Cerebrospinal Fluid Flow Dynamics in Multiple Sclerosis Patients through Phase Contrast Magnetic Resonance Imaging

Abstract

We studied cerebrospinal fluid (CSF) flow dynamics at the cervical level in association with internal jugular veins (IJV) flow for 92 patients with multiple sclerosis (MS). Phase contrast magnetic resonance imaging was used to quantify flow of the CSF and major vessels (including the IJV and the carotid arteries) at the C2-C3 level in the neck. Contrast enhanced MR angiography and time-of-flight MR venography were used to subdivide MS patients into stenotic (ST) and non-stenotic (NST) populations. We evaluated: IJV flow normalized by arterial flow; CSF peaks; CSF outflow duration and its onset from systole. We tested if these variables were statistically different among different MS phenotypes and between ST and NST MS patients. The delay between the beginning of beginning of systole and the CSF outflow was higher in ST compared to NST MS. Less IJV flow was observed in ST vs NST MS. None of the measures was different between the different MS phenotypes. These results suggest that alterations of IJV morphology affect both IJV flow and CSF flow timing but not CSF flow amplitude.

Intracranial fluid dynamics changes in idiopathic intracranial hypertension: pre and post therapy

“…Artero-CSF delays were estimated as the lag in time between arterial systolic peak and aCSF (AaCD) and cCSF (AcCD). To assess the contribution of collateral pathways for venous blood flow exiting the intracranial compartment, we calculated the ratio, expressed in percentage, between the total internal jugular vein outflow (tIJV) and the total intracranial arterial inflow (tA), that is tIJV/tA=tIJV/(ICAs+VAs) (Lagana et al, 2014). When tIJV/tA is close to 100%, venous blood outflow through the IJVs matches the arterial blood inflow, and therefore the contribution of collaterals is minimum.…”

“…technique often employed in clinical settings to allow quantification of CSF flow parameters in the aqueduct of Sylvius (AoS) and determine therapeutic strategies (Stoquart-El Sankari et al, 2008;Yousef et al, 2016). It can provide useful information regarding velocity, flow, amplitude and direction of CSF flow but also in the arteries and veins (Enzmann and Pelc, 1993;Lagana et al, 2014).…”

Predicting the Aqueductal Cerebrospinal Fluid Pulse: A Statistical Approach

“…The slice of the PC sequences were positioned perpendicularly to the flow of interest: for the cervical blood flow, the sagittal neck localizer ( Figure 1A) and the sagittal and coronal TOF MIP on the images ( Figure 1B,C) were used for positioning the PC slice at the C2/C3 level perpendicularly to the IJVs ( Figure 1A,B,C); for the cCSF flow the sagittal neck localizer was used for positioning perpendicularly to the spinal canal at C2/C3 level ( Figure 1A); for the aCSF flow the sagittal T1-weighted brain localizer was used ( Figure 1D) for positioning perpendicularly to the AoS. The flow data were processed with FlowQ software, an in-house program written in MATLAB (The Mathworks, Natick, MA, USA), with the methods described in [25] by a single trained examiner. Briefly, for every PC sequence, the processing consisted in manually drawing two kinds of regions of interest (ROIs) on the magnitude and phase images.…”

“…The flow rate (in ml/s) was computed for each time point, based on the mean velocity and the cross sectional area of the corresponding structure. The flow data were processed with FlowQ software, an in-house program written in MATLAB (The Mathworks, Natick, MA, USA), with the methods described in [25] by a single trained examiner. Briefly, for every PC sequence, the processing consisted in manually drawing two kinds of regions of interest (ROIs) on the magnitude and phase images.…”

Accuracy of 4D Flow Measurement of Cerebrospinal Fluid Dynamics in the Cervical Spine: An In Vitro Verification Against Numerical Simulation

“…As such, a better understanding of CSF dynamics can improve the diagnosis and treatment of CNS disorders. Numerous studies have been carried out to assess CSF dynamics in the spinal subarachnoid space (SAS) using in vivo measurement techniques such as phase contrast magnetic resonance imaging (PCMRI) 24 and intraoperative ultrasound. More recently, the development of time-resolved three directional PCMRI sequences (4D Flow) has enabled the simultaneous measurement of velocities in through-plane and in-plane directions and allows for higher spatio-temporal resolution compared with conventional 2D PCMRI methods within a clinically feasible time-frame 5, 35 .…”