The oscillatory flow of the cerebrospinal fluid in the Sylvian aqueduct and the prepontine cistern measured with phase contrast MRI in children with hydrocephalus—a preliminary report

Abstract

IntroductionRecognizing patients with ventriculomegaly who are at risk of developing acute hydrocephalus presents a challenge for the clinician. The association between disturbed cerebrospinal fluid flow (CSF) and impaired brain compliance may play a role in the pathogenesis of hydrocephalus. Phase contrast MRI is a noninvasive technique which can be used to assess CSF parameters. The aim of the work is to evaluate the effectiveness of phase contrast MRI in recognizing patients at risk of acute hydrocephalus, based on measuring the pulsatile CSF flow parameters in the Sylvian aqueduct and prepontine cistern in children with ventriculomegaly.AimThe aim of the work is to characterize the parameters of cerebrospinal fluid (CSF) flow in the Sylvian aqueduct and prepontine cistern in children with ventriculomegaly with regard to patient age and symptoms. We hypothesize that the relationship between CSF flow parameters in these two regions will vary according to analyzed factors and it will allow to recognize children at risk of hydrocephalus.Materials and methodsA group of 26 children with ventriculomegaly (five girls and 21 boys) underwent phase contrast MRI examinations (Philips 3T Achieva with Q-flow integral application). Amplitudes of average and peak velocities of the CSF flow through the Sylvian aqueduct and prepontine cistern were used to calculate ratios of oscillation and peak velocities, respectively. The relationship between the oscillation coefficient, the peak velocity coefficient, and stroke volume was then assessed in accordance with age and clinical symptoms.ResultsThe peak velocity coefficient was significantly higher in patients with hyper-oscillating flow through the Sylvian aqueduct (3.04 ± 3.37 vs. 0.54 ± 0.28; p = 0.0094). Moreover, these patients tended to develop symptoms more often (p = 0.0612). No significant age-related changes were observed in CSF flow parameters.ConclusionPhase contrast MRI is a useful tool for noninvasive assessment of CSF flow parameters. The application of coefficients instead of direct values seems to better represent hemodynamic conditions in the ventricular system. However, further studies are required to evaluate their clinical significance and normal limits.

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

“…The goal of the present study was to characterize CSF flow dynamics and geometry in people with ALS compared to healthy controls. A few groups have made strides towards characterizing CSF dynamics in conditions such as Chiari malformation [15][16][17][18][19][20][21], Syringomyelia [20][21][22], and hydrocephalus [23], as well as investigation of CSF flow dynamics in people with ALS [24]. We expand on this characterization by providing a more complete analysis of the hydrodynamic environment.…”

Endoscopic third ventriculostomy for patients with Blake’s pouch cyst with adult-onset hydrocephalus: Importance of improved cerebrospinal fluid flow in the prepontine cistern – A case report

“…[ 14 ] In pediatric cases with an enlarged cerebral ventricle, poor pulsation in the prepontine cistern can be detected using cine MRI, unlike in asymptomatic cases. [ 8 ] Moreover, a study by Anik et al . reported that good pulsation in the prepontine cistern can be observed after ETV in successful cases of BPC in pediatric patients.…”

Neurofluids—Deep inspiration, cilia and preloading of the astrocytic network

“…Similar investigations using phase‐contrast MRI have been repeated by other groups (Miyazaki et al, 2019). To explain the underlying pathophysiology, CSF flow studies have been undertaken (Nowosławska et al., 2018). These studies are based on cardiac‐gated MRI phase contrast and could demonstrate that the strength of the flow void signal (Figure 7) through the aqueduct predicts the success rate by shunt therapy.…”