Cerebrospinal Fluid Dynamics in Patients with Multiple Sclerosis: The Role of Phase-Contrast MRI in the Differential Diagnosis of Active and Chronic Disease

Abstract

ObjectiveMultiple sclerosis (MS) is an inflammatory disease characterized by demyelinating plaques in the white matter. Chronic cerebrospinal venous insufficiency (CCSVI) has been proposed as a new hypothesis for the etiopathogenesis of MS disease. MS-CCSVI includes a significant decrease of cerebrospinal fluid (CSF) flow through the cerebral aqueduct secondary to an impaired venous outflow from the central nervous system. This study aimed to determine whether CSF flow dynamics are affected in MS patients and the contributions to differential diagnosis in active and chronic disease using phase-contrast magnetic resonance imaging (PC-MRI).Materials and MethodsWe studied 16 MS patients with chronic plaques (group 1), 16 MS patients with active plaques-enhanced on MRI (group 2), and 16 healthy controls (group 3). Quantitatively evaluation of the CSF flow was performed from the level of the cerebral aqueduct by PC-MRI. According to heart rates, 14–30 images were obtained in a cardiac cycle. Cardiac triggering was performed prospectively using finger plethysmography.ResultsNo statistically significant difference was found between the groups regarding average velocity, net forward volume and the average flow (p > 0.05). Compared with the controls, group 1 and group 2, showed a higher peak velocity (5.5 ± 1.4, 4.9 ± 1.0, and 4.3 ± 1.3 cm/sec, respectively; p = 0.040), aqueductal area (5.0 ± 1.3, 4.1 ± 1.5, and 3.1 ± 1.2 mm2, respectively; p = 0.002), forward volume (0.039 ± 0.016, 0.031 ± 0.013, and 0.021 ± 0.010 mL, respectively; p = 0.002) and reverse volume (0.027 ± 0.016, 0.018 ± 0.009, and 0.012 ± 0.006 mL, respectively; p = 0.000). There were no statistical significance between the MS patients with chronic plaques and active plaques except for reverse volume. The MS patients with chronic plaques showed a significantly higher reverse volume (p = 0.000).ConclusionThis study indicated that CSF flow is affected in MS patients, contrary to the hypothesis that CCSVI-induced CSF flow decreases in MS patients. These findings may be explained by atrophy-dependent ventricular dilatation, which may occur at every stage of MS.

Predicting the Aqueductal Cerebrospinal Fluid Pulse: A Statistical Approach

“…In particular, it is important to understand why The dynamics of the aCSF pulse are an issue of clinical importance. Increased amplitude of the aCSF pulse has been shown to be associated with MS [3][4][5][6][7], NPH [8][9][10][11][12][13], and early-stage WM changes [14,15]. However, the mechanism linking aCSF pulse dynamics with these pathologies is poorly understood.…”

“…As such, the aCSF pulse is often measured in order to evaluate structural changes that may occur in the brain parenchyma. Numerous studies have found increased pulsatility of the aCSF to be associated with multiple sclerosis (MS) [3][4][5][6][7], normal pressure hydrocephalus (NPH) [8][9][10][11][12][13], and white matter (WM) alterations [14,15], suggesting that increases in the amplitude of the aqueductal pulse may be linked to pathological changes.…”

Hemodynamic Alterations in Multiple Sclerosis

“…Notably, compensatory functional adaptations might also account for MS-related changes in brain perfusion and activity [70]. Zamboni [30]. Their results favor Beggs et al who observed increased CSF pulsatility in the aqueduct of Sylvius, which they explain by the mechanisms increasing the hydraulic resistance of the cerebral vascular bed [19].…”

“…MS is characterized by changes in the WM in the periventricular region and is also associated with enlarged lateral ventricles. The brain atrophy seen in MS might be primarily responsible for ventricular enlargement [19,30]. The cerebral venous system plays an important role in the intracranial hemodynamic/cerebrospinal fluid regulatory system.…”

Measuring Aqueduct of Sylvius Cerebrospinal Fluid Flow in Multiple Sclerosis Using Different Software

“…Related to this, increased aqueductal CSF pulsatility has been shown to be related to dirty appearing white matter areas in a group of subjects without neurological diseases [ 9 ]. Hyperdynamic AoS CSF and enlarged AoS cross-sectional area (CSA) have also been shown in people with multiple sclerosis (pwMS) [ 10 , 11 , 12 , 13 ], but not with Alzheimer’s disease and mild cognitive impairment [ 14 , 15 ]. Lower net CSF flow volume has been reported in pwMS compared to normal controls (NC), with a significant association to impaired venous outflow [ 16 ].…”