observed in CSF flow parameters. CONCLUSION Phase contrast MRI is a useful tool for noninvasive assessment of CSF flow parameters. The application of coefficients instead of direct values seems to better represent hemodynamic conditions in the ventricular system. However, further studies are required to evaluate their clinical significance and normal limits.
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Affiliation(s)
- Emilia Nowosławska
- Department of Neurosurgery, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland.
| | - Dominika Gwizdała
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Dobromiła Barańska
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Piotr Grzelak
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Michał Podgórski
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Krzysztof Zakrzewski
- Department of Neurosurgery, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Bartosz Polis
- Department of Neurosurgery, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Mariusz Stasiołek
- Department of Neurology, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Lech Polis
- Department of Neurosurgery, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
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18
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Ringstad G, Lindstrøm EK, Vatnehol SAS, Mardal KA, Emblem KE, Eide PK. Non-invasive assessment of pulsatile intracranial pressure with phase-contrast magnetic resonance imaging. PLoS One 2017; 12:e0188896. [PMID: 29190788 PMCID: PMC5708728 DOI: 10.1371/journal.pone.0188896] [Citation(s) in RCA: 25] [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: 10/26/2016] [Accepted: 11/02/2017] [Indexed: 12/04/2022] Open
Abstract
Invasive monitoring of pulsatile intracranial pressure can accurately predict shunt response in patients with idiopathic normal pressure hydrocephalus, but may potentially cause complications such as bleeding and infection. We tested how a proposed surrogate parameter for pulsatile intracranial pressure, the phase-contrast magnetic resonance imaging derived pulse pressure gradient, compared with its invasive counterpart. In 22 patients with suspected idiopathic normal pressure hydrocephalus, preceding invasive intracranial pressure monitoring, and any surgical shunt procedure, we calculated the pulse pressure gradient from phase-contrast magnetic resonance imaging derived cerebrospinal fluid flow velocities obtained at the upper cervical spinal canal using a simplified Navier-Stokes equation. Repeated measurements of the pulse pressure gradient were also undertaken in four healthy controls. Of 17 shunted patients, 16 responded, indicating high proportion of “true” normal pressure hydrocephalus in the patient cohort. However, there was no correlation between the magnetic resonance imaging derived pulse pressure gradient and pulsatile intracranial pressure (R = -.18, P = .43). Pulse pressure gradients were also similar in patients and healthy controls (P = .26), and did not differ between individuals with pulsatile intracranial pressure above or below established thresholds for shunt treatment (P = .97). Assessment of pulse pressure gradient at level C2 was therefore not found feasible to replace invasive monitoring of pulsatile intracranial pressure in selection of patients with idiopathic normal pressure hydrocephalus for surgical shunting. Unlike invasive, overnight monitoring, the pulse pressure gradient from magnetic resonance imaging comprises short-term pressure fluctuations only. Moreover, complexity of cervical cerebrospinal fluid flow and -pulsatility at the upper cervical spinal canal may render the pulse pressure gradient a poor surrogate marker for intracranial pressure pulsations.
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Affiliation(s)
- Geir Ringstad
- Department of Radiology and Nuclear Medicine, Oslo University Hospital—Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- * E-mail:
| | - Erika Kristina Lindstrøm
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Svein Are Sirirud Vatnehol
- Faculty of Medicine, University of Oslo, Oslo, Norway
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Kent-André Mardal
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | | | - Per Kristian Eide
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
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Corte AD, de Souza CFM, Anés M, Maeda FK, Lokossou A, Vedolin LM, Longo MG, Ferreira MM, Perrone SGP, Balédent O, Giugliani R. Correlation of CSF flow using phase-contrast MRI with ventriculomegaly and CSF opening pressure in mucopolysaccharidoses. Fluids Barriers CNS 2017; 14:23. [PMID: 28918752 PMCID: PMC5603164 DOI: 10.1186/s12987-017-0073-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/04/2017] [Indexed: 11/30/2022] Open
Abstract
