Abstract
BackgroundPhase contrast magnetic resonance imaging, PC MRI, is a valuable tool allowing for non-invasive quantification of CSF dynamics, but has lacked adoption in clinical practice for Chiari malformation diagnostics. To improve these diagnostic practices, a better understanding of PC MRI based measurement agreement, repeatability, and reproducibility of CSF dynamics is needed.MethodsAn anatomically realistic in vitro subject specific model of a Chiari malformation patient was scanned three times at five different scanning centers using 2D PC MRI and 4D Flow techniques to quantify intra-scanner repeatability, inter-scanner reproducibility, and agreement between imaging modalities. Peak systolic CSF velocities were measured at nine axial planes using 2D PC MRI, which were then compared to 4D Flow peak systolic velocity measurements extracted at those exact axial positions along the model.ResultsComparison of measurement results showed good overall agreement of CSF velocity detection between 2D PC MRI and 4D Flow (p = 0.86), fair intra-scanner repeatability (confidence intervals ± 1.5 cm/s), and poor inter-scanner reproducibility. On average, 4D Flow measurements had a larger variability than 2D PC MRI measurements (standard deviations 1.83 and 1.04 cm/s, respectively).ConclusionAgreement, repeatability, and reproducibility of 2D PC MRI and 4D Flow detection of peak CSF velocities was quantified using a patient-specific in vitro model of Chiari malformation. In combination, the greatest factor leading to measurement inconsistency was determined to be a lack of reproducibility between different MRI centers. Overall, these findings may help lead to better understanding for application of 2D PC MRI and 4D Flow techniques as diagnostic tools for CSF dynamics quantification in Chiari malformation and related diseases.
Highlights
The dynamic movement of cerebrospinal fluid (CSF) has long been the subject of scientific investigation, and its important functional role to support central nervous system health is increasingly realized
Clinical application of 2D PC Phase contrast magnetic resonance imaging (MRI) is widely varied with use in visualizing morphological and functional alterations in normal pressure hydrocephalous patients as well as CSF flow assessment in Chiari malformation populations with and without syringomyelia [9]. 4D Flow has shown potential to advance in vivo assessment of complex hemodynamic and CSF flow patterns [10,11,12]
A study by Tawfik et al [43] detailed 2D phase contrast magnetic resonance imaging (PC MRI) measurement repeatability at the cerebral aqueduct and reported a peak velocity standard deviation of 1.9 cm/s, which is comparable to the 1.83 cm/s peak velocity standard deviation we found in the cervical spine (Table 2)
Summary
The dynamic movement of cerebrospinal fluid (CSF) has long been the subject of scientific investigation, and its important functional role to support central nervous system health is increasingly realized For this reason, Williams et al Fluids Barriers CNS (2021) 18:12 non-invasive phase contrast magnetic resonance imaging (PC MRI) quantification of CSF dynamics has been pursued for diagnosis, prognosis, and treatment of neurological diseases such as hydrocephalus [1, 2], Chiari malformation [3], and syringomyelia [4, 5]. Phase contrast magnetic resonance imaging, PC MRI, is a valuable tool allowing for non-invasive quantification of CSF dynamics, but has lacked adoption in clinical practice for Chiari malformation diagnostics. To improve these diagnostic practices, a better understanding of PC MRI based measurement agreement, repeatability, and reproducibility of CSF dynamics is needed
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