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Gholampour S, Fatouraee N. Boundary conditions investigation to improve computer simulation of cerebrospinal fluid dynamics in hydrocephalus patients. Commun Biol 2021; 4:394. [PMID: 33758352 PMCID: PMC7988041 DOI: 10.1038/s42003-021-01920-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/01/2021] [Indexed: 01/31/2023] Open
Abstract
Three-D head geometrical models of eight healthy subjects and 11 hydrocephalus patients were built using their CINE phase-contrast MRI data and used for computer simulations under three different inlet/outlet boundary conditions (BCs). The maximum cerebrospinal fluid (CSF) pressure and the ventricular system volume were more effective and accurate than the other parameters in evaluating the patients' conditions. In constant CSF pressure, the computational patient models were 18.5% more sensitive to CSF volume changes in the ventricular system under BC "C". Pulsatile CSF flow rate diagrams were used for inlet and outlet BCs of BC "C". BC "C" was suggested to evaluate the intracranial compliance of the hydrocephalus patients. The results suggested using the computational fluid dynamic (CFD) method and the fully coupled fluid-structure interaction (FSI) method for the CSF dynamic analysis in patients with external and internal hydrocephalus, respectively.
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Affiliation(s)
- Seifollah Gholampour
- Department of Biomedical Engineering, North Tehran Branch, Islamic Azad University, Tehran, Iran.
| | - Nasser Fatouraee
- Biological Fluid Mechanics Research Laboratory, Biomechanics Department, Biomedical Engineering Faculty, Amirkabir University of Technology, Tehran, Iran
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2
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Extracranial versus intracranial hydro-hemodynamics during aging: a PC-MRI pilot cross-sectional study. Fluids Barriers CNS 2020; 17:1. [PMID: 31931818 PMCID: PMC6958565 DOI: 10.1186/s12987-019-0163-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/19/2019] [Indexed: 12/04/2022] Open
Abstract
Background Both aging and changes in blood flow velocity between the extracranial (intraspinal) and intracranial regions of cerebral vessels have an impact on brain hydro-hemodynamics. Arterial and venous cerebral blood flows interact with cerebrospinal fluid (CSF) in the both the cranial and spinal systems. Studies suggest that increased blood and CSF flow pulsatility plays an important role in certain neurological diseases. Here, we investigated the changes in blood-CSF flow pulsatility in the cranial and spinal systems with age as well as the impact of the intracranial compartment on flow patterns. Method Phase-contrast magnetic resonance imaging (PC-MRI) was performed in 16 young and 19 elderly healthy volunteers to measure the flows of CSF and blood. CSF stroke volume (SV), blood SV, and arterial and venous pulsatility indexes (PIs) were assessed at intra- and extracranial levels in both samples. Correlations between ventricular and spinal CSF flow, and between blood and CSF flow during aging were also assessed. Results There was a significant decrease in arterial cerebral blood flow and intracranial venous cerebral blood flow with aging. We also found a significant increase of intracranial blood SV, spinal CSF SV and arterial/venous pulsatility indexes with aging. In regard to intracranial compartment impact, arterial and venous PIs decreased significantly at intracranial level in elderly volunteers, while young adults exhibited decrease in venous PI only. Intracranial venous PI was paradoxically lower than extracranial venous PI, regardless of age. In both sample groups, spinal CSF SV and aqueductal CSF SV were positively correlated, and so were extracranial blood and spinal CSF SVs. Conclusion The study demonstrates that aging changes blood flow but preserves blood and CSF interactions. We also showed that many parameters related to blood and CSF flows differ between young and elderly adults.
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3
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Vivas-Buitrago T, Lokossou A, Jusué-Torres I, Pinilla-Monsalve G, Blitz AM, Herzka DA, Robison J, Xu J, Guerrero-Cazares H, Mori S, Quiñones-Hinojosa A, Baledént O, Rigamonti D. Aqueductal Cerebrospinal Fluid Stroke Volume Flow in a Rodent Model of Chronic Communicating Hydrocephalus: Establishing a Homogeneous Study Population for Cerebrospinal Fluid Dynamics Exploration. World Neurosurg 2019; 128:e1118-e1125. [PMID: 31121363 DOI: 10.1016/j.wneu.2019.05.093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus (iNPH) is a cause of dementia that can be reversed when treated timely with cerebrospinal fluid (CSF) diversion. Understanding CSF dynamics throughout the development of hydrocephalus is crucial to identify prognostic markers to estimate benefit/risk to shunts. OBJECTIVE To explore the cerebral aqueduct CSF flow dynamics with phase-contrast magnetic resonance imaging (MRI) in a novel rodent model of adult chronic communicating hydrocephalus. METHODS Kaolin was injected into the subarachnoid space at the convexities in Sprague-Dawley adult rats. 11.7-T Bruker MRI was used to acquire T2-weighted images for anatomic identification and phase-contrast MRI at the cerebral aqueduct. Aqueductal stroke volume (ASV) results were compared with the ventricular volume (VV) at 15, 60, 90, and 120 days. RESULTS Significant ventricular enlargement was found in kaolin-injected animals at all times (P < 0.001). ASV differed between cases and controls/shams at every time point (P = 0.004, 0.001, 0.001, and <0.001 at 15, 60, 90, and 120 days, respectively). After correlation between the ASV and the VV, there was a significant correlation at 15 (P = 0.015), 60 (P = 0.001), 90 (P < 0.001), and 120 days. Moreover, there was a significant positive correlation between the VV expansion and the aqueductal CSF stroke between 15 and 60 days. CONCLUSIONS An initial active phase of rapid ventricular enlargement shows a strong correlation between the expansion of the VV and the increment in the ASV during the first 60 days, followed by a second phase with less ventricular enlargement and heterogeneous behavior in the ASV. Further correlation with complementary data from intracranial pressure and histologic/microstructural brain parenchyma assessments are needed to better understand the ASV variations after 60 days.