Background Very little is known about the incidence and prevalence of hydrocephalus in patients with mucopolysaccharidoses (MPS). The biggest challenge is to distinguish communicating hydrocephalus from ventricular dilatation secondary to brain atrophy, because both conditions share common clinical and neuroradiological features. The main purpose of this study is to assess the relationship between ventriculomegaly, brain and cerebrospinal fluid (CSF) volumes, aqueductal and cervical CSF flows, and CSF opening pressure in MPS patients, and to provide potential biomarkers for abnormal CSF circulation. Methods Forty-three MPS patients (12 MPS I, 15 MPS II, 5 MPS III, 9 MPS IV A and 2 MPS VI) performed clinical and developmental tests, and T1, T2, FLAIR and phase-contrast magnetic resonance imaging (MRI) followed by a lumbar puncture with the CSF opening pressure assessment. For the analysis of MRI variables, we measured the brain and CSF volumes, white matter (WM) lesion load, Evans’ index, third ventricle width, callosal angle, dilated perivascular spaces (PVS), craniocervical junction stenosis, aqueductal and cervical CSF stroke volumes, and CSF glycosaminoglycans concentration. Results All the scores used to assess the supratentorial ventricles enlargement and the ventricular CSF volume presented a moderate correlation with the aqueductal CSF stroke volume (ACSV). The CSF opening pressure did not correlate either with the three measures of ventriculomegaly, or the ventricular CSF volume, or with the ACSV. Dilated PVS showed a significant association with the ventriculomegaly, ventricular CSF volume and elevated ACSV. Conclusions In MPS patients ventriculomegaly is associated with a severe phenotype, increased cognitive decline, WM lesion severity and enlarged PVS. The authors have shown that there are associations between CSF flow measurements and measurements related to CSF volumetrics. There was also an association of volumetric measurements with the degree of dilated PVS.
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Affiliation(s)
- Amauri Dalla Corte
- Post-Graduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90035-903, Brazil.
| | - Carolina F M de Souza
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90035-903, Brazil
| | - Maurício Anés
- Medical Physics and Radioprotection Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Fabio K Maeda
- Clinical Engineering, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Armelle Lokossou
- Image Processing Unit, Amiens University Hospital, Amiens, France
| | | | | | - Monica M Ferreira
- Anesthesiology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Solanger G P Perrone
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90035-903, Brazil
| | - Olivier Balédent
- Image Processing Unit, Amiens University Hospital, Amiens, France
| | - Roberto Giugliani
- Post-Graduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90035-903, Brazil
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20
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Shibukawa S, Miyati T, Niwa T, Matsumae M, Ogino T, Horie T, Imai Y, Muro I. Time-spatial Labeling Inversion Pulse (Time-SLIP) with Pencil Beam Pulse: A Selective Labeling Technique for Observing Cerebrospinal Fluid Flow Dynamics. Magn Reson Med Sci 2017; 17:259-264. [PMID: 28835572 PMCID: PMC6039785 DOI: 10.2463/mrms.tn.2017-0032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We assessed labeling region selectivity on time-spatial labeling inversion pulse (Time-SLIP) with pencil beam pulse (PB Time-SLIP) for the use of visualizing cerebrospinal fluid (CSF) flow dynamics. We compared the selectivity of labeling to the third and fourth ventricles between PB Time-SLIP and conventional Time-SLIP (cTime-SLIP) in eight volunteers and one patient using a 1.5T MRI. PB Time-SLIP provided more selective labeling in CSF than cTime-SLIP, particularly in complex anatomical regions.
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Affiliation(s)
- Shuhei Shibukawa
- Department of Radiology, Tokai University Hospital.,Division of Health Sciences, Graduate School of Medical Science, Kanazawa University
| | - Tosiaki Miyati
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University
| | - Tetsu Niwa
- Department of Radiology, Tokai University School of Medicine
| | | | | | | | - Yutaka Imai
- Department of Radiology, Tokai University School of Medicine
| | - Isao Muro
- Department of Radiology, Tokai University Hospital
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Ichikawa S, Motosugi U, Okumura A, Shimizu T, Onishi H. Measurement of Cerebrospinal Fluid Flow Dynamics Using Phase Contrast MR Imaging with Bilateral Jugular Vein Compression: A Feasibility Study in Healthy Volunteers. Magn Reson Med Sci 2017; 17:265-268. [PMID: 28819086 PMCID: PMC6039778 DOI: 10.2463/mrms.tn.2017-0056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We measured the changes in the cerebrospinal fluid (CSF) flow dynamics after compression of the bilateral jugular veins using phase contrast-magnetic resonance imaging (PC-MRI). PC-MRI was performed in 10 healthy male volunteers using a 3T clinical scanner with a two-dimensional gradient echo sequence. We successfully measured the changes in CSF flow velocity using PC-MRI with and without compression of the bilateral jugular veins. The relative velocity range decreased by about 30% when the bilateral jugular veins were compressed.
