Quantifying the influence of respiration and cardiac pulsations on cerebrospinal fluid dynamics using real‐time phase‐contrast MRI

Yıldız, Selda; Thyagaraj, Suraj; Jin, Ning; Zhong, Xiaodong; Pahlavian, Soroush Heidari; Martin, Bryn A.; Loth, Francis; Oshinski, John N.; Sabra, Karim G.

doi:10.1002/jmri.25591

Cited by 130 publications

(195 citation statements)

References 34 publications

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“…Additionally, in vitro studies have been performed by our group to quantify the reliability of MRI for CSF geometric and flow measurements. Yildiz et al 2017, found a CV of 4.8% for peak CSF flow at a single location [31] and Thyagaraj et al 2017, found a an average CV of 8% for peak CSF flow across several locations [32]. Geometric reconstruction was also analyzed by Thyagaraj et al 2017, and found to be in good agreement with the digital.…”

Section: Reliability Of Mri Based Measurements Of Csf Hydrodynamicsmentioning

confidence: 92%

Non-invasive MRI quantification of cerebrospinal fluid dynamics in amyotrophic lateral sclerosis patients

Sass

Khani

Romm

et al. 2020

Fluids Barriers CNS

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Background: Developing novel therapeutic agents to treat amyotrophic lateral sclerosis (ALS) has been difficult due to multifactorial pathophysiologic processes at work. Intrathecal drug administration shows promise due to close proximity of cerebrospinal fluid (CSF) to affected tissues. Development of effective intrathecal pharmaceuticals will rely on accurate models of how drugs are dispersed in the CSF. Therefore, a method to quantify these dynamics and a characterization of differences across disease states is needed. Methods: Complete intrathecal 3D CSF geometry and CSF flow velocities at six axial locations in the spinal canal were collected by T2-weighted and phase-contrast MRI, respectively. Scans were completed for eight people with ALS and ten healthy controls. Manual segmentation of the spinal subarachnoid space was performed and coupled with an interpolated model of CSF flow within the spinal canal. Geometric and hydrodynamic parameters were then generated at 1 mm slice intervals along the entire spine. Temporal analysis of the waveform spectral content and feature points was also completed. Results: Comparison of ALS and control groups revealed a reduction in CSF flow magnitude and increased flow propagation velocities in the ALS cohort. Other differences in spectral harmonic content and geometric comparisons may support an overall decrease in intrathecal compliance in the ALS group. Notably, there was a high degree of variability between cases, with one ALS patient displaying nearly zero CSF flow along the entire spinal canal. Conclusion: While our sample size limits statistical confidence about the differences observed in this study, it was possible to measure and quantify inter-individual and cohort variability in a non-invasive manner. Our study also shows the potential for MRI based measurements of CSF geometry and flow to provide information about the hydrodynamic environment of the spinal subarachnoid space. These dynamics may be studied further to understand the behavior of CSF solute transport in healthy and diseased states.

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Section: Reliability Of Mri Based Measurements Of Csf Hydrodynamicsmentioning

confidence: 92%

Non-invasive MRI quantification of cerebrospinal fluid dynamics in amyotrophic lateral sclerosis patients

Sass

Khani

Romm

et al. 2020

Fluids Barriers CNS

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“…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].…”

