Does Phase-Contrast Imaging through the Cerebral Aqueduct Predict the Outcome of Lumbar CSF Drainage or Shunt Surgery in Patients with Suspected Adult Hydrocephalus?

Abstract

BACKGROUND AND PURPOSE:Radiologic imaging plays a key role in diagnosing chronic adult hydrocephalus, but its role in predicting prognosis is still controversial. We sought to evaluate the effectiveness of cardiac-gated phase-contrast MR imaging through the cerebral aqueduct in predicting the clinical response to diagnostic lumbar puncture/lumbar drainage and shunt surgery in suspected adult hydrocephalus. MATERIALS AND METHODS:In this retrospective study, the phase-contrast MR imaging of 185 patients with suspected chronic adult hydrocephalus was evaluated using the CSF Flow software package. Decision-making for shunt placement was performed in this cohort on the basis of clinical assessment alone without the availability of quantitative phase-contrast MR imaging results. We recorded the response to lumbar puncture or lumbar drainage and shunt surgery using quantitative tests such as the Tinetti Test, the Timed Up and Go, and the Mini-Mental State Examination and qualitative measures of gait, urinary, and cognitive symptom improvement before and after lumbar puncture/lumbar drainage and shunt surgery. Quantitative analysis of phase-contrast MR imaging was compared with clinical outcome measures. RESULTS:Both CSF stroke volume and flow rate overlapped between lumbar puncture/lumbar drainage responders and nonresponders. There was also a significant overlap between shunt responders and nonresponders. Aqueductal stroke volume or flow rate alone was a poor predictor of lumbar puncture/lumbar drainage and shunt surgery response. Quantitative clinical measures after lumbar puncture/ lumbar drainage were better predictors of shunt response. CONCLUSIONS:This study suggests that the results of phase-contrast MR imaging through the cerebral aqueduct alone should not be used to select patients for diagnostic or therapeutic CSF diversion. ABBREVIATIONS:AQ-PCMR ϭ aqueductal phase-contrast MRI; CAH ϭ chronic adult hydrocephalus; LD ϭ lumbar drainage; LP ϭ lumbar puncture; MMSE ϭ Mini-Mental State Examination; TUG ϭ Timed Up and Go

In vitro and numerical simulation of blood removal from cerebrospinal fluid: comparison of lumbar drain to Neurapheresis therapy

“…Our modeling approach did not include flow oscillations within the ventricles [69,70] or a respiratory component of CSF pulsations [71][72][73] because the MRI scanning time did not allow measurement of these parameters in addition to the other parameters used to formulate the model. Additionally, the presented model used a rigid material in which boundary motion of the dura was not prescribed [25].…”

Idiopathic Normal Pressure Hydrocephalus and Elderly Acquired Hydrocephalus: Evaluation With Cerebrospinal Fluid Flow and Ventricular Volume Parameters

“…The participants in all three groups underwent PC-MRI examination with the same scanning sequence. In order to reduce heterogeneities in baseline aqueductal flow with PC-MR as much as possible, PC-MR scanning time of all patients with hydrocephalus and participants of NC group were selected at night (8-10 p.m) (Blitz et al, 2018) NE. Ref.…”

In vitro and Numerical Simulation of Blood Removal from Cerebrospinal Fluid: Comparison of Lumbar Drain to Neurapheresis Therapy

“…Our modeling approach did not include flow oscillations within the ventricles (60,61) or a respiratory component of CSF pulsations (62)(63)(64) because the MRI scanning time did not allow measurement of these parameters in addition to the other parameters used to formulate the model. Additionally, the presented model used a rigid material in which boundary motion of the dura was not prescribed (24).…”