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Affiliation(s)
| | - Utaroh Motosugi
- Corresponding author, Phone: +81-55-273-1111, Fax: +81-55-273-6744, E-mail:
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22
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Phase-Contrast MRI CSF Flow Measurements for the Diagnosis of Normal-Pressure Hydrocephalus: Observer Agreement of Velocity Versus Volume Parameters. AJR Am J Roentgenol 2017; 208:838-843. [PMID: 28140607 DOI: 10.2214/ajr.16.16995] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Manual segmentation of the aqueduct for CSF flow analysis may induce measurement variability. The aim of our study was to assess observer agreement of manual segmentation and to compare the repeatability and accuracy of different flow parameters in differentiating normal-pressure hydrocephalus (NPH) from brain atrophy. SUBJECTS AND METHODS Thirty-two subjects were included and were divided into three groups: control, NPH, and brain atrophy. Subjects underwent phase-contrast MRI. Quantitative analysis of aqueductal CSF flow using manual ROI placement was performed by two independent readers. Reader 1 repeated measurements 3 months after the first session to assess interobserver and intraobserver agreement. Intraclass correlation coefficients (ICCs), within-subject SD, and repeatability were calculated. Peak systolic velocity (PSV), peak mean velocity, and aqueductal CSF stroke volume, which we refer to as "stroke volume," were recorded and compared between the three patient groups. The ROC curves of diagnostic accuracy for NPH were compared. RESULTS PSV was ROI-independent, so only one measurement was obtained. The NPH group had significantly higher PSV, peak mean velocity, and stroke volume values in all readings than both the control and brain atrophy groups. The accuracy of PSV for the diagnosis of NPH was 82.7%, and the accuracy of peak mean velocity was 92.5-93.3% for the three readings. Stroke volume had perfect accuracy of 100% for the three readings. The stroke volume had higher ICCs (0.97 and 0.98) than the peak mean velocity (0.88). The intraobserver repeatability and interobserver repeatability of peak mean velocity were 1.9 cm/s, and the intraobserver repeatability and interobserver repeatability of stroke volume were 27.4 and 19.6 µL/cycle, respectively. CONCLUSION Stroke volume had better agreement and repeatability and was more accurate than peak mean velocity for the diagnosis of NPH. PSV lacks variability but was the least accurate.
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Effects of lumbar drainage on CSF dynamics in subarachnoid hemorrhage condition: A computational study. Comput Biol Med 2016; 77:49-58. [DOI: 10.1016/j.compbiomed.2016.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 07/30/2016] [Accepted: 08/02/2016] [Indexed: 11/24/2022]
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Abstract
Normal pressure hydrocephalus (NPH) is a syndrome characterized by the triad of gait disturbance, mental deterioration and urinary incontinence, associated with ventriculomegaly and normal cerebrospinal fluid (CSF) pressure. The clinical presentation (triad) may be atypical or incomplete, or mimicked by other diseases, hence the need for supplementary tests, particularly to predict postsurgical outcome, such as CSF tap-tests and computed tomography (CT) or magnetic resonance imaging (MRI). The CSF tap-test, especially the 3 to 5 days continuous external lumbar drainage of at least 150 ml/day, is the only procedure that simulates the effect of definitive shunt surgery, with high sensitivity (50-100%) and high positive predictive value (80-100%). According to international guidelines, the following are CT or MRI signs decisive for NPH diagnosis and selection of shunt-responsive patients: ventricular enlargement disproportionate to cerebral atrophy (Evans index >0.3), and associated ballooning of frontal horns; periventricular hyperintensities; corpus callosum thinning and elevation, with callosal angle between 40º and 90º; widening of temporal horns not fully explained by hippocampal atrophy; and aqueductal or fourth ventricular flow void; enlarged Sylvian fissures and basal cistern, and narrowing of sulci and subarachnoid spaces over the high convexity and midline surface of the brain. On the other hand, other imaging methods such as radionuclide cisternography, SPECT, PET, and also DTI or resting-state functional MRI, although suitable for NPH diagnosis, do not yet provide improved accuracy for identifying shunt-responsive cases.
