Cine cerebrospinal fluid imaging in multiple sclerosis

Abstract

Purpose: To investigate cerebrospinal fluid (CSF) dynamics in the aqueduct of Sylvius in multiple sclerosis (MS) patients and healthy controls (HC) using cine phase contrast imaging. Materials and Methods:In all, 67 MS patients (48 relapsing-remitting [RR] and 19 secondary-progressive [SP]), nine patients with clinically isolated syndrome (CIS), and 35 age-and sex-matched HC were examined. CSF flow and velocity measures were quantified using a semiautomated method and compared with clinical and magnetic resonance imaging (MRI) disease outcomes.Results: Significantly decreased CSF net flow was detected in MS patients compared to HC (À3.7 vs. À7.1 mL/beat, P ¼ 0.005). There was a trend for increased net positive flow between SP, RR, and CIS patients. Altered CSF flow and velocity measures were associated with more severe T1 and T2 lesion volumes, lateral and fourth ventricular volumes, and third ventricular width in MS and CIS patients (P < 0.01 for all). In CIS patients, conversion to clinically definite MS in the following year was related to decreased CSF net flow (P ¼ 0.007). There was a trend between increased annual relapse rate and altered CSF flow/velocity measures in RRMS patients (P < 0.05).Conclusion: CSF flow dynamics are altered in MS patients. More severe clinical and MRI outcomes in RRMS and CIS patients relate to altered CSF flow and velocity measures.

Longitudinal Mixed-Effect Model Analysis of the Association between Global and Tissue-Specific Brain Atrophy and Lesion Accumulation in Patients with Clinically Isolated Syndrome

“…33 Other mechanisms at work, including an effect of altered CSF flow pulsatility, may be considered when interpreting these findings. 34 There is evidence that approximately 40% of patients with CIS have cortical lesions according to histopathologic examination. 35 They occur early in patients with CIS and increase in number and size over time.…”

Concomitant Analysis of Arterial, Venous, and CSF Flows using Phase-Contrast MRI: A Quantitative Comparison Between MS Patients and Healthy Controls

“…Magnano et al 37 using comparable definitions, concluded that MS patients had higher net positive CSF flows in caudocranial direction (reflecting increased CSF pulsatility in the aqueduct) contrasting with reduced CSF net flow (reflecting decreased CSF drainage). They hypothesized that the increased pulsatile flow could lead to increased perfusion and permeability of the ventricles, thereby resulting in higher accumulation of periventricular and deep white matter lesions.…”

Brain venous haemodynamics, neurological diseases and mathematical modelling. A review

“…Their work was motivated by recent studies that suggest that the dynamics of CSF inside the brain may provide indicators that distinguish between HCs and MS patients. In particular, the study performed by Magnano and collaborators [77] showed that CSF flow dynamics is altered in patients with MS and that more severe clinical and MR imaging outcomes in RRMS and CIS relate to altered CSF flow and velocity measures. In particular, it is noted that increased CSF flow and decreased CSF velocity are indicative of improved venous parenchyma drainage.…”

“…We suggest to use the solution that can be obtained by assuming a priori that both non-linear waves are rarefaction waves. That is, f L and f R in (76), (77) correspond to rarefactions. Then (75) becomes…”