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Affiliation(s)
- Tito Vivas-Buitrago
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA; School of Medicine, Faculty of Health Sciences, Universidad de Santander UDES, Bucaramanga, Colombia
| | - Armelle Lokossou
- Chimère EA, Research Team for Head & Neck, University of Picardie Jules Verne, Amiens, France
| | - Ignacio Jusué-Torres
- Department of Neurosurgery, Loyola University School of Medicine, Maywood, Illinois, USA
| | | | - Ari M Blitz
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Daniel A Herzka
- Department of Biomedical Engineering, Johns Hopkins School of Engineering, Baltimore, Maryland, USA
| | - Jamie Robison
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jiadi Xu
- Department of Neurosurgery, Kennedy Krieger Institute, Kirby Research Center for Functional Brain Imaging, Baltimore, Maryland, USA
| | | | - Susumu Mori
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Kennedy Krieger Institute, Kirby Research Center for Functional Brain Imaging, Baltimore, Maryland, USA
| | | | - Olivier Baledént
- Chimère EA, Research Team for Head & Neck, University of Picardie Jules Verne, Amiens, France; Department of Image Processing, Jules Verne University Hospital, Amiens, France
| | - Daniele Rigamonti
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
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Makki MI, O'Gorman RL, Buhler P, Baledent O, Kellenberger CJ, Sabandal C, Weiss M, Scheer I, Schmitz A. Total cerebrovascular blood flow and whole brain perfusion in children sedated using propofol with or without ketamine at induction: An investigation with 2D-Cine PC and ASL. J Magn Reson Imaging 2019; 50:1433-1440. [PMID: 30892782 DOI: 10.1002/jmri.26725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Multiple sedation regimes may be used to facilitate pediatric MRI scans. These regimes might affect cerebral blood flow and hemodynamics to varying degrees, particularly in children who may be vulnerable to anesthetic side effects. PURPOSE To compare the effects of propofol monosedation solely (Pm group) vs. a combination of propofol and ketamine (KP group) on brain hemodynamics and perfusion. STUDY TYPE Prospective double-blind randomized trial. FIELD STRENGTH/SEQUENCES 1.5T and 3T. 2D-Cine phase contrast (2D-Cine PC) and pseudocontinuous arterial spin labeling (ASL). POPULATION Children aged from 3 months to 10 years referred for MRI with deep sedation were randomized into either the KP or the Pm group. Perfusion images were acquired with ASL followed by single-slice 2D-Cine PC acquired between the cervical vertebra C2 and C3. ASSESSMENT Average whole-brain perfusion (WBP ml.min-1 .100 ml-1 ) was extracted from the ASL perfusion maps and total cerebrovascular blood flow (CVF) was quantified by bilaterally summing the flow in the vertebral and the internal carotid arteries. The CVF values were converted to units of ml.min-1 .100 g-1 to calculate the tissue CVF100g (ml.min-1 .100 g-1 ). Images were assessed by a neuroradiologist and data from n = 81 (ASL) and n = 55 (PC) cases with no apparent pathology were entered into the analysis. STATISTICAL TESTS Multivariate analysis of covariance was performed to compare drug sedation effects on WBP, CVF, and CVF100g . RESULTS No significant difference in arterial flow was observed (P = 0.57), but the KP group showed significantly higher WBP than the Pm group, covarying for scanner and age (P = 0.003). A correlation analysis showed a significant positive correlation between mean WBP (ml.min-1 .100 g-1 ) and mean CVF100g . DATA CONCLUSION The KP group showed higher perfusion but no significant difference in vascular flow compared with the Pm group. WBP and CVF100g correlated significantly, but ASL appeared to have more susceptibility to perfusion differences arising from the different sedation regimes. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2019;50:1433-1440.
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Affiliation(s)
- Malek I Makki
- MRI Research Center, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University Children's Hospital, Zurich, Switzerland.,MRI Research GIE-FF, CHU Amiens Picardie, Amiens, France
| | - Ruth L O'Gorman
- MRI Research Center, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Philip Buhler
- Anesthesia, University Children Hospital, Zurich, Switzerland
| | | | - Christian J Kellenberger
- Children's Research Center, University Children's Hospital, Zurich, Switzerland.,Department of Diagnostic Radiology, University Children's Hospital, Zurich, Switzerland
| | - Carola Sabandal
- Children's Research Center, University Children's Hospital, Zurich, Switzerland.,Anesthesia, University Children Hospital, Zurich, Switzerland
| | - Markus Weiss
- Children's Research Center, University Children's Hospital, Zurich, Switzerland.,Anesthesia, University Children Hospital, Zurich, Switzerland
| | - Ianina Scheer
- Children's Research Center, University Children's Hospital, Zurich, Switzerland.,Department of Diagnostic Radiology, University Children's Hospital, Zurich, Switzerland
| | - Achim Schmitz
- Children's Research Center, University Children's Hospital, Zurich, Switzerland.,Anesthesia, University Children Hospital, Zurich, Switzerland
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Stecco A, Cassarà A, Zuccalà A, Anoaica MB, Genovese E, Car PG, Panzarasa GP, Guzzardi G, Carriero A. Quantitative analysis of cerebrospinal fluid dynamics at phase contrast cine-MRI: predictivity of neurosurgical "Shunt" responsiveness in patients with idiopathic normal pressure hydrocephalus. J Neurosurg Sci 2017; 64:420-426. [PMID: 28869371 DOI: 10.23736/s0390-5616.17.04092-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Aqueductal stroke volume (ACSV) measured by phase-contrast cine (PCC)-MRI has been proposed with controversy as a tool for the selection of patients with normal pressure hydrocephalus (NPH) as candidates for shunt-surgery. The aim of this study was to assess if PCC-MRI scan measurements of ACSV could select properly these patients. METHODS We retrospectively reviewed charts and MRI of 38 shunted patients (72.16±6.16 years). ACSV measurements were performed 7-30 days before shunt and at the first and sixth months after surgery. Normally distributed variables were compared in the two groups (improved/unimproved) by t-test for baseline values and with repeated measures analysis of variance. RESULTS Twenty-six patients (68,4%) improved after VPS (mean time of symptom onset was 8.15±7.19 months). Mean preoperative ACSV value was 271.85±143.03, which decreased by 21.6% (mean 213±125.14) at the first month and 40.3% sixth months after VPS (mean 162.15±91.5). Twelve patients (31.6%) did not improve (mean time of symptom onset was 29±5.62 months). Mean preoperative ACSV value was 79.83±31.24, decreased to 8.7% (mean 72.83±28.66) at first month after VPS. 21.2% (mean 62.83±31.12) after six months. We found statistical difference between preoperative ACSV of improved and unimproved patients (P<0.01), onset time of symptoms (P<0.01) and the changes in ACSV after one and six months in both groups (P<0.001). CONCLUSIONS ACSV is useful to stratify patients with NPH after surgery (improved /not improved) suggesting to proceed with serial ACSV measurements before deciding treatment.
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Affiliation(s)
- Alessandro Stecco
- Department of Radiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy -
| | - Alessia Cassarà
- Department of Radiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Alberto Zuccalà
- Department of Radiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Mihaela B Anoaica
- Department of Radiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Egidio Genovese
- Department of Radiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Pier G Car
- Department of Neurosurgery, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Gabriele P Panzarasa
- Department of Neurosurgery, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Giuseppe Guzzardi
- Department of Radiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Alessandro Carriero
- Department of Radiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
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Daouk J, Bouzerar R, Baledent O. Heart rate and respiration influence on macroscopic blood and CSF flows. Acta Radiol 2017; 58:977-982. [PMID: 28273732 DOI: 10.1177/0284185116676655] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Changes in blood volume in the intracranial arteries and the resulting oscillations of brain parenchyma have been presumed as main initiating factors of cerebrospinal fluid (CSF) pulsations. However, respiration has been recently supposed to influence CSF dynamics via thoracic pressure changes. Purpose To measure blood and CSF cervical flow and quantify the contribution of cardiac and respiratory cycles on the subsequent signal evolution. Material and Methods Sixteen volunteers were enrolled. All participant underwent two-dimensional fast field echo echo planar imaging (FFE-EPI). Regions of interest were placed on internal carotids, jugular veins, and rachidian canal to extract temporal profiles. Spectral analysis was performed to extract respiratory and cardiac frequencies. The contribution of respiration and cardiac activity was assessed to signal evolution by applying a multiple linear model. Results Mean respiratory frequency was 14.6 ± 3.9 cycles per min and mean heart rate was 66.8 ± 9 cycles per min. Cardiac contribution was higher than breathing for internal carotids, explaining 74.68% and 10.27% of the signal variance, respectively. For the jugular veins, respiratory component was higher than the cardiac one contributing 44.28% and 6.53% of the signal variance, respectively. For CSF, breathing and cardiac component contributed less than half of signal variance (12.61% and 23.23%, respectively). Conclusion Respiration and cardiac activity both influence fluid flow at the cervical level. Arterial inflow is driven by the cardiac pool whereas venous blood aspiration seems more due to thoracic pressure changes. CSF dynamics acts as a buffer between these two blood compartments.