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Affiliation(s)
- Benito Pereira Damasceno
- MD, PhD, Department of Neurology, Medical School, University of Campinas (UNICAMP), Campinas SP, Brazil
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Ringstad G, Emblem KE, Geier O, Alperin N, Eide PK. Reply: To PMID 25977480. AJNR Am J Neuroradiol 2015; 36:1633-4. [PMID: 26251437 DOI: 10.3174/ajnr.a4488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - O Geier
- The Intervention Centre Oslo University Hospital-Rikshospitalet Oslo, Norway
| | - N Alperin
- University of Miami Miller School of Medicine Miami, Florida
| | - P K Eide
- Department of Neurosurgery Oslo University Hospital-Rikshospitalet Oslo, Norway
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Dynamics of respiratory and cardiac CSF motion revealed with real-time simultaneous multi-slice EPI velocity phase contrast imaging. Neuroimage 2015; 122:281-7. [PMID: 26241682 DOI: 10.1016/j.neuroimage.2015.07.073] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 06/22/2015] [Accepted: 07/24/2015] [Indexed: 11/20/2022] Open
Abstract
Cerebrospinal fluid (CSF) dynamics have been mostly studied with cardiac-gated phase contrast MRI combining signal from many cardiac cycles to create cine-phase sampling of one time-averaged cardiac cycle. The relative effects of cardiac and respiratory changes on CSF movement are not well understood. There is possible respiration-driven movement of CSF in ventricles, cisterns, and subarachnoid spaces which has not been characterized with velocity measurements. To date, commonly used cine-phase contrast techniques of velocity imaging inherently cannot detect respiratory velocity changes since cardiac-gated data acquired over several minutes randomizes respiratory phase contributions. We have developed an extremely fast, real-time, and quantitative MRI technique to image CSF velocity in simultaneous multi-slice (SMS) echo planar imaging (EPI) acquisitions of 3 or 6 slice levels simultaneously over 30s and observe 3D spatial distributions of CSF velocity. Measurements were made in 10 subjects utilizing a respiratory belt to record respiratory phases and visual cues to instruct subjects on breathing rates. A protocol is able to measure velocity within regions of brain and basal cisterns covered with 24 axial slices in 4 minutes, repeated for 3 velocity directions. These measurements were performed throughout the whole brain, rather than in selected line regions so that a global view of CSF dynamics could be visualized. Observations of cardiac and breathing-driven CSF dynamics show bidirectional respiratory motion occurs primarily along the central axis through the basal cisterns and intraventricular passageways and to a lesser extent in the peripheral Sylvian fissure with little CSF motion present in subarachnoid spaces. During inspiration phase, there is upward (inferior to superior) CSF movement into the cranial cavity and lateral ventricles and a reversal of direction in expiration phase.
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Ringstad G, Emblem KE, Geier O, Alperin N, Eide PK. Aqueductal Stroke Volume: Comparisons with Intracranial Pressure Scores in Idiopathic Normal Pressure Hydrocephalus. AJNR Am J Neuroradiol 2015; 36:1623-30. [PMID: 25977480 DOI: 10.3174/ajnr.a4340] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/11/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE Aqueductal stroke volume from phase-contrast MR imaging has been proposed for predicting shunt response in normal pressure hydrocephalus. However, this biomarker has remained controversial in use and has a lack of validation with invasive intracranial monitoring. We studied how aqueductal stroke volume compares with intracranial pressure scores in the presurgical work-up and clinical score, ventricular volume, and aqueduct area and assessed the patient's response to shunting. MATERIALS AND METHODS Phase-contrast MR imaging was performed in 21 patients with probable idiopathic normal pressure hydrocephalus. Patients were selected for shunting on the basis of pathologically increased intracranial pressure pulsatility. Patients with shunts were offered a second MR imaging after 12 months. Ventricular volume and transverse aqueductal area were calculated, as well as clinical symptom score. RESULTS No correlations between aqueductal stroke volume and preoperative scores of mean intracranial pressure or mean wave amplitudes were observed. Preoperative aqueductal stroke volume was not different between patients with shunts and conservatively treated patients (P = .69) but was correlated with ventricular volume (R = 0.60, P = .004) and aqueductal area (R = 0.58, P = .006) but not with the severity or duration of clinical symptoms. After shunting, aqueductal stroke volume (P = .006) and ventricular volume (P = .002) were reduced. A clinical improvement was seen in 16 of 17 patients who had shunts (94%). CONCLUSIONS Aqueductal stroke volume does not reflect intracranial pressure pulsatility or symptom score, but rather aqueduct area and ventricular volume. The results do not support the use of aqueductal stroke volume for selecting patients for shunting.
