Noninvasive assessment of intracranial elastance and pressure in spontaneous intracranial hypotension by MRI

Tsai, Yi-Hsin; Chen, Hung-Chieh; Tung, Hsin; Wu, Yi‐Ying; Chen, Hsian‐Min; Pan, Kuan-Jung; Cheng, Da‐Chuan; Chen, Jeon‐Hor; Chen, Clayton Chi‐Chang; Chai, Jyh‐Wen; Shen, Wu‐Chung

doi:10.1002/jmri.25976

Cited by 10 publications

(15 citation statements)

References 38 publications

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“…Finally, the phase contrast magnetic resonance imaging (PC‐MRI) is a non‐invasive MRI sequence able to quantify variations in CSF flow. Three comparative studies confirmed abnormal results of PC‐MRI in SIH . These results were correlated to the CSF opening pressure in a case‐control study …”

Section: Discussionsupporting

confidence: 56%

Contribution of Otoacoustic Emissions for Diagnosis of Atypical or Recurrent Intracranial Hypotension. A Cases Series

Redon¹,

Elzière

Kaphan

et al. 2019

Headache

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Background The diagnosis of spontaneous or post‐traumatic intracranial hypotension mainly rely on clinical features and neuroimaging. In atypical presentations, other non‐invasive tests are missing to support the diagnosis of intracranial hypotension. The assessment of otoacoustic emissions (OAE) shown interest to monitor intracranial pressure mainly in cases of intracranial hypertension. This non‐invasive method was also assessed in response to pressure change after lumbar puncture. A few reports showed abnormal results of distortion product otoacoustic emissions (DPOAE) in cases of spontaneous or post‐traumatic intracranial hypotension. We describe additional results in a series of intracranial hypotension cases. We discuss the interest of DPOAE assessment in atypical presentations of intracranial hypotension. We review the other non‐invasive tests reported in literature. Methods We studied 4 atypical or recurrent cases of spontaneous or post‐traumatic intracranial hypotension by recording OAE in sitting then supine position. Results Unilateral or bilateral abnormal changes of DPOAE were recorded in all cases, in response to postural test. These changes were present even in the absence of vestibular symptoms. Conclusion The study of OAE may be a non‐invasive tool for the diagnosis of spontaneous intracranial hypotension.

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Section: Discussionsupporting

confidence: 56%

Contribution of Otoacoustic Emissions for Diagnosis of Atypical or Recurrent Intracranial Hypotension. A Cases Series

Redon¹,

Elzière

Kaphan

et al. 2019

Headache

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“…Multiple successful smaller‐scale studies will therefore strengthen the justification and help obtain resources for a larger‐scale study. This work adds to multiple reports, some by independent investigators, which presented direct or indirect evidence supporting the validity of MR‐ICP. For example, Muehlmann et al demonstrated a good correlation between MR‐ICP and shunt opening pressure setting .…”

supporting

confidence: 64%

“…Significant correlation over a narrow range of ICP values was found when MR‐ICP was compared with ventriculo‐peritoneal shunt‐valve opening pressure in 15 children with hydrocephalus . A diagnostic accuracy of MR‐ICP was reported in idiopathic normal‐pressure hydrocephalus, pediatric idiopathic intracranial hypertension patients, subjects who acquired symptoms of mountain sickness using normobaric hypoxia, Chiari malformation type I patients, and in the early diagnosis of spontaneous intracranial hypotension …”

Section: Discussionmentioning

confidence: 97%

“…15 A diagnostic accuracy of MR-ICP was reported in idiopathic normal-pressure hydrocephalus, 14 pediatric idiopathic intracranial hypertension patients, 19 subjects who acquired symptoms of mountain sickness using normobaric hypoxia, 16 Chiari malformation type I patients, 17 and in the early diagnosis of spontaneous intracranial hypotension. 20 The MR-ICP calculates the CSF pressure gradient to derive the pulse pressure. One group tested the correspondence between the MRI-derived pressure gradient and the invasively measured pulse pressure in two different cohorts.…”

Section: Discussionmentioning

confidence: 99%

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Comparing invasive with MRI‐derived intracranial pressure measurements in healthy elderly and brain trauma cases: A pilot study