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Affiliation(s)
- Joël Daouk
- Bioflow Image Unit, Jules Verne University of Picardie, Amiens, France
| | - Roger Bouzerar
- Bioflow Image Unit, Jules Verne University of Picardie, Amiens, France
- Medical Image Processing Unit, Amiens University Medical Center, Amiens, France
| | - Olivier Baledent
- Bioflow Image Unit, Jules Verne University of Picardie, Amiens, France
- Medical Image Processing Unit, Amiens University Medical Center, Amiens, France
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7
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Kondrakhov SV, Zakharova NE, Fadeeva LM, Tanyashin SV. [Phase contrast MRI-based evaluation of cerebrospinal fluid circulation parameters in patients with foramen magnum meningiomas]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2017; 80:42-54. [PMID: 28139572 DOI: 10.17116/neiro201680642-54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Meningiomas of the foramen magnum (FMR) region account for 1.8 to 3.2% of all meningiomas. The international literature has insufficient data describing the state of cerebrospinal fluid (CSF) circulation in these patients. MATERIAL AND METHODS We studied 38 patients with FM meningiomas, aged from 35 to 79 years (mean age, 56.7 years). The mean meningioma size was 30 mm (10-60 mm). Meningiomas had the anterolateral localization in 29 patients, ventral localization in 5 patients, and dorsal localization in 4 patients. Twenty nine patients underwent surgery. All operated patients were examined before and after surgery. The CSF circulation was studied using phase contrast MRI (PC-MRI). RESULTS The size and localization of FM meningiomas do not significantly affect the CFS circulation parameters. Pyramidal symptoms, sensory disorders, and XIth cranial nerve dysfunction are correlated with the CFS circulation parameters. According to the preoperative PC-MRI data, the CFS circulation parameters in all FM meningioma patients were significantly higher than their normal values. Surgery was followed by a reduction in the peak positive velocity, negative peak velocity, and range of the maximum linear velocity amplitude. Positive and negative volumes and the stroke volume did not change. Recovery dynamics of the CFS circulation parameters was similar, regardless of surgery completeness. According to the PC-MRI data, the CFS circulation parameters did not reach normal values in all groups of operated patients. CONCLUSION The results of investigation of the CFS circulation in patients with FM meningiomas support the use of palliative surgery (partial resection, dural plasty, craniovertebral junction decompression) in the case of inoperable meningiomas.
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Affiliation(s)
| | | | - L M Fadeeva
- Burdenko Neurosurgical Institute, Moscow, Russia
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Chun SW, Lee HJ, Nam KH, Sohn CH, Kim KD, Jeong EJ, Chung SG, Kim K, Kim DJ. Cerebrospinal fluid dynamics at the lumbosacral level in patients with spinal stenosis: A pilot study. J Orthop Res 2017; 35:104-112. [PMID: 27664416 DOI: 10.1002/jor.23448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/15/2016] [Indexed: 02/04/2023]
Abstract
Spinal stenosis is a common degenerative condition. However, how neurogenic claudication develops has not been clearly elucidated. Moreover, cerebrospinal fluid physiology at the lumbosacral level has not received adequate attention. This study was conducted to compare cerebrospinal fluid hydrodynamics at the lumbosacral spinal level between patients with spinal stenosis and healthy controls. Twelve subjects (four patients and eight healthy controls; 25-77 years old; seven males) underwent phase-contrast magnetic resonance imaging to quantify cerebrospinal fluid dynamics. The cerebrospinal fluid flow velocities were measured at the L2 and S1 levels. All subjects were evaluated at rest and after walking (to provoke neurogenic claudication in the patients). The caudal peak flow velocity in the sacral spine (-0.25 ± 0.28 cm/s) was attenuated compared to that in the lumbar spine (-0.93 ± 0.46 cm/s) in both patients and controls. The lumbar caudal peak flow velocity was slower in patients (-0.65 ± 0.22 cm/s) than controls (-1.07 ± 0.49 cm/s) and this difference became more pronounced after walking (-0.66 ± 0.37 cm/s in patients, -1.35 ± 0.52 cm/s in controls; p = 0.028). The sacral cerebrospinal fluid flow after walking was barely detectable in patients (caudal peak flow velocity: -0.09 ± 0.03 cm/s). Cerebrospinal fluid dynamics in the lumbosacral spine were more attenuated in patients with spinal stenosis than healthy controls. After walking, the patients experiencing claudication did not exhibit an increase in the cerebrospinal fluid flow rate as the controls did. Altered cerebrospinal fluid dynamics may partially explain the pathophysiology of spinal stenosis. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:104-112, 2017.
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Affiliation(s)
- Se-Woong Chun
- Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine, Gyeongsangnam-do, South Korea
| | - Hack-Jin Lee
- Department of Brain and Cognitive Engineering, Korea University, Anam-dong, Seongbuk-gu, Seoul, 136-713, South Korea
| | - Koong-Ho Nam
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwang Dong Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Eun-Jin Jeong
- Department of Brain and Cognitive Engineering, Korea University, Anam-dong, Seongbuk-gu, Seoul, 136-713, South Korea
| | - Sun G Chung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Dong-Joo Kim
- Department of Brain and Cognitive Engineering, Korea University, Anam-dong, Seongbuk-gu, Seoul, 136-713, South Korea
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Yamada S, Kelly E. Cerebrospinal Fluid Dynamics and the Pathophysiology of Hydrocephalus: New Concepts. Semin Ultrasound CT MR 2016; 37:84-91. [DOI: 10.1053/j.sult.2016.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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10
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Kelly EJ, Yamada S. Cerebrospinal Fluid Flow Studies and Recent Advancements. Semin Ultrasound CT MR 2016; 37:92-9. [DOI: 10.1053/j.sult.2016.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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11
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Martin BA, Yiallourou TI, Pahlavian SH, Thyagaraj S, Bunck AC, Loth F, Sheffer DB, Kröger JR, Stergiopulos N. Inter-operator Reliability of Magnetic Resonance Image-Based Computational Fluid Dynamics Prediction of Cerebrospinal Fluid Motion in the Cervical Spine. Ann Biomed Eng 2015; 44:1524-37. [PMID: 26446009 DOI: 10.1007/s10439-015-1449-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 09/03/2015] [Indexed: 11/30/2022]
Abstract
For the first time, inter-operator dependence of MRI based computational fluid dynamics (CFD) modeling of cerebrospinal fluid (CSF) in the cervical spinal subarachnoid space (SSS) is evaluated. In vivo MRI flow measurements and anatomy MRI images were obtained at the cervico-medullary junction of a healthy subject and a Chiari I malformation patient. 3D anatomies of the SSS were reconstructed by manual segmentation by four independent operators for both cases. CFD results were compared at nine axial locations along the SSS in terms of hydrodynamic and geometric parameters. Intraclass correlation (ICC) assessed the inter-operator agreement for each parameter over the axial locations and coefficient of variance (CV) compared the percentage of variance for each parameter between the operators. Greater operator dependence was found for the patient (0.19 < ICC < 0.99) near the craniovertebral junction compared to the healthy subject (ICC > 0.78). For the healthy subject, hydraulic diameter and Womersley number had the least variance (CV = ~2%). For the patient, peak diastolic velocity and Reynolds number had the smallest variance (CV = ~3%). These results show a high degree of inter-operator reliability for MRI-based CFD simulations of CSF flow in the cervical spine for healthy subjects and a lower degree of reliability for patients with Type I Chiari malformation.