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Affiliation(s)
- G Ringstad
- From the Department of Radiology and Nuclear Medicine (G.R.)
| | - K E Emblem
- Intervention Centre (K.E.E., O.G.), Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - O Geier
- Intervention Centre (K.E.E., O.G.), Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - N Alperin
- Department of Radiology (N.A.), University of Miami Miller School of Medicine, Miami, Florida
| | - P K Eide
- Department of Neurosurgery (P.K.E.), Oslo University Hospital, Oslo, Norway Faculty of Medicine (P.K.E.), University of Oslo, Oslo, Norway
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Updated physiology and pathophysiology of CSF circulation--the pulsatile vector theory. Childs Nerv Syst 2013; 29:1811-25. [PMID: 23832074 DOI: 10.1007/s00381-013-2219-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 06/19/2013] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Hydrocephalus is still a not well-understood diagnostic and a therapeutic dilemma because of the lack of sufficient and comprehensive model of cerebrospinal fluid circulation and pathological alterations. CONCLUSIONS Based on current studies, reviews, and knowledge of cerebrospinal fluid dynamics, brain water dynamics, intracranial pressure, and cerebral perfusion physiology, a new concept is deducted that can describe normal and pathological changes of cerebrospinal fluid circulation and pathophysiology of idiopathic intracranial hypertension.
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Abstract
Flow compensation, a gradient pulse used for artifact reduction, often used to suppress cerebrospinal fluid (CSF) flow artifacts in spinal magnetic resonance imaging (MRI), can be switched off to make the CSF flow voids within syrinx (syringomyelia) and within aqueduct [normal pressure hydrocephalus (NPH)] more obvious (thus confirming CSF flow). It is a simple method which does not require much time or expertise.
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Affiliation(s)
- Anitha Sen
- Government Medical College, Kottayam, Kerala, India
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Aqueductal flow of cerebrospinal fluid (CSF) and anatomical configuration of the cerebral aqueduct (AC) in patients with communicating hydrocephalus--the trumpet sign. Eur J Radiol 2013; 82:664-70. [PMID: 23318053 DOI: 10.1016/j.ejrad.2012.11.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 11/16/2012] [Accepted: 11/17/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE We explore the relationship of aqueductal flow of cerebrospinal fluid (CSF) and the changes of the anatomical configuration of the cerebral aqueduct (AC) in patients with communicating hydrocephalus (CH) in a routine MRI setting. METHODS/PATIENTS We performed a retrospective evaluation of different anatomical configurations of the AC on midsaggital MRI images in 43 patients (medial age 67 years, median 68 years, range from 14 to 85, 25 women) with suspected communicating hydrocephalus and compared the anatomical form of the AC on the sagittal sequences with MRI CSF flow data. The measured acqueductal cross sectional area was correlated (Pearson's correlation coefficient, which is a measure of the linear dependence between two variables, is 0.747. From 0.7 to 1 correlation is strong, from 0.7 to 0.5 moderate correlation, from 0.5 to 0.3 weak correlation, and 0.3 to 0 means no correlation) with MRI CSF flow data based on phase contrast measurements. RESULTS Two independent neuroradiologists were blinded to the patients' diagnosis. In 53% (Rater I) and 67% (Rater II) the anatomical appearance of the AC on sagittal MRI was tubular shaped and in 47% (Rater I) and 33% (Rater II) trumpet shaped. Highly elevated CSF flow correlated with a dilated and trumpet shaped AC lumen area. CONCLUSION The anatomical morphology of the AC in midsagittal MRI sequences may be a significant diagnostic sign for suspected communicating hydrocephalus, already discernible on routine MRI scans; consequently, this may also be a sensitive method of supporting the clinical diagnosis of communicating hydrocephalus and moreover supports patients' selection for further CSF flow measurements.
