CSF dynamics disorders: Association of brain MRI and nuclear medicine cisternogram findings

Cogswell, Petrice M; Graff‐Radford, Jonathan; Wurtz, Lincoln; Graff‐Radford, Neill R.; Johnson, Derek R.; Hunt, Christopher H.; Gunter, Jeffrey L.; Cutsforth‐Gregory, Jeremy K.; Jones, David T.; Elder, Benjamin D.; Huston, John; Jack, Clifford R.

doi:10.1016/j.nicl.2020.102481

Cited by 6 publications

(7 citation statements)

References 18 publications

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“…Reflux grades 3 to 4 were observed in 46/92 patients (50%), characterized by a high degree of tracer enrichment in lateral ventricles at 24 h. If the CSF of the ventricles is replaced by CSF reproduction three times over 24 h, the continued presence of tracer at 24 h suggests either reduced formation of CSF or increased dispersion. A recent nuclear medicine cisternogram study found the radiotracer to more frequently enrich in lateral ventricles, though being absent or delayed over cerebral convexity, of individuals with DESH sign and high convexity tight sulci [ 38 ]. The latter is seen in iNPH patients (see Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

Direction and magnitude of cerebrospinal fluid flow vary substantially across central nervous system diseases

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Lindstrøm

et al. 2021

Fluids Barriers CNS

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Background Several central nervous system diseases are associated with disturbed cerebrospinal fluid (CSF) flow patterns and have typically been characterized in vivo by phase-contrast magnetic resonance imaging (MRI). This technique is, however, limited by its applicability in space and time. Phase-contrast MRI has yet to be compared directly with CSF tracer enhanced imaging, which can be considered gold standard for assessing long-term CSF flow dynamics within the intracranial compartment. Methods Here, we studied patients with various CSF disorders and compared MRI biomarkers of CSF space anatomy and phase-contrast MRI at level of the aqueduct and cranio-cervical junction with dynamic intrathecal contrast-enhanced MRI using the contrast agent gadobutrol as CSF tracer. Tracer enrichment of cerebral ventricles was graded 0–4 by visual assessment. An intracranial pressure (ICP) score was used as surrogate marker of intracranial compliance. Results The study included 94 patients and disclosed marked variation of CSF flow measures across disease categories. The grade of supra-aqueductal reflux of tracer varied, with strong reflux (grades 3–4) in half of patients. Ventricular tracer reflux correlated with stroke volume and aqueductal CSF pressure gradient. CSF flow in the cerebral aqueduct was retrograde (from 4th to 3rd ventricle) in one third of patients, with estimated CSF net flow volume about 1.0 L/24 h. In the cranio-cervical junction, net flow was cranially directed in 78% patients, with estimated CSF net flow volume about 4.7 L/24 h. Conclusions The present observations provide in vivo quantitative evidence for substantial variation in direction and magnitude of CSF flow, with re-direction of aqueductal flow in communicating hydrocephalus, and significant extra-cranial CSF production. The grading of ventricular reflux of tracer shows promise as a clinical useful method to assess CSF flow pattern disturbances in patients. Graphic abstract

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Section: Discussionmentioning

confidence: 99%

Direction and magnitude of cerebrospinal fluid flow vary substantially across central nervous system diseases

Eide

Valnes

Lindstrøm

et al. 2021

Fluids Barriers CNS

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“…Dynamic positron emission tomography (PET) with radionuclide injected intravenously or intrathecally has also been used to investigate the main clearance and drainage pathways of PVS fluid ( Cogswell et al, 2020 ; de Leon et al, 2017 ), although the limited anatomic resolution of PET scans does not currently enable the visualization of the details of the perivascular system.…”

Section: Imaging Pvs Functionmentioning

confidence: 99%

Imaging perivascular space structure and function using brain MRI

et al. 2022

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“…This “disproportionately enlarged subarachnoid-space hydrocephalus” (DESH) ( 43 , 44 ) is found in many but not all ( 45 ) cases of iNPH, and as a potential marker of response to shunt surgery ( 44 , 46 , 47 ), some centres have incorporated it into management pathways ( 30 ). The pathophysiological mechanisms underlying DESH are unclear but it is likely to be associated with disrupted CSF dynamics ( 48 ).…”

Section: Imagingmentioning

confidence: 99%

“…A number of recent studies have now investigated the presence of DESH in the wider population, where it is found in 1–7% and associated with poorer cognition ( 49 – 52 ). A study examining over a thousand participants with either no or only mild cognitive impairment found that DESH was a predictor of progressive cognitive decline independent of established features including age, cortical thickness, or APOE status ( 48 ). There is also evidence that in some cases DESH may be a marker of preclinical iNPH: a long term follow up study of asymptomatic individuals with DESH imaging features found that approximately 17% per year subsequently progressed to symptomatic iNPH ( 53 ).…”

Section: Imagingmentioning

confidence: 99%

Update on the Cognitive Presentations of iNPH for Clinicians

2022

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This mini-review focuses on cognitive impairment in iNPH. This symptom is one of the characteristic triad of symptoms in a condition long considered to be the only treatable dementia. We present an update on recent developments in clinical, neuropsychological, neuroimaging and biomarker aspects. Significant advances in our understanding have been made, notably regarding biomarkers, but iNPH remains a difficult diagnosis. Stronger evidence for permanent surgical treatment is emerging but selection for treatment remains challenging, particularly with regards to cognitive presentations. Encouragingly, there has been increasing interest in iNPH, but more research is required to better define the underlying pathology and delineate it from overlapping conditions, in order to inform best practise for the clinician managing the cognitively impaired patient. In the meantime, we strongly encourage a multidisciplinary approach and a structured service pathway to maximise patient benefit.

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CSF dynamics disorders: Association of brain MRI and nuclear medicine cisternogram findings

Cited by 6 publications

References 18 publications

Direction and magnitude of cerebrospinal fluid flow vary substantially across central nervous system diseases

Direction and magnitude of cerebrospinal fluid flow vary substantially across central nervous system diseases

Imaging perivascular space structure and function using brain MRI

Update on the Cognitive Presentations of iNPH for Clinicians

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