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Affiliation(s)
- Bryn A Martin
- Neurophysiological Imaging and Modeling Laboratory, Department of Biological Engineering, The University of Idaho, 875 Perimeter Drive MS 0904, Moscow, ID, 83844-0904, USA.
| | - Theresia I Yiallourou
- Laboratory of Hemodynamics and Cardiovascular Technology, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Soroush Heidari Pahlavian
- Department of Mechanical Engineering, Conquer Chiari Research Center, The University of Akron, Akron, OH, USA
| | - Suraj Thyagaraj
- Department of Mechanical Engineering, Conquer Chiari Research Center, The University of Akron, Akron, OH, USA
| | - Alexander C Bunck
- Department of Radiology, University Hospital of Cologne, Cologne, Germany.,Department of Clinical Radiology, University of Muenster, Münster, Germany
| | - Francis Loth
- Department of Mechanical Engineering, Conquer Chiari Research Center, The University of Akron, Akron, OH, USA
| | - Daniel B Sheffer
- Department of Biomedical Engineering, The University of Akron, Akron, OH, USA
| | - Jan Robert Kröger
- Department of Radiology, University Hospital of Cologne, Cologne, Germany.,Department of Clinical Radiology, University of Muenster, Münster, Germany
| | - Nikolaos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Daouk J, Chaarani B, Zmudka J, Capel C, Fichten A, Bouzerar R, Gondry-Jouet C, Jouanny P, Balédent O. Relationship between cerebrospinal fluid flow, ventricles morphology, and DTI properties in internal capsules: differences between Alzheimer's disease and normal-pressure hydrocephalus. Acta Radiol 2014; 55:992-9. [PMID: 24136984 DOI: 10.1177/0284185113508112] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Normal-pressure hydrocephalus (NPH) and Alzheimer's disease (AD) have some similar clinical features and both involve white matter and cerebrospinal fluid (CSF) disorders. PURPOSE To compare putative relationships between ventricular morphology, CSF flow, and white matter diffusion in AD and NPH. MATERIAL AND METHODS Thirty patients (18 with AD and 12 with suspected NPH) were included in the study. All patients underwent a 3-Tesla MRI scan, which included phase-contrast MRI of the aqueduct (to assess the aqueductal CSF stroke volume) and a DTI session (to calculate the fractional anisotropy [FA] and apparent diffusion coefficient [ADC]) in the internal capsules). RESULTS FA was correlated with ventricular volume in the suspected NPH population (P < 0.001; rs = 0.88), whereas the ADC was highly correlated with the aqueductal CSF stroke volume in AD (P < 0.001; rs = 0.79). CONCLUSION Although AD and NPH both involve CSF disorders, the two diseases do not have the same impact on the internal capsules. The magnitude of the ADC is related to the aqueductal CSF stroke volume in AD, whereas FA is related to ventricular volume in NPH.
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Affiliation(s)
- Joël Daouk
- Bioflow Image Laboratory, University of Picardie Jules Verne, France
| | - Bader Chaarani
- Bioflow Image Laboratory, University of Picardie Jules Verne, France
- Medical Image Processing Unit, Amiens University Hospital, France
| | - Jadwiga Zmudka
- Bioflow Image Laboratory, University of Picardie Jules Verne, France
- Geriatric Department, Amiens University Hospital, France
| | - Cyrille Capel
- Neurosurgery Department, Amiens Univwsersity Hospital, France
| | - Anthony Fichten
- Neurosurgery Department, Amiens Univwsersity Hospital, France
| | - Roger Bouzerar
- Bioflow Image Laboratory, University of Picardie Jules Verne, France
- Medical Image Processing Unit, Amiens University Hospital, France
| | - Catherine Gondry-Jouet
- Bioflow Image Laboratory, University of Picardie Jules Verne, France
- Radiology Department, Amiens University Hospital, France
| | - Pierre Jouanny
- Bioflow Image Laboratory, University of Picardie Jules Verne, France
- Geriatric Department, Amiens University Hospital, France
| | - Olivier Balédent
- Bioflow Image Laboratory, University of Picardie Jules Verne, France
- Medical Image Processing Unit, Amiens University Hospital, France
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13
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Yamada S, Tsuchiya K, Bradley WG, Law M, Winkler ML, Borzage MT, Miyazaki M, Kelly EJ, McComb JG. Current and emerging MR imaging techniques for the diagnosis and management of CSF flow disorders: a review of phase-contrast and time-spatial labeling inversion pulse. AJNR Am J Neuroradiol 2014; 36:623-30. [PMID: 25012672 DOI: 10.3174/ajnr.a4030] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This article provides an overview of phase-contrast and time-spatial labeling inversion pulse MR imaging techniques to assess CSF movement in the CNS under normal and pathophysiologic situations. Phase-contrast can quantitatively measure stroke volume in selected regions, notably the aqueduct of Sylvius, synchronized to the heartbeat. Judicious fine-tuning of the technique is needed to achieve maximal temporal resolution, and it has limited visualization of CSF motion in many CNS regions. Phase-contrast is frequently used to evaluate those patients with suspected normal pressure hydrocephalus and a Chiari I malformation. Correlation with successful treatment outcome has been problematic. Time-spatial labeling inversion pulse, with a high signal-to-noise ratio, assesses linear and turbulent motion of CSF anywhere in the CNS. Time-spatial labeling inversion pulse can qualitatively visualize whether CSF flows between 2 compartments and determine whether there is flow through the aqueduct of Sylvius or a new surgically created stoma. Cine images reveal CSF linear and turbulent flow patterns.