Burman

Shah

Benveniste

et al. 2019

Magnetic Resonance Imaging

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Background Intracranial pressure (ICP) is an important physiological parameter in several neurological disorders. Considerable effort has been made to measure ICP noninvasively. MR‐based ICP (MR‐ICP) is a nonempirical method based on principles of cerebrospinal fluid (CSF) physiology, where ICP is obtained from measurements of blood and CSF flows to and from the cranium during the cardiac cycle. Purpose To compare MR‐ICP with invasive ICP measurements obtained using lumbar puncture (LP) or external ventricular drainage (EVD). Study Type Prospective, cross‐sectional, observational study. Subjects Ten cognitively healthy elderly subjects (age 69.6 ± 6.6 years; seven females) and six brain trauma patients (age 36.8 ± 19.7 years; two females). Field Strength Velocity encoding cine phase‐contrast at 1.5 T and 3 T. Assessment MR‐ICP and craniospinal compliance distribution were estimated from arterial inflow and venous outflow to and from cranium, and craniospinal CSF flow at the upper cervical region, measured using cine phase contrast MRI. LP (done 177 ± 163 days after scan) and EVD measurements (at the time of scan) were performed in lateral recumbent and supine positions, respectively. Statistical Tests Linear regression was used to assess the relationships of MR‐ICP with invasive ICP, and the dependency of these measurements on age, weight, height, and BMI. A Shapiro–Wilks test and Bland–Altman plot were respectively used to evaluate the normality and agreement between these two pressure distributions. Student's t‐test was used throughout the analysis to compare differences between the EVD and LP cohorts. Results In the combined cohort, MR‐ICP and invasive ICP were positively correlated (r = 0.95, P < 0.001), with invasive ICP being higher than MR‐ICP by 2.2 mmHg on average. In the healthy cohort, the cranial contribution to total craniospinal compliance was negatively correlated with MR‐ICP (r = −0.90, P < 0.001). Data Conclusion MR‐ICP provides a reliable estimate of ICP, with 14 out of 16 datapoints within the clinically acceptable error. Craniospinal compliance distribution plays a role in modulating ICP in supine position. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:975–981.

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“…Few studies have investigated CSF flow in patients with SIH focusing on CSF flow through the aqueduct. [32][33][34][35] One study reported lower CSF flow at C2/C3 among 23 patients with definite SIH and 4 patients with assumed SIH (controls: 1.2 ± 0.3 mL/s, patients: 0.8 ± 0.4 mL/s, p > 0.001). This is in contrast to current results.…”

Section: Discussionmentioning

confidence: 99%

CSF Flow and Spinal Cord Motion in Patients With Spontaneous Intracranial Hypotension

et al. 2023

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Background& Objectives: Spontaneous intracranial hypotension (SIH) is characterized by loss of CSF-volume. We hypothesize that in this situation of low volume, a larger CSF-flow and spinal cord motion at the upper spine can be measured by non-invasive phase-contrast MRI.Methods:A prospective, age-, gender- and BMI- matched controlled cohort study on SIH patients presenting with spinal longitudinal extradural fluid collection (SLEC) was conducted November 2021 to February 2022. Adapted cardiac-gated 2D phase-contrast MRI sequences were acquired at segment C2/C3, and C5/C6 for CSF-flow, and spinal cord motion analysis. Data processing was fully automated. CSF-flow and spinal cord motion were analyzed by peak-to-peak-amplitude and total displacement per segment and heartbeat, respectively. Clinical data included: age, height, body mass index, duration of symptoms, Bern score according to Dobrocky et al. 2019, and type of the spinal CSF leak according to Schievink et al. 2016. Groups were compared via Mann-Whitney U-test; multiple linear regression analysis was performed to address possible relations.Results:20 SIH patients and 40 healthy controls were analyzed; each group consisted of 70% women. 11 SIH patients presented with Type 1 leak, eight with Type 2, and one was indeterminate. CSF flow per heartbeat was increased at C2/C3 (peak-to-peak-amplitude 65.68 ± 18.3 mm/s vs. 42.50 ± 9.8 mm/s, total displacement 14.32 ± 3.5 mm vs. 9.75 ± 2.7 mm, p<0.001, respectively). Craniocaudal spinal cord motion per heartbeat was larger at segment C2/C3 (peak-to-peak-amplitude 7.30 ± 2.4 mm/s vs. 5.82 ± 2.0 mm/s, total displacement 1.01 ± 0.4 mm vs. 0.74 ± 0.4 mm, p=0.006, respectively) and at segment C5/C6 (total displacement 1.41 ± 0.7 mm vs. 0.97 ± 0.4 mm, p=0.021).Discussion:SLEC-positive SIH patients show higher CSF-flow and higher spinal cord motion at the upper cervical spine. This increased craniocaudal motion of the spinal cord per heartbeat might produce increased mechanic strain on neural tissue and adherent structures which may be a mechanism leading to cranial nerve dysfunction, neck pain and stiffness in SIH. Non-invasive phase-contrast MRI of CSF-flow and spinal cord motion is a promising diagnostic tool in SIH.German Clinical Trials Register, identification number:DRKS00017351Classification of Evidence:This study provides Class III evidence that non-invasive phase-contrast MRI of the upper spine identifies differences in CSF-flow and spinal cord motion in SIH patients compared to healthy controls.

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Noninvasive assessment of intracranial elastance and pressure in spontaneous intracranial hypotension by MRI

Abstract: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1255-1263.

Cited by 10 publications

References 38 publications

Contribution of Otoacoustic Emissions for Diagnosis of Atypical or Recurrent Intracranial Hypotension. A Cases Series

Contribution of Otoacoustic Emissions for Diagnosis of Atypical or Recurrent Intracranial Hypotension. A Cases Series

Comparing invasive with MRI‐derived intracranial pressure measurements in healthy elderly and brain trauma cases: A pilot study

CSF Flow and Spinal Cord Motion in Patients With Spontaneous Intracranial Hypotension

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