Analysis Of Cerebrospinal Fluid Flow Research Articles

Hydrocephalic cerebrospinal fluid flowing rotationally with pulsatile boundaries: A mathematical simulation of the thermodynamical approach

To study the kinematics of flow rate and ventricular dilatation, an analytical perturbation approach of hydrocephalus has been devised. This research provides a comprehensive investigation of the characteristics of cerebrospinal fluid (CSF) flow and pressure in a hydrocephalic patient. The influence of hydrocephalic CSF, flowing rotationally with realistic dynamical characteristics on pulsatile boundaries of subarachnoid space, was demonstrated using a nonlinear controlling system of CSF. An analytical perturbation method of hydrocephalus has been developed to investigate the biomechanics of fluid flow rate and the ventricular enlargement. In this paper presents a detailed analysis of CSF flow and pressure dynamics in a hydrocephalic patient. It was elaborated with a nonlinear governing model of CSF to show the influence of hydrocephalic CSF, flowing rotationally with realistic dynamical behaviors on pulsatile boundaries of subarachnoid space. In accordance with the suggested model, the elasticity factor changes depending on how much a porous layer, in this case the brain parenchyma, is stretched. It was improved to include the relaxation of internal mechanical stresses for various perturbation orders, modelling the potential plasticity of brain tissue. The initial geometry that was utilised to create the framework of CSF with pathological disease hydrocephalus and indeed the output of simulations using this model were compared to the actual progression of ventricular dimensions and shapes in patients. According to this observation, the non - linear and elastic mechanical phenomena incorporated into the current model are probably true. Further modelling of ventricular dilation at a normal pressure may benefit from the existence of a valid model whose parameters approximate genuine mechanical characteristics of the cerebral cortex.

Advanced magnetic resonance imaging of chronic whiplash patients: a clinical practice-based feasibility study

BackgroundWhiplash injury is common following road traffic crashes affecting millions worldwide, with up to 50% of the injured developing chronic symptoms and 15% having a reduced working capability due to ongoing disability. Many of these patients receive treatment in primary care settings based upon clinical and diagnostic imaging findings. Despite the identification of different types of injuries in the whiplash patients, clinically significant relationships between injuries and chronic symptoms remains to be fully established. This study investigated the feasibility of magnetic resonance imaging (MRI) techniques including quantitative diffusion weighted imaging and measurements of cerebrospinal fluid (CSF) flow as novel non-invasive biomarkers in a population of healthy volunteers and chronic whiplash patients recruited from a chiropractic clinic for the purpose of improving our understanding of whiplash injury.MethodsTwenty chronic whiplash patients and 18 healthy age- and gender matched control subjects were included [mean age ± SD (sex ratio; females/males), case group: 37.8 years ± 9.1 (1.22), control group: 35.1 years ± 9.2 (1.25)]. Data was collected from May 2019 to July 2020. Data from questionnaires pertaining to the car crash, acute and current symptoms were retrieved and findings from clinical examination and MRI including morphologic, diffusion weighted and phase-contrast images were recorded. The apparent diffusion coefficient and fractional anisotropy were calculated, and measurement and analysis of CSF flow was conducted. Statistical analyses included Fisher’s exact test, Mann Whitney U test and analysis of variance between groups.ResultsThe studied population was described in detail using readily available clinical tools. No statistically significant differences were found between the groups on MRI.ConclusionsThis study did not show that MRI‐based measures of morphology, spinal cord and nerve root diffusion or cerebrospinal fluid flow are sensitive biomarkers to distinguish between chronic whiplash patients and healthy controls. The detailed description of the chronic whiplash patients using readily available clinical tools may be of great relevance to the clinician. In the context of feasibility, clinical practice-based advanced imaging studies with a technical setup similar to the presented can be expected to have a high likelihood of successful completion.