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Zhang BO, Li SB. Cine-PC MR in assessment of cerebrospinal fluid velocity in the aqueduct of the midbrain correlated with intracranial pressure – Initial study. Med Hypotheses 2012; 78:227-30. [DOI: 10.1016/j.mehy.2011.10.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 08/30/2011] [Accepted: 10/23/2011] [Indexed: 11/25/2022]
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Wagshul ME, Eide PK, Madsen JR. The pulsating brain: A review of experimental and clinical studies of intracranial pulsatility. Fluids Barriers CNS 2011; 8:5. [PMID: 21349153 PMCID: PMC3042979 DOI: 10.1186/2045-8118-8-5] [Citation(s) in RCA: 261] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 01/18/2011] [Indexed: 02/01/2023] Open
Abstract
The maintenance of adequate blood flow to the brain is critical for normal brain function; cerebral blood flow, its regulation and the effect of alteration in this flow with disease have been studied extensively and are very well understood. This flow is not steady, however; the systolic increase in blood pressure over the cardiac cycle causes regular variations in blood flow into and throughout the brain that are synchronous with the heart beat. Because the brain is contained within the fixed skull, these pulsations in flow and pressure are in turn transferred into brain tissue and all of the fluids contained therein including cerebrospinal fluid. While intracranial pulsatility has not been a primary focus of the clinical community, considerable data have accrued over the last sixty years and new applications are emerging to this day. Investigators have found it a useful marker in certain diseases, particularly in hydrocephalus and traumatic brain injury where large changes in intracranial pressure and in the biomechanical properties of the brain can lead to significant changes in pressure and flow pulsatility. In this work, we review the history of intracranial pulsatility beginning with its discovery and early characterization, consider the specific technologies such as transcranial Doppler and phase contrast MRI used to assess various aspects of brain pulsations, and examine the experimental and clinical studies which have used pulsatility to better understand brain function in health and with disease.
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Affiliation(s)
- Mark E Wagshul
- Albert Einstein College of Medicine, Department of Radiology, Bronx, NY 10461, USA.
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Anile C, De Bonis P, Albanese A, Di Chirico A, Mangiola A, Petrella G, Santini P. Selection of patients with idiopathic normal-pressure hydrocephalus for shunt placement: a single-institution experience. J Neurosurg 2010; 113:64-73. [PMID: 20151782 DOI: 10.3171/2010.1.jns091296] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The ability to predict outcome after shunt placement in patients with idiopathic normal-pressure hydrocephalus (NPH) represents a challenge. To date, no single diagnostic tool or combination of tools has proved capable of reliably predicting whether the condition of a patient with suspected NPH will improve after a shunting procedure. In this paper, the authors report their experience with 120 patients with the goal of identifying CSF hydrodynamics criteria capable of selecting patients with idiopathic NPH. Specifically, they focused on the comparison between CSF-outflow resistance (R-out) and intracranial elastance (IE). METHODS Between January 1977 and December 2005, 120 patients in whom idiopathic NPH had been diagnosed (on the basis of clinical findings and imaging) underwent CSF hydrodynamics evaluation based on an intraventricular infusion test. Ninety-six patients underwent CSF shunt placement: 32 between 1977 and 1989 (Group I) on the basis of purely clinical and radiological criteria; 44 between 1990 and 2002 (Group II) on the basis of the same criteria as Group I and because they had an IE slope > 0.25; and 20 between 2003 and 2005 (Group III) on the basis of the same criteria as Group II but with an IE slope > or = 0.30. Outcomes were evaluated by means of both Stein-Langfitt and Larsson scores. Patients' conditions were considered improved when there was a stable decrease (at 6- and 12-month follow-up) of at least 1 point in the Stein-Langfitt score and 2 points in the Larsson score. RESULTS Group I: while no statistically significant difference in mean R-out value between improved and unimproved cases was observed, a clear-cut IE slope value of 0.25 differentiated very sharply between unimproved and improved cases. Group II: R-out values in the 2 unimproved cases were 20 and 47 mm Hg/ml/min, respectively. The mean IE slope in the improved cases was 0.56 (range 0.30-1.4), while the IE slopes in the 2 unimproved cases were 0.26 and 0.27. Group III: the mean IE slope was 0.51 (range 0.31-0.7). The conditions of all patients improved after shunting. A significant reduction of the Evans ratio was observed in 34 (40.5%) of the 84 improved cases and in none of the unimproved cases. CONCLUSIONS Our strategy based on the analysis of CSF pulse pressure parameters seems to have a great accuracy in predicting surgical outcome in clinical practice.