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Affiliation(s)
- S Yamada
- From the Department of Neurosurgery (S.Y.), Toshiba Rinkan Hospital, Sagamihara, Kanagawa, Japan
| | - K Tsuchiya
- Department of Radiology (K.T.), Kyorin University, Mitaka, Tokyo, Japan
| | - W G Bradley
- Department of Radiology (W.G.B.), University of California, San Diego, San Diego, California
| | - M Law
- Department of Neuroradiology (M.L.), University of Southern California, Los Angeles, California
| | - M L Winkler
- Steinberg Diagnostic Imaging Center (M.L.W.), Las Vegas, Nevada
| | - M T Borzage
- Division of Neuroradiology (M.T.B.), Department of Radiology, Institute for Maternal Fetal Health, Children's Hospital Los Angeles, Los Angeles, California Department of Biomedical Engineering (M.T.B.), USC Viterbi School of Engineering, University of Southern California, Los Angeles, California
| | - M Miyazaki
- Toshiba Medical Research Institute (M.M.), Vernon Hills, Illinois
| | - E J Kelly
- Toshiba America Medical Systems Inc (E.J.K.), Tustin, California
| | - J G McComb
- Division of Neurosurgery (J.G.M.), Children's Hospital Los Angeles, Los Angeles, California Department of Neurological Surgery (J.G.M.), Keck School of Medicine, University of Southern California, Los Angeles, California
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14
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Quantitative phase-contrast MRI study of cerebrospinal fluid flow: a method for identifying patients with normal-pressure hydrocephalus. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2013.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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15
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Kim DJ, Carrera E, Czosnyka M, Keong N, Smielewski P, Balédent O, Sutcliffe MPF, Pickard JD, Czosnyka Z. Cerebrospinal compensation of pulsating cerebral blood volume in hydrocephalus. Neurol Res 2013; 32:587-92. [DOI: 10.1179/174313209x455673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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16
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Forner Giner J, Sanz-Requena R, Flórez N, Alberich-Bayarri A, García-Martí G, Ponz A, Martí-Bonmatí L. Quantitative phase-contrast MRI study of cerebrospinal fluid flow: a method for identifying patients with normal-pressure hydrocephalus. Neurologia 2013; 29:68-75. [PMID: 23643684 DOI: 10.1016/j.nrl.2013.02.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 02/19/2013] [Accepted: 02/27/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The aim of this study is to evaluate the use of phase-contrast MR imaging to diagnose normal pressure hydrocephalus (NPH) and differentiate it from other neurological disorders with similar clinical symptoms. METHODS The study included 108 subjects, of whom 61 were healthy controls and 47, patients; in the patient group, 19 had cerebrovascular disease (CVD) and 28 had NPH. All patients underwent a phase-contrast MRI study and several CSF flow and velocity parameters were measured at the aqueduct of Sylvius. Discriminant analyses were performed to evaluate the classification capacity of both individual parameters and the combination of different parameters. RESULTS Maximum diastolic velocity, mean flow, and stroke volume showed statistically significant differences that could be used to distinguish between NPH and CVD patients (P<.001). Stroke volume and mean flow showed no false positive results and successful classification rates of 86% and 79%, respectively. No other parameters or combination produced better results. CONCLUSIONS Phase-contrast MR imaging is a useful tool for the early diagnosis of patients with NPH. CSF flow quantitative parameters, along with morphological features in a conventional MR study, enable us to differentiate between NPH and CVD patients.
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Affiliation(s)
- J Forner Giner
- Servicio de Radiología, Hospital Quirón Valencia, Valencia, España.
| | - R Sanz-Requena
- Servicio de Radiología, Hospital Quirón Valencia, Valencia, España
| | - N Flórez
- Universidad de Santo Tomás, Bucaramanga, Colombia
| | | | - G García-Martí
- Servicio de Radiología, Hospital Quirón Valencia, Valencia, España; CIBER-SAM, ISCIII, Valencia, España
| | - A Ponz
- Servicio de Neurología, Hospital Clínic Universitari de Valencia, Valencia, España
| | - L Martí-Bonmatí
- Servicio de Radiología, Hospital Quirón Valencia, Valencia, España; Unidad de Radiología, Facultad de Medicina, Universidad de Valencia, Valencia, España
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17
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Ying Hsu, Linninger AA. Quantitative Integration of Biological, Pharmacokinetic, and Medical Imaging Data for Organ-Wide Dose-Response Predictions. IEEE Trans Biomed Eng 2013; 60:625-32. [DOI: 10.1109/tbme.2013.2244893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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18
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Park JH, Park YS, Suk JS, Park SW, Hwang SN, Nam TK, Kim YB, Lee WB. Cerebrospinal fluid pathways from cisterns to ventricles in N-butyl cyanoacrylate-induced hydrocephalic rats. J Neurosurg Pediatr 2011; 8:640-6. [PMID: 22132924 DOI: 10.3171/2011.8.peds1190] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Cerebrospinal fluid typically enters the subarachnoid space from the ventricles via the fourth ventricular foramina. However, there is clinical evidence that CSF also flows in the opposite direction. Ventricular reflux of CSF from a cistern is a well-known phenomenon in radioisotope studies in patients with normal-pressure hydrocephalus. Additionally, the presence of ventricular blood in acute subarachnoid hemorrhage is frequently observed. The goal of this investigation was to examine the potential CSF pathways from cisterns to ventricles. The authors examined pathways in rat models in which they occluded the fourth ventricular outlets and injected a tracer into the subarachnoid space. METHODS The model for acute obstructive hydrocephalus was induced using N-butyl cyanoacrylate (NBCA) in 10 Sprague-Dawley rats. After 3 days, cationized ferritin was infused into the lumbar subarachnoid space to highlight retrograde CSF flow pathways. The animals were sacrificed at 48 hours, and the brains were prepared. The CSF flow pathway was traced by staining the ferritin with ferrocyanide. RESULTS Ferritin was observed in the third ventricle in 7 of 8 rats with hydrocephalus and in the temporal horn of the lateral ventricles in 4 of 8 rats with hydrocephalus. There was no definite staining in the aqueduct, which suggests that the ventricular reflux originated from routes other than through the fourth ventricular outlets. CONCLUSIONS The interfaces between the quadrigeminal cistern and third ventricle and those between the ambient cistern and lateral ventricle appear to be potential sites of CSF reflux from cisterns to ventricles in obstructive hydrocephalus.
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Affiliation(s)
- Jong-Hyuk Park
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
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19
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d’Arailh L, Lacaille S, Foucart-Caron S, Patry C, Raynaud-Simon A. Paget's disease of bone and cognitive dysfunction. Eur Geriatr Med 2011. [DOI: 10.1016/j.eurger.2011.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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20
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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: 258] [Impact Index Per Article: 19.8] [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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21
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Wagshul ME, Kelly EJ, Yu HJ, Garlick B, Zimmerman T, Egnor MR. Resonant and notch behavior in intracranial pressure dynamics. J Neurosurg Pediatr 2009; 3:354-64. [PMID: 19409013 DOI: 10.3171/2009.1.peds08109] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The intracranial pulse pressure is often increased when neuropathology is present, particularly in cases of increased intracranial pressure (ICP) such as occurs in hydrocephalus. This pulse pressure is assumed to originate from arterial blood pressure oscillations entering the cranium; the fact that there is a coupling between the arterial blood pressure and the ICP is undisputed. In this study, the nature of this coupling and how it changes under conditions of increased ICP are investigated. METHODS In 12 normal dogs, intracarotid and parenchymal pulse pressure were measured and their coupling was characterized using amplitude and phase transfer function analysis. Mean intracranial ICP was manipulated via infusions of isotonic saline into the spinal subarachnoid space, and changes in transfer function were monitored. RESULTS Under normal conditions, the ICP wave led the arterial wave, and there was a minimum in the pulse pressure amplitude near the frequency of the heart rate. Under conditions of decreased intracranial compliance, the ICP wave began to lag behind the arterial wave and increased significantly in amplitude. Most interestingly, in many animals the pulse pressure exhibited a minimum in amplitude at a mean pressure that coincided with the transition from a leading to lagging ICP wave. CONCLUSIONS This transfer function behavior is characteristic of a resonant notch system. This may represent a component of the intracranial Windkessel mechanism, which protects the microvasculature from arterial pulsatility. The impairment of this resonant notch system may play a role in the altered pulse pressure in conditions such as hydrocephalus and traumatic brain swelling. New models of intracranial dynamics are needed for understanding the frequency-sensitive behavior elucidated in these studies and could open a path for development of new therapies that are geared toward addressing the pulsation dysfunction in pathological conditions, such as hydrocephalus and traumatic brain injury, affecting ICP and flow dynamics.
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Affiliation(s)
- Mark E Wagshul
- Department of Radiology, Stony Brook University, Stony Brook, New York 11794, USA.