Using deep learning convolutional neural networks to automatically perform cerebral aqueduct CSF flow analysis

Since the development of phase-contrast magnetic resonance imaging (PC-MRI), quantification of cerebrospinal fluid (CSF) flow across the cerebral aqueduct has been utilized for diagnosis of conditions such as normal pressure hydrocephalus (NPH). This study aims to develop an automated method of aqueduct CSF flow analysis using convolution neural networks (CNNs), which can replace the current standard involving manual segmentation of aqueduct region of interest (ROI). Retrospective analysis was performed on 333 patients who underwent PC-MRI, totaling 353 imaging studies. Aqueduct flow measurements using manual ROI placement was performed independently by two radiologists. Two types of CNNs, MultiResUNet and UNet, were trained using ROI data from the senior radiologist, with PC-MRI studies being randomly divided into training (80%) and validation (20%) datasets. Segmentation performance was assessed using Dice similarity coefficient (DSC), and CSF flow parameters were calculated from both manual and CNN-derived ROIs. MultiResUNet, UNet and second radiologist (Rater 2) had DSCs of 0.933, 0.928, and 0.867, respectively, with p < 0.001 between CNNs and Rater 2. Comparison of CSF flow parameters showed excellent intraclass correlation coefficients (ICCs) for MultiResUNet, with lowest correlation being 0.67. For UNet, lower ICCs of −0.01 to 0.56 were observed. Only 3/353 (0.8%) studies failed to have appropriate ROIs placed by MultiResUNet, compared to 12/353 (3.4%) failed cases for UNet. In conclusion, CNNs were able to measure aqueductal CSF flow with similar performance to a senior neuroradiologist. MultiResUNet demonstrated fewer cases of segmentation failure and more consistent flow measurements compared to the widely adopted UNet.

Automated Analysis of Cerebrospinal Fluid Flow and Motile Cilia Properties in The Central Canal of Zebrafish Embryos.

Circulation of cerebrospinal fluid (CSF) plays an important role during development. In zebrafish embryo, the flow of CSF has been found to be bidirectional in the central canal of the spinal cord. In order to compare conditions and genetic mutants across each other, we recently automated the quantification of the velocity profile of exogenous fluorescent particles in the CSF. We demonstrated that the beating of motile and tilted cilia localized on the ventral side of the central canal was sufficient to generate locally such bidirectionality. Our approach can easily be extended to characterize CSF flow in various genetic mutants. We provide here a detailed protocol and a user interface program to quantify CSF dynamics. In order to interpret potential changes in CSF flow profiles, we provide additional tools to measure the central canal diameter, characterize cilia dynamics and compare experimental data with our theoretical model in order to estimate the impact of cilia in generating a volume force in the central canal. Our approach can also be of use for measuring particle velocity in vivo and modeling flow in diverse biological solutions.

Time-SLIP Reveals Intramedullary Flow in Syringomyelia

Case Presentation Magnetic resonance imaging (MRI) using a time-spatial labeling inversion pulse (Time-SLIP) method permits visualization of cerebrospinal fluid (CSF) dynamics noninvasively. Time-SLIP enables quantitative and qualitative CSF flow analysis without any limitations in flow velocity or direction. An 85-year-old old male: Syringomyelia (C7-T12) Conventional MRI revealed syringomyelia with multiple syrinx cavities. Time SLIP can detect the CSF flow dynamics in both the intra- and peri-spinal cord simultaneously. The basic CSF flow pattern in the syringomyelia cavity was pulsatile motion in the Cranio-caudal direction and harmonious with the flow in subarachnoid space (Figure 1). Time-SLIP also detected over flow through septum or web. The unique flow across the intramedullary compartments indicated several paths throughout the septum of syrinx (Figure 2). These findings may improve our understanding of disease pathology of syringomyelia and be useful in surgical planning MRI imaging technique 1.5-T MR imager with quadrature-detected phased-array coils Sphygmographic gated single-shot half Fourier fast spin-echo (FSE) sequence. Representative imaging parameters TR: 12−13P−P intervals, TE: 80 msec, BBTI: 1500-4400 msec (100 msec interval), Tag pulse thickness: 30 mm, ETS 6.5 msec, MTX: 256 × 288, FOV: 25 × 25 cm, Slice thickness 5 mm.