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Affiliation(s)
- Carmelo Anile
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy
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Tarnaris A, Toma AK, Kitchen ND, Watkins LD. Ongoing search for diagnostic biomarkers in idiopathic normal pressure hydrocephalus. Biomark Med 2009; 3:787-805. [DOI: 10.2217/bmm.09.37] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Idiopathic normal pressure hydrocephalus is a syndrome, which typically has a clinical presentation of gait/balance disturbance, often accompanied by cognitive decline and/or urinary incontinence. Its diagnosis is based on relevant history and clinical examination, appropriate imaging findings and physiological testing. The clinical picture of idiopathic normal pressure hydrocephalus may occasionally be difficult to distinguish from that of Alzheimer’s dementia, subcortical ischemic vascular dementia and Parkinson’s disease. The aim of this article is to systematically review the literature from the last 29 years in order to identify cerebrospinal fluid (CSF) or imaging biomarkers that may aid in the diagnosis of the syndrome. The authors concluded that no CSF or imaging biomarker is currently fulfilling the criteria required to aid in the diagnosis of the condition. However, a few studies have revealed promising CSF and imaging markers that need to be verified by independent groups. The reasons that the progress in this field has been slow so far is also commented on, as well as steps required to apply the current evidence in the design of future studies within the field.
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Affiliation(s)
- Andrew Tarnaris
- Department of Neurosurgery, National Hospital for Neurology & Neurosurgery, Box 32, Queen Square, London, WC1N 3BG, UK
| | - Ahmed K Toma
- Department of Neurosurgery, National Hospital for Neurology & Neurosurgery, Box 32, Queen Square, London, WC1N 3BG, UK
| | - Neil D Kitchen
- Department of Neurosurgery, National Hospital for Neurology & Neurosurgery, Box 32, Queen Square, London, WC1N 3BG, UK
| | - Laurence D Watkins
- Department of Neurosurgery, National Hospital for Neurology & Neurosurgery, Box 32, Queen Square, London, WC1N 3BG, UK
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Abstract
In typical cases, normal pressure hydrocephalus (NPH) manifests itself with the
triad of gait disturbance, which begins first, followed by mental deterioration
and urinary incontinence associated with ventriculomegaly (on CT or MRI) and
normal cerebrospinal fluid (CSF) pressure. These cases present minor diagnostic
difficulties and are the most likely to improve after shunting. Problems arise
when NPH shows atypical or incomplete clinical manifestations (25–50% of cases)
or is mimicked by other diseases. In this scenario, other complementary tests
have to be used, preferentially those that can best predict surgical outcome.
Radionuclide cisternography, intracranial pressure monitoring (ICP) and lumbar
infusion tests can show CSF dynamics malfunction, but none are able to confirm
whether the patient will benefit from surgery. The CSF tap test (CSF-TT) is the
only procedure that can temporarily simulate the effect of definitive shunt.
Since the one tap CSF-TT has low sensitivity, it cannot be used to exclude
patients from surgery. In such cases, we have to resort to a repeated CSF-TT
(RTT) or continuous lumbar external drainage (LED). The most reliable prediction
would be achieved if RTT or LED proved positive, in addition to the occurrence
of B-waves during more than 50% of ICP recording time. This review was based on
a PubMed literature search from 1966 to date. It focuses on clinical
presentation, neuroimaging, complementary prognostic tests, and differential
diagnosis of NPH, particularly on the problem of selecting appropriate
candidates for shunt.
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Affiliation(s)
- Benito Pereira Damasceno
- Unidade de Neuropsicologia e Neurolinguística, Departamento de Neurologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, SP, Brazil
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Abstract
Normal Pressure Hydrocephalus first became recognized as a treatable, reversible disorder in the 1960s. The classic triad of magnetic apraxia, urinary incontinence, and dementia remain relevant into the 21(st) century as being the basis for symptomatic diagnosis and predicting potential benefit from ventriculoperitoneal shunting, though they have been greatly augmented by the addition of modern neuroimaging, particularly MRI. Modern criteria recognize a wider range of diagnostic criteria, and new positive and negative prognostic indicators for treatment benefit have been discovered, though the mainstay remains initial drainage of a large volume of cerebrospinal fluid and monitoring for clinical improvement. Even with our advances in understanding both primary and secondary normal pressure hydrocephalus, diagnosis, management, and counseling remain challenging in this disorder.
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Affiliation(s)
- Glen R Finney
- Memory and Cognitive Disorders Program, University of Florida Department of Neurology, Gainesville, Florida 32610-0236, USA
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Übeyli ED, Ilbay K, Ilbay G, Sahin D, Akansel G. Differentiation of Two Subtypes of Adult Hydrocephalus by Mixture of Experts. J Med Syst 2008; 34:281-90. [DOI: 10.1007/s10916-008-9239-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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