Section: Limitationsmentioning

confidence: 99%

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

Khani

Sass

Sharp

et al. 2020

Fluids Barriers CNS

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Background: Blood removal from cerebrospinal fluid (CSF) in post-subarachnoid hemorrhage patients may reduce the risk of related secondary brain injury. We formulated a computational fluid dynamics (CFD) model to investigate the impact of a dual-lumen catheter-based CSF filtration system, called Neurapheresis ™ therapy, on blood removal from CSF compared to lumbar drain. Methods:A subject-specific multiphase CFD model of CSF system-wide solute transport was constructed based on MRI measurements. The Neurapheresis catheter geometry was added to the model within the spinal subarachnoid space (SAS). Neurapheresis flow aspiration and return rate was 2.0 and 1.8 mL/min, versus 0.2 mL/min drainage for lumbar drain. Blood was modeled as a bulk fluid phase within CSF with a 10% initial tracer concentration and identical viscosity and density as CSF. Subject-specific oscillatory CSF flow was applied at the model inlet. The dura and spinal cord geometry were considered to be stationary. Spatial-temporal tracer concentration was quantified based on time-average steady-streaming velocities throughout the domain under Neurapheresis therapy and lumbar drain. To help verify CFD results, an optically clear in vitro CSF model was constructed with fluorescein used as a blood surrogate. Quantitative comparison of numerical and in vitro results was performed by linear regression of spatial-temporal tracer concentration over 24-h. Results:After 24-h, tracer concentration was reduced to 4.9% under Neurapheresis therapy compared to 6.5% under lumbar drain. Tracer clearance was most rapid between the catheter aspiration and return ports. Neurapheresis therapy was found to have a greater impact on steady-streaming compared to lumbar drain. Steady-streaming in the cranial SAS was ~ 50× smaller than in the spinal SAS for both cases. CFD results were strongly correlated with the in vitro spatial-temporal tracer concentration under Neurapheresis therapy (R 2 = 0.89 with + 2.13% and − 1.93% tracer concentration confidence interval). Conclusion:A subject-specific CFD model of CSF system-wide solute transport was used to investigate the impact of Neurapheresis therapy on tracer removal from CSF compared to lumbar drain over a 24-h period. Neurapheresis therapy was found to substantially increase tracer clearance compared to lumbar drain. The multiphase CFD results were verified by in vitro fluorescein tracer experiments. © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article' s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article'

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“…Other investigators used magnitude intensity variations in real‐time MRI to demonstrate that respiration may also influence CSF hydrodynamics, especially during deep breathing . This was confirmed by real‐time phase‐contrast echo‐planar imaging (PCEPI) applications in the brain and cranium, the foramen magnum and real‐time phase‐contrast combined with radial gradient echo acquisitions in different cervical and thoracic levels …”

Section: Introductionmentioning

confidence: 91%

Influence of respiration‐induced B₀ variations in real‐time phase‐contrast echo planar imaging of the cervical cerebrospinal fluid

Peters

Weiss

Maintz

et al. 2019

Magnetic Resonance in Med

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Purpose Respiration induces temporal variations of the main magnetic field B0 along the spinal cord. These variations are typically not compensated for in velocity quantifications using phase‐contrast MRI. The goal of this study was to analyze errors caused by respiration‐induced B0 variations in real‐time phase‐contrast echo planar imaging (PCEPI) of cervical cerebrospinal fluid (CSF) velocity measurements and to evaluate this effect for various sequence parameters using numerical simulations. Methods Real‐time B0 measurements with double gradient echo sequence and PCEPI measurements were acquired in the cervical CSF of 10 healthy subjects. Dynamic phase offsets attributed to respiration‐induced B0 variations were analyzed by quantifying amplitudes and comparing the temporal behavior with respiratory signals. In experiments and simulations, the influence of the echo time (TE) and the delay between PCEPI images (Δt) with respect to respiration on the dynamic phase offsets were investigated. Results A good agreement was found between phase offsets extracted from both acquisition types. Furthermore, respiratory signals qualitatively matched the temporal behavior of the measured phase offsets showing a dependency on subject‐dependent local B0 distribution and respiration physiology. Simulations revealed residual background phases in PCEPI velocity quantification varying with TE and Δt. Conclusion Respiration‐induced B0 variations result in dynamic background phases in real‐time PCEPI velocity quantifications of the CSF in the cervical spine. The current work underlines that these background phases need to be corrected to avoid confounding effects.

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Quantifying the influence of respiration and cardiac pulsations on cerebrospinal fluid dynamics using real‐time phase‐contrast MRI

Abstract: 1 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:431-439.

Cited by 130 publications

References 34 publications

Non-invasive MRI quantification of cerebrospinal fluid dynamics in amyotrophic lateral sclerosis patients

Non-invasive MRI quantification of cerebrospinal fluid dynamics in amyotrophic lateral sclerosis patients

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

Influence of respiration‐induced B₀ variations in real‐time phase‐contrast echo planar imaging of the cervical cerebrospinal fluid

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Quantifying the influence of respiration and cardiac pulsations on cerebrospinal fluid dynamics using real‐time phase‐contrast MRI

Abstract: 1 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:431-439.

Cited by 130 publications

References 34 publications

Non-invasive MRI quantification of cerebrospinal fluid dynamics in amyotrophic lateral sclerosis patients

Non-invasive MRI quantification of cerebrospinal fluid dynamics in amyotrophic lateral sclerosis patients

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

Influence of respiration‐induced B0 variations in real‐time phase‐contrast echo planar imaging of the cervical cerebrospinal fluid

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Influence of respiration‐induced B₀ variations in real‐time phase‐contrast echo planar imaging of the cervical cerebrospinal fluid