Analysis of cerebrospinal fluid flow in hydrocephalic mouse models of primary ciliary dyskinesia (1125.1)

Patients with primary ciliary dyskinesia (PCD) suffer from a variety of disorders that include chronic sinusitis, otitis media, infertility, situs inversus, and hydrocephalus. We have shown that two mouse models of PCD, nm1054 and bgh, have hydrocephalus characterized by dilatation of the lateral ventricles. These models also have male infertility and sinus abnormalities that result from a decrease in respiratory ciliary beat frequency. We therefore hypothesize that the hydrocephalus results from dysfunction of ependymal cilia that prevents proper cerebrospinal fluid (CSF) flow. To investigate CSF flow in vivo, we injected India ink into the lateral ventricles of live mice and histologically demonstrated that ink migrated through the ventricular system of wild type mice but failed to progress past the cerebral aqueduct of either mutant. To validate that this defect was directly due to ciliary dysfunction, we used an ex vivo method to measure ink flow rate over the ependymal cells on dissected ventricular walls. This method demonstrated a decreased flow rate and altered directional flow in the mutant brains, confirming that ependymal ciliary function is required for proper CSF flow.Grant Funding Source: Supported by the NIH NIGMS (1P20GM103620‐01A1) and an NSF REU (1262744)

Why does endoscopic aqueductoplasty fail so frequently? Analysis of cerebrospinal fluid flow after endoscopic third ventriculostomy and aqueductoplasty using cine phase-contrast magnetic resonance imaging

The aim of this study was to evaluate and compare CSF flow after endoscopic third ventriculostomy (ETV) and endoscopic aqueductoplasty (EAP) in patients presenting with obstructive hydrocephalus caused by aqueductal stenosis. In patients harboring aqueductal stenosis who underwent EAP (n=8), ETV (n=8), and both ETV and EAP (n=6), CSF flow through the restored aqueduct and through the ventriculostomy was investigated using cine cardiac-gated phase-contrast MRI. For qualitative evaluation of CSF flow, an in-plane phase-contrast sequence in the midsagittal plane was used. The MR images were displayed in a closed-loop cine format. Quantitative through-plane measurements were performed in the axial plane perpendicular to the aqueduct and/or floor of the third ventricle. Evaluation revealed significantly higher CSF flow through the ventriculostomies compared with flow through the aqueducts. This was true both when comparing the ETV group with the EAP group and when comparing the flow of the ventriculostomy and aqueduct within the ETV and EAP group. There was no difference in aqueductal CSF flow between patients who underwent EAP alone and patients who underwent ETV and EAP. There was also no difference in ventriculostomy CSF flow between patients who underwent ETV alone and patients who underwent ETV and EAP. Fifty percent of the restored aqueducts became occluded at a mean of 46 months after surgery (range 18-126 months). In contrast, all ETVs remained patent in the mean follow-up period of 110 months after surgery, although 1 patient required shunt placement after 66 months. Cerebrospinal fluid flow through ventriculostomies is significantly higher than aqueductal CSF flow after EAP. This could be one factor to explain why the reclosure rate of aqueducts after EAP is higher than the reclosure rate of the ventriculostoma after ETV.

Magnetic resonance 4D flow analysis of cerebrospinal fluid dynamics in Chiari I malformation with and without syringomyelia

To analyse cerebrospinal fluid (CSF) hydrodynamics in patients with Chiari type I malformation (CM) with and without syringomyelia using 4D magnetic resonance (MR) phase contrast (PC) flow imaging. 4D-PC CSF flow data were acquired in 20 patients with CM (12 patients with presyrinx/syrinx). Characteristic 4D-CSF flow patterns were identified. Quantitative CSF flow parameters were assessed at the craniocervical junction and the cervical spinal canal and compared with healthy volunteers and between patients with and without syringomyelia. Compared with healthy volunteers, 17 CM patients showed flow abnormalities at the craniocervical junction in the form of heterogeneous flow (n = 3), anterolateral flow jets (n = 14) and flow vortex formation (n = 5), most prevalent in patients with syringomyelia. Peak flow velocities at the craniocervical junction were significantly increased in patients (-15.5 ± 11.3 vs. -4.7 ± 0.7 cm/s in healthy volunteers, P < 0.001). At the level of C1, maximum systolic flow was found to be significantly later in the cardiac cycle in patients (30.8 ± 10.3 vs. 22.7 ± 4.1%, P < 0.05). 4D-PC flow imaging allowed comprehensive analysis of CSF flow in patients with Chiari I malformation. Alterations of CSF hydrodynamics were most pronounced in patients with syringomyelia.

