To visualize the flow of cerebrospinal fluid (CSF) throughout the ventricles and subarachnoid space, measure mean and maximum CSF velocities, and quantitate CSF flow through the aqueduct of Sylvius, magnetic resonance (MR) imaging was performed with a sagittal technique that is flow-sensitive in the craniocaudal direction (along the readout axis) and a high-resolution axial technique sensitive to through-plane flow in three healthy subjects and 19 patients with known or suspected disorders of the CSF circulation. In both techniques, retrospective cardiac gating was used to cover the complete cardiac cycle. The sagittal technique was superior in overall assessment of CSF flow dynamics, including the motion of adjacent brain parenchyma. The high-resolution axial technique provided an accurate measurement of the rate of CSF flow through the aqueduct; only this technique provided sufficient accuracy to enable distinction between normal and hyperdynamic CSF flow. It is concluded that assessment of CSF flow dynamics is a useful adjunct to routine MR imaging in communicating and obstructive hydrocephalus.

Focal and confluent areas of periventricular hyperintensity have been reported on magnetic resonance (MR) images in 30% of patients over 60 years of age. In order to better understand the pathologic basis of these lesions, the authors studied 14 formalin-fixed brains with MR imaging. Multiple focal areas of hyperintensity were identified in the periventricular white matter in three of the 14 brains studied (21%). Subsequent gross and microscopic pathologic examination of both hyperintense and normal-intensity areas was performed on 87 tissue sections. The larger lesions were characterized centrally by necrosis, axonal loss, and demyelination and therefore represent true infarcts. Reactive astrocytes oriented along the degenerated axons were identified at distances of up to several centimeters from the central infarct. This is called isomorphic gliosis and is associated with increased intensity on T2-weighted images that increases the apparent size of the central lesion.

Experiments were conducted in which various intravascular filters, stents, and coils were imaged using magnetic resonance (MR) spin-echo technique at 0.35 T. These devices were also evaluated for ferromagnetism (at 0.35, 1.5, and 4.7 T), magnetic torque (at 0.35 and 1.5 T), and magnetically induced migration within a plastic tube (at 0.35 and 1.5 T for the Greenfield filter [GF]). The stainless-steel GF was evaluated in vitro for its propensity to perforate canine inferior venae cavae (IVC). Magnetic force and torque at 1.5 T did not dislodge the GF or result in perforation of canine IVC by the GF. Beta-3 titanium alloy (used in a new percutaneous version of the GF) is apparently one of the best-suited metals for use with MR imaging because of its lack of ferromagnetism (up to 4.7 T) and absence of MR imaging artifacts (at 0.35 T). Devices composed of Elgiloy (Mobin-Uddin filter), nitinol, and MP32-N (Amplatz filter) alloys all created mild artifacts. Devices fashioned from 304 and 316L (GF and Palmaz stent) stainless-steel alloys created severe "black-hole" artifacts, with the 304 alloy devices also showing marked image distortion. Generally, the greater the ferromagnetism of a device, the greater its magnetic susceptibility artifact.

Radionuclide scanning images published inNatureby Di Chiro in 1964 showed a downward migration along the spinal canal of particle tracers injected in the brain ventricles while also showing an upward flow of tracers injected in the lumbar region of the canal. These observations, since then corroborated by many radiological measurements, have been the basis for the hypothesis that there must be an active circulation mechanism associated with the transport of cerebrospinal fluid (CSF) deep down into the spinal canal and subsequently returning a portion back to the cranial vault. However, to date, there has been no physical explanation for the mechanism responsible for the establishment of such a bulk recirculating motion. To investigate the origin and characteristics of this recirculating flow, we have analyzed the motion of the CSF in the subarachnoid space of the spinal canal. Our analysis accounts for the slender geometry of the spinal canal, the small compliance of the dura membrane enclosing the CSF in the canal, and the fact that the CSF is confined to a thin annular subarachnoid space surrounding the spinal cord. We apply this general formulation to study the characteristics of the flow generated in a simplified model of the spinal canal consisting of a slender compliant cylindrical pipe with a coaxial cylindrical inclusion, closed at its distal end, and subjected to small periodic pressure pulsations at its open entrance. We show that the balance between the local acceleration and viscous forces produces a leading-order flow consisting of pure oscillatory motion with axial velocities on the order of a few centimetres per second and amplitudes monotonically decreasing along the length of the canal. We then demonstrate that the nonlinear term associated with the convective acceleration contributes to a second-order correction consisting of a steady streaming that generates a bulk recirculating motion of the CSF along the length of the canal with characteristic velocities two orders of magnitude smaller than the leading-order oscillatory flow. The results of the analysis of this idealized geometry of the spinal canal are shown to be in good agreement not only with experimental measurements in anin-vitromodel but also with radiological measurements conducted in human adults.

The appearance of flowing fluid has been evaluated in several clinical situations using a flow phantom, computer simulation, and clinical magnetic resonance (MR) images. Unsaturated protons just entering the imaging volume can emit a strong signal relative to the partially saturated adjacent tissue ("flow-related enhancement"). Slow laminar flow in veins can be distinguished on the basis of a stronger second echo due to rephasing effects ("even echo rephasing"). Synchronization of the cardiac cycle and the MR pulsing sequence produces increased signal in sections acquired during diastole ("diastolic pseudogating"). Intraluminal signal is shown to decrease as velocity is increased ("high velocity signal loss"). Onset of turbulence causes further loss of signal. Direction of flow oblique to the imaging plane can be predicted on the basis of decreased upstream and increased downstream signal.