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22
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Relationship Between Ventricular Morphology and Aqueductal Cerebrospinal Fluid Flow in Healthy and Communicating Hydrocephalus. Invest Radiol 2009; 44:192-9. [DOI: 10.1097/rli.0b013e31819a640b] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Abbey P, Singh P, Khandelwal N, Mukherjee KK. Shunt surgery effects on cerebrospinal fluid flow across the aqueduct of Sylvius in patients with communicating hydrocephalus. J Clin Neurosci 2009; 16:514-8. [PMID: 19195891 DOI: 10.1016/j.jocn.2008.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 05/11/2008] [Accepted: 05/18/2008] [Indexed: 10/21/2022]
Abstract
We aimed to visualize and quantify the flow of cerebrospinal fluid (CSF) across the aqueduct of Sylvius in patients with communicating hydrocephalus using phase contrast MRI, and to evaluate the effect of ventriculoperitoneal (VP) shunt surgery on flow. We investigated aqueductal CSF flow using cine cardiac-gated phase contrast MRI in 10 normal volunteers and 10 patients with communicating hydrocephalus (who underwent VP shunt surgery). For qualitative evaluation, we used an in-plane phase contrast sequence in the midsagittal plane. Quantitative through-plane measurements were performed in the axial plane perpendicular to the aqueduct. The aqueduct area ranged from 0.02 cm(2) to 0.27 cm(2) in the shunt group; and from 0.01 cm(2) to 0.04 cm(2) in the control group (p<0.05). Aqueductal stroke volume (mean, standard deviation SD) ranged from 1.9 microL to 33.17 microL (17.41 microL, 10.1132) in the control group; and from 5.63 microL to 256 microL (87.20 microL, 79.0383) in the study group. Post-operatively the aqueductal stroke volume reduced significantly, ranging from 0.60 microL to 48.77 microL (13.19 microL, 18.08) (p<0.05). Peak systolic velocity (PSV) values in the patients before shunt surgery ranged from -1.05 cm/s to -8.10 cm/s (-4.39cm/s, 2.7619) and peak diastolic velocities (PDV) ranged from 0.62 cm/s to 5.16 cm/s (3.33 cm/s, 1.4451). Post- shunt; PSV values ranged from -0.37 cm/s to -3.90 cm/s (1.78 cm/s, 1.5143) and PDV range was 0.32 cm/s to 4.43 cm/s (1.78 cm/s, 1.6782). The post-operative reduction in velocity was significant (p<0.05). Thus, the aqueductal CSF flow after VP shunt was similar to flow in healthy volunteers.
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Affiliation(s)
- Pooja Abbey
- Radiology, All India Institute of Medical Sciences, New Delhi, India.
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24
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Saliou G, Balédent O, Lehmann P, Paradot G, Gondry-Jouet C, Bouzerar R, Devisme G, Theaudin M, Deramond H, Le Gars D, Meyer ME, Vallée JN. [Acute CSF changes in the mesencephalon aqueduct after subarachnoid hemorrhage as measured by PC-MRI]. J Neuroradiol 2008; 36:41-7. [PMID: 18701163 DOI: 10.1016/j.neurad.2008.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Determining acute intracranial hydrodynamic changes after subarachnoid hemorrhage through an analysis of the CSF stroke volume (SV) as measured by phase-contrast MRI (PC-MRI) in the mesencephalon aqueduct. METHOD A prospective study was performed in 33 patients with subarachnoid hemorrhage. A PC-MRI imaging study was performed n the acute phase (< 48 hours). CSF flow was measured in the aqueduct. The appearance of acute hydrocephalus (HCA) was then compared with data on CSF flow, and the location of the intraventricular and perimesencephalic bleeding. RESULTS CSF analysis was performed on 27 patients, 11 of whom presented with an acute HCA. All 11 patients had an abnormal SV in the aqueduct: patients with a communicating HCA had an increased SV (n=8); and patients with a noncommunicating HCA had a nil SV (n=3). Patients with a normal SV in the aqueduct did not develop an acute HCA. Intraventricular bleeding significantly led to HCA (P=0.02), which was of the communicating type in 70% of cases. CONCLUSION Subarachnoid hemorrhage leads to intracranial CSF hydrodynamic modifications in the aqueduct in the majority of patients. CSF flow can help us to understand the mechanism of the appearance of acute HCA. Indeed, hydrocephalus occurred - of the communicating type in most cases - even in the presence of intraventricular bleeding.
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Affiliation(s)
- G Saliou
- Service de neurologie, hôpital de Bicêtre, 94275 Kremlin-Bicêtre cedex, France.
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25
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Henry-Feugeas MC, Onen F, Claeys ES. Classifying late-onset dementia with MRI: is arteriosclerotic brain degeneration the most common cause of Alzheimer's syndrome? Clin Interv Aging 2008; 3:187-99. [PMID: 18488889 PMCID: PMC2544365 DOI: 10.2147/cia.s2537] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Our aim was to use early magnetic resonance imaging (MRI) to investigate the causes of cognitive decline in elderly people with mild cognitive impairment (MCI). Baseline structural and flow quantification MR sequences, and clinical and neuropsychological follow-up for at least two years, were performed on 62 elderly subjects with MCI. Of these subjects, 17 progressed to dementia, and 15 of these progressed to dementia of the Alzheimer type (DAT). Conversion to clinically diagnosed DAT was related to six distinct MR profiles, including one profile suggesting severe AD (20% of these converters) and five profiles suggesting severe cerebrovascular dysfunction. Two profiles suggested arteriosclerotic brain degeneration, one profile suggested severe venous windkessel dysfunction, and two suggested marked cerebral hypoperfusion associated with very low craniospinal compliance or marked brain atrophy. As compared with vascular MR type converters, AD MR type converters showed high executive and mobility predementia performances. Severe whole anteromesial temporal atrophy and predominantly left brain atrophy on visual MR analysis was only observed in AD MR type converters. In conclusion, these observations enhance the pathogenic complexity of the Alzheimer syndrome, and suggest that the role of arteriosclerotic brain degeneration in late life dementia is underestimated.
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26
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Shin BS, Ko JS, Gwak MS, Yang M, Kim CS, Hahm TS, Lee SM, Cho HS, Kim ST, Kim JH, Kim GS. The Effects of Prehydration on the Properties of Cerebrospinal Fluid and the Spread of Isobaric Spinal Anesthetic Drug. Anesth Analg 2008; 106:1002-7, table of contents. [DOI: 10.1213/ane.0b013e318161520c] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Interest in the identification of cognitive decline in its earliest manifestations and the heterogeneity of clinically diagnosed Alzheimer's disease (AD) explain the growing number of neuroimaging studies of AD. Alzheimer-type lesions are associated with loss of neurons, and magnetic resonance imaging (MRI) can detect predominantly left atrophic changes in the entorhinal cortex, amygdala and anterior hippocampus several years before the onset of clinical symptoms. Cerebrovascular disease can mimic AD in the elderly whereas MR markers of subcortical vascular disease-leukoaraiosis, lacunar infarcts, microbleeds, ventricular enlargement, cortical and hippocampal atrophy-appear to be structural changes associated with vascular-related cognitive impairment. Furthermore, analysis of prodromal forms of late-onset dementia of Alzheimer's type (DAT) differentiates amnesic single-domain mild cognitive impairment, which shows MR patterns similar to those observed in early-onset DAT, from other predementia patterns without atrophy at the earliest sites of AD pathology. Mesiotemporal atrophy on MRI predicts late-onset DAT, but the current rating scales or measurements of mesiotemporal atrophy do not differentiate anteromesial temporal atrophy that is highly suggestive of AD from predominantly hippocampal atrophy, suggestive of non-AD damage and, usually, vascular disease. The other, most common MRI predictors of late-onset DAT may be considered indirect markers of arterial senescence whereas brain atrophy is diffusely milder and MR markers of small-vessel disease more frequent in late-onset, compared with early-onset, DAT. Thus, MRI suggests an overestimation of AD pathology while underestimating 'arteriosclerotic brain degeneration' in the clinical picture of 'Alzheimer syndrome'.