Visualisation of cerebrospinal fluid flow patterns in albino Xenopus larvae in vivo

BackgroundIt has long been known that cerebrospinal fluid (CSF), its composition and flow, play an important part in normal brain development, and ependymal cell ciliary beating as a possible driver of CSF flow has previously been studied in mammalian fetuses in vitro. Lower vertebrate animals are potential models for analysis of CSF flow during development because they are oviparous. Albino Xenopus laevis larvae are nearly transparent and have a straight, translucent brain that facilitates the observation of fluid flow within the ventricles. The aim of these experiments was to study CSF flow and circulation in vivo in the developing brain of living embryos, larvae and tadpoles of Xenopus laevis using a microinjection technique.MethodsThe development of Xenopus larval brain ventricles and the patterns of CSF flow were visualised after injection of quantum dot nanocrystals and polystyrene beads (3.1 or 5.8 μm in diameter) into the fourth cerebral ventricle at embryonic/larval stages 30-53.ResultsThe fluorescent nanocrystals showed the normal development of the cerebral ventricles from embryonic/larval stages 38 to 53. The polystyrene beads injected into stage 47-49 larvae revealed three CSF flow patterns, left-handed, right-handed and non-biased, in movement of the beads into the third ventricle from the cerebral aqueduct (aqueduct of Sylvius). In the lateral ventricles, anterior to the third ventricle, CSF flow moved anteriorly along the outer wall of the ventricle to the inner wall and then posteriorly, creating a semicircle. In the cerebral aqueduct, connecting the third and fourth cerebral ventricles, CSF flow moved rostrally in the dorsal region and caudally in the ventral region. Also in the fourth ventricle, clear dorso-ventral differences in fluid flow pattern were observed.ConclusionsThis is the first visualisation of the orchestrated CSF flow pattern in developing vertebrates using a live animal imaging approach. CSF flow in Xenopus albino larvae showed a largely consistent pattern, with the exception of individual differences in left-right asymmetrical flow in the third ventricle.

Assessment of CSF Flow Dynamics Using PC‐MRI in Spontaneous Intracranial Hypotension

Spontaneous intracranial hypotension (SIH) is caused by spontaneous cerebrospinal fluid (CSF) leaks and is known to cause orthostatic headaches. Phase-contrast magnetic resonance imaging (PC-MRI) is a non-invasive technique that can be used to quantify variation in CSF flow. The aim of this study was to assess CSF flow dynamics using PC-MRI in SIH. Twenty-five patients with a definitive diagnosis of SIH and 25 healthy subjects were evaluated with PC-MRI. Magnetic resonance (MR) images were acquired using a 1.5-T unit with an 8-channel head coil. Differences between SIH patients and control subjects were assessed statistically using Wilcoxon's rank sum test, Spearman's rho test, or Pearson's chi-square test, as appropriate. CSF flow volumes toward the third ventricle, CSF flow volumes toward the fourth ventricle, the absolute stroke volume, the peak systolic velocity, and the peak diastolic velocity in SIH patients were significantly smaller than those in control subjects (P < .0001). On the other hand, the net CSF flow volume (P = .9227) and the net CSF flow direction (P = .2472) for SIH patients and control subjects were not significantly different. The results obtained by CSF flow analysis were directly related to values of CSF opening pressure, determined by lumbar puncture, and clinical findings, such as headache scores. Thus, CSF flow analysis with PC-MRI, which has a short performance time and is non-invasive, may contribute to assessment of SIH patients.

Quantitative analysis of cerebrospinal fluid flow in complex regions by using phase contrast magnetic resonance imaging

AbstractTo develop a method for segmenting cerebrospinal fluid (CSF) regions with complex, inhomogeneous pulsatile patterns in phase contrast magnetic resonance imaging (PC‐MRI) sequences. Our approach used various temporal features of flow behavior as input attributes in an unsupervised k‐means classification algorithm. CSF flow parameters for the cervical subarachnoid spaces and the pontine cistern were calculated in 26 healthy volunteers. Background and aliasing corrections were applied automatically. The algorithm's reproducibility was determined by calculating two parameters (area and stroke volume) while varying the initially selected seed point. The influence of background correction on these parameters was also assessed. The method was highly reproducible, with coefficients of variation of 3 and 4% for the cervical stroke volume and area, respectively. In an analysis of variance, background correction did not have a statistically significant effect on either the stroke volume (p = 0.32) or the CSF net mean flow (p = 0.69) at the C2C3 level. The method presented here enables rapid, reproducible, quantitative analysