Evaluation of cerebrospinal fluid flow dynamic changes in patients with idiopathic intracranial hypertension using phase contrast cine MR imaging

Tamer Belal,Alshaimaa Ramadan,Fatema Mohamed Sherif,Abd-Elhalim Al Tantawy

doi:10.1186/s41983-020-00227-7

Tamer Belal, Alshaimaa Ramadan + Show 2 more

Open Access

https://doi.org/10.1186/s41983-020-00227-7

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Abstract

BackgroundIdiopathic intracranial hypertension (IIH) mainly affects overweight women in the middle age period. The pathophysiology of IIH stays unclear, but suggested mechanisms include excess CSF production, reduced CSF absorption, increased brain water content, and increased cerebral venous pressureObjectivesTo assess the cerebrospinal fluid (CSF) flow dynamic changes in aqueduct of Sylvius in patients of idiopathic intracranial hypertension (IIH) with new MRI technique: phase contrast cine MRI (PCC-MRI).MethodsThirty patients diagnosed with idiopathic intracranial hypertension were divided into 3 groups according to treatment options (no treatment, medical treatment, and medical treatment with repeated lumbar tapping). CSF flow data were evaluated by phase contrast cine MRI.ResultsPCC-MRI parameters were significantly higher in group who was on medical treatment (group II) than other groups. The sensitivity of PCC MRI parameters ranged from 56.7 (stroke volume (SV) and mean flow (MF)) to 83.3% (peak systolic velocity (PSV)). A statistically significant difference was found for the mean flow value (p 0.039) between the control group and IIH patients.ConclusionThe most specific CSF flowmetry parameter detected to help diagnosis of IIH is mean flow especially among early discovered patients. PCC MRI can be used as non-invasive technique for diagnosis of IIH and treatment follow-up.

Highlights

Idiopathic intracranial hypertension (IIH) is a disease with no clear etiology that mainly affects overweight women in the middle age period with incidence of 1–2/ 100,000 [1]
PCC magnetic resonance imaging (MRI) can be used as non-invasive technique for diagnosis of IIH and treatment follow-up
The peak systolic velocity (PSV), peak diastolic velocity (PDV), and stroke volume (SV) were significantly higher in group who was on medical treatment than other groups (Table 2)

Summary

Introduction

Idiopathic intracranial hypertension (IIH) is a disease with no clear etiology that mainly affects overweight women in the middle age period with incidence of 1–2/ 100,000 [1]. The research of CSF flow has gained an attention especially in the recent years by using phase contrast cine magnetic resonance imaging (PCC-MRI); which is very sensitive even for very slow flows. PCC-MRI makes it possible to show the CSF flow depending on anatomical structures and phase sensitive methods and allows for quantitative assessment of the flow. It is important to make a good assessment whether the abnormalities seen using PCC-MRI for changes in CSF flow dynamic parameters were due to the disease itself or secondary to medications or repeated spinal tapping [6]. Idiopathic intracranial hypertension (IIH) mainly affects overweight women in the middle age period. The pathophysiology of IIH stays unclear, but suggested mechanisms include excess CSF production, reduced CSF absorption, increased brain water content, and increased cerebral venous pressure

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