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Affiliation(s)
- M C Henry-Feugeas
- Department of Radiology, Bichat-Claude-Bernard University Hospital, APHP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
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28
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Balédent O, Fin L, Khuoy L, Ambarki K, Gauvin AC, Gondry-Jouet C, Meyer ME. Brain hydrodynamics study by phase-contrast magnetic resonance imaging and transcranial color doppler. J Magn Reson Imaging 2007; 24:995-1004. [PMID: 17024656 DOI: 10.1002/jmri.20722] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the contributions of phase-contrast magnetic resonance (PCMR) and transcranial color Doppler (TCCD) imaging in the investigation of cerebral hydrodynamics. MATERIALS AND METHODS A total of 13 healthy subjects were studied. Blood velocity measurements were performed with TCCD and gated PCMR imaging in major intracranial and extracranial arteries stages. Peak systolic velocity and end-diastolic velocity were extracted to establish correlations between TCCD and PCMR imaging. Cerebral blood flow (CBF) and intracranial volume change (IVC) during the cardiac cycle were calculated, taking into account cerebrospinal fluid (CSF) oscillations. RESULTS Despite an underestimation of velocities with PCMR imaging, significant correlations were observed for velocity measurements between the two modalities in extracranial vessels, but were poorly correlated in intracranial vessels. PCMR data processing gave a mean CBF of 690+/-90 mL/minute. CONCLUSION PCMR imaging provides complementary information to TCCD to assess various intracranial parameters such as instantaneous velocities, blood and CSF flow distributions, volume variation, or pressure regulation mechanisms during cardiac cycles.
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Affiliation(s)
- Olivier Balédent
- Department of Imaging and Biophysics, University Hospital, Jules Verne University of Picardie, Amiens, France.
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Burnett MG, Sonnad SS, Stein SC. Screening tests for normal-pressure hydrocephalus: sensitivity, specificity, and cost. J Neurosurg 2006; 105:823-9. [PMID: 17405251 DOI: 10.3171/jns.2006.105.6.823] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Many tests have been proposed to help choose candidates for shunt insertion in cases of suspected normal-pressure hydrocephalus (NPH). It is unclear what sensitivity and specificity a prospective test must have to improve outcomes, compared with the results of automatic shunt insertion.
Methods
The authors adapted the decision analysis model used in a companion article to allow for application of a screening test. Using the reported sensitivities and specificities of several such tests, they evaluated the effects such tests would have on the expected outcome of an average 65-year-old patient with moderate dementia. They also evaluated the cost-effectiveness of a theoretical screening test with superior sensitivity and specificity.
Conclusions
Although external lumbar drainage comes quite close, none of the screening tests reported to date have sufficient sensitivity and specificity to improve expected outcome in an average candidate, compared with the results of automatic shunt placement in cases of suspected NPH. In addition, even a theoretically improved test would need to be considerably less expensive than prolonged lumbar drainage to be cost-effective in clinical practice.
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Affiliation(s)
- Mark G Burnett
- Department of Neurosurgery and Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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30
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Henry Feugeas MC, De Marco G, Peretti II, Godon-Hardy S, Fredy D, Claeys ES. Age-related cerebral white matter changes and pulse-wave encephalopathy: observations with three-dimensional MRI. Magn Reson Imaging 2005; 23:929-37. [PMID: 16310108 DOI: 10.1016/j.mri.2005.09.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Accepted: 09/11/2005] [Indexed: 11/21/2022]
Abstract
Our purpose was to investigate leukoaraïosis (LA) using three-dimensional MR imaging combined with advanced image-processing technology to attempt to group signal abnormalities according to their etiology. Coronal T2-weighted fast fluid-attenuated inversion-recovery (FLAIR) sequences and three-dimensional T1-weighted fast spoiled gradient recalled echo sequences were used to examine cerebral white matter changes in 75 elderly people with memory complaint but no dementia. They were otherwise healthy, community-dwelling subjects. Three subtypes of LA were defined on the basis of their shape, geography and extent: the so-called subependymal/subpial LA, perivascular LA and "bands" along long white matter tracts. Subependymal changes were directly contiguous with ventricular spaces. They showed features of "water hammer" lesions with ventricular systematisation and a more frequent location around the frontal horns than around the bodies (P=.0008). The use of cerebrospinal fluid (CSF) contiguity criterion allowed a classification of splenial changes in the subpial group. Conversely, posterior periventricular lesions in the centrum ovale as well as irregular and extensive periventricular lesions were not directly contiguous with CSF spaces. The so-called perivascular changes showed features of small-vessel-associated disease; they surrounded linear CSF-like signals that followed the direction of perforating vessels. Distribution of these perivascular changes appeared heterogeneous (P ranging from .04 to 5.10(-16)). These findings suggest that subependymal/subpial LA and subcortical LA may be separate manifestations of a single underlying pulse-wave encephalopathy.
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Affiliation(s)
- Marie Cécile Henry Feugeas
- Department of Radiology, Bichat-Claude Bernard University Hospital, AP-HP, 75877 Paris Cedex 18, France.
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31
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Onen F, Feugeas MCH, De Marco G, Baron G, Ravaud P, Legrain S, Moretti JL, Claeys ES, Peretti II. Cerebrospinal fluid MR dynamics and risk of falls in the elderly. J Neuroradiol 2005; 32:3-9. [PMID: 15798607 DOI: 10.1016/s0150-9861(05)83015-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate the relationship between CSF dynamics and risk of falls of unknown origin in the elderly. POPULATION AND METHODS Phase contrast MR studies allowed CSF aqueductal flow quantification on 23 community-dwelling older people initially explored for mild cognitive impairment. Mobility assessment included report of falls, talking walking test, stance test, one leg standing test, up and go test, and measurement of fast gait speed. RESULTS History of falls was associated with larger aqueduct, steeper diastolic slopes higher ratios RDV/SD of diastolic volume/CSF systole duration (p</=0.0006). Amplitude CSF parameters, diastolic slopes and RDV/SD appeared correlated with the aqueduct area (p<0.01). CONCLUSIONS These preliminary data suggest that disturbances of CSF dynamics could play a role in mobility decline with aging especially in falls of unknown origin.
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Affiliation(s)
- F Onen
- Department of Geriatrics, Bichat-Claude Bernard University Hospital, AP-HP, 46 rue Henri Huchard, 75877 Paris cedex 18, France.
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Rodrigo S, Henry-Feugeas MC, Oppenheim C, Verny M, Meder JF, Fredy D. [Imaging of dementia with magnetic resonance]. Presse Med 2004; 33:1027-33. [PMID: 15523253 DOI: 10.1016/s0755-4982(04)98832-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The diagnostic approach of dementia has clearly improved with the progress in medical imaging, notably magnetic resonance imaging. The conventional T1 and T2 sequences or morphological imaging have demonstrated their interest in the positive and differential diagnosis of dementia, together with the more precise description of normal ageing of the brain. The ANAES (French medicines agency) proposes systematic brain imaging, notably by magnetic resonance imaging (MRI) in their practical guidelines for the diagnosis of Alzheimer's disease (http://www.anaes.fr). THE INTEREST OF CERTAIN IMAGING TECHNIQUES: The therapeutic progress in treatment of dementia implies that the different affections be recognised as early as possible. With this in mind, the functional MRI is capable of describing the damage in cases when morphological imaging is not sufficiently specific. Recent studies have reported the interest of diffusion and perfusion imaging, activation MRI and proton spectroscopy. FROM A THERAPEUTIC POINT OF VIEW: The combination of morphological and functional approaches will provide a better definition of the groups at risk in order to target current treatments and those to come.
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Affiliation(s)
- S Rodrigo
- Département d'imagerie morphologique et fonctionnelle, Centre Hospitalier Sainte-Anne, Paris
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Lee JH, Lee HK, Kim JK, Kim HJ, Park JK, Choi CG. CSF flow quantification of the cerebral aqueduct in normal volunteers using phase contrast cine MR imaging. Korean J Radiol 2004; 5:81-6. [PMID: 15235231 PMCID: PMC2698144 DOI: 10.3348/kjr.2004.5.2.81] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate whether the results of cerebrospinal fluid (CSF) flow quantification differ according to the anatomical location of the cerebral aqueduct that is used and the background baseline region that is selected. Materials and Methods The CSF hydrodynamics of eleven healthy volunteers (mean age = 29.6 years) were investigated on a 1.5T MRI system. Velocity maps were acquired perpendicular to the cerebral aqueduct at three different anatomical levels: the inlet, ampulla and pars posterior. The pulse sequence was a prospectively triggered cardiac-gated flow compensated gradient-echo technique. Region-of-interest (ROI) analysis was performed for the CSF hydrodynamics, including the peak systolic velocity and mean flow on the phase images. The selection of the background baseline regions was done based on measurements made in two different areas, namely the anterior midbrain and temporal lobe, for 10 subjects. Results The mean peak systolic velocities showed a tendency to increase from the superior to the inferior aqueduct, irrespective of the background baseline region, with the range being from 3.30 cm/sec to 4.08 cm/sec. However, these differences were not statistically significant. In the case of the mean flow, the highest mean value was observed at the mid-portion of the ampulla (0.03 cm3/sec) in conjunction with the baseline ROI at the anterior midbrain. However, no other differences were observed among the mean flows according to the location of the cerebral aqueduct or the baseline ROI. Conclusion We obtained a set of reference data of the CSF peak velocity and mean flow through the cerebral aqueduct in young healthy volunteers. Although the peak systolic velocity and mean flow of the CSF differed somewhat according to the level of the cerebral aqueduct at which the measurement was made, this difference was not statistically significant.
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Affiliation(s)
- Jeong Hyun Lee
- Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Korea
| | - Ho Kyu Lee
- Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Korea
| | - Jae Kyun Kim
- Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Korea
| | - Hyun Jeong Kim
- Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Korea
| | - Ji Kang Park
- Department of Radiology, Ulsan University Hospital, Ulsan University College of Medicine, Korea
| | - Choong Gon Choi
- Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Korea
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de Marco G, Idy-Peretti I, Didon-Poncelet A, Baledent O, Onen F, Feugeas MCH. Intracranial Fluid Dynamics in Normal and Hydrocephalic States. J Comput Assist Tomogr 2004; 28:247-54. [PMID: 15091130 DOI: 10.1097/00004728-200403000-00015] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To present a novel magnetic resonance (MR) method of analysis of cerebrospinal fluid (CSF) flow dynamics. METHODS Fifty-one subjects were explored with phase-contrast cine MR imaging. There were 36 volunteers, 9 patients with normal pressure hydrocephalus (NPH), and 6 patients with asymptomatic ventricular dilation (VD). The transfer function XFRA/CSF from the arterial pulse waves (APWs) and the CSF pulse waves (CSFPWs) and the transfer function XFRCSF/SS from the CSF pulse waves (CSFPWs) and the sagittal sinus pulse waves (SSPWs) were studied separately. RESULTS There was a significant difference in the amplitude spectrum of the XFRA/CSF of patients with VD and volunteers (P < 0.05) and in that of patients with NPH and volunteers (P = 0.005). The amplitude of the fundamental frequency was higher in the NPH group than in the VD group (P = 0.02). In patients with NPH, the amplitude spectrum of XFRCSF/SS showed an attenuation of the pulse wave components that significantly differed from the observed amplification in healthy subjects (P = 0.009) and patients with VD (P = 0.012). CONCLUSION This systems analysis method could help to detect increased venous compliance in VD and decreased venous compliance in NPH.
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Affiliation(s)
- Giovanni de Marco
- Department of Biophysics and Image Processing, Northern Hospital, and University of Picardie Jules Verne, Amiens, France
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Balédent O, Gondry-Jouet C, Meyer ME, De Marco G, Le Gars D, Henry-Feugeas MC, Idy-Peretti I. Relationship Between Cerebrospinal Fluid and Blood Dynamics in Healthy Volunteers and Patients with Communicating Hydrocephalus. Invest Radiol 2004; 39:45-55. [PMID: 14701988 DOI: 10.1097/01.rli.0000100892.87214.49] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
RATIONALE AND OBJECTIVES Using magnetic resonance imaging (MRI), we investigated cerebral blood and cerebrospinal fluid (CSF) flows in patients with communicating hydrocephalus (CH) and in healthy volunteers to determine the contribution of CSF flow to brain pressure regulation in CH patients. METHODS Cine phase-contrast MRI data from 16 healthy volunteers and 12 patients with CH characterized by hyperdynamic aqueductal CSF flow were analyzed using in-house image-processing software that automatically measured flow curves. Amplitude and temporal CSF and blood flow parameters were compared in the 2 groups. RESULTS Jugular peak flow occurred significantly earlier (P < 0.01) in the CH patients than in the healthy volunteers. Cervical CSF oscillations were not significantly different between the 2 groups. CONCLUSION Venous vessel compression and/or changes in intracranial subarachnoid CSF flow produce an increase in ventricular CSF flush that compensates for vascular brain expansion in patients with CH.
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Affiliation(s)
- Olivier Balédent
- Department of Imaging and Biophysics, UMR 6600 CNRS, Teaching Hospitals, Jules Verne University of Picardie, Amiens, France.
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Abstract
OBJECTIVE To illustrate the influence of cerebrospinal fluid (CSF) flow on lumbar CSF protein concentration and to test for an altered blood-CSF barrier permeability as additional influence. PATIENTS AND METHODS Consecutively hospitalized patients with normotensive hydrocephalus (n = 21) underwent lumbar puncture with CSF being sampled in sequential portions. CSF/blood quotients of albumin (QAlb) and of immunoglobulin G (QIgG) were compared intra-individually and with calculated values from a reference patient sample. RESULTS AND CONCLUSIONS QAlb and QIgG of intra-individual sequential portions correlated highly with each other (median r = 0.95), suggesting lumbar CSF flow as the main thecal determinant of lumbar QAlb and QIgG variation. In addition, QIgG, relative to QAlb, was significantly lower in study patients compared with a reference patient sample (P = 0.002), implying an alteration of the blood-CSF barrier permeability as a minor determinant of QAlb and QIgG variation in study patients.
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Affiliation(s)
- S Seyfert
- Department of Neurology, University Hospital Benjamin Franklin, Free University of Berlin, Berlin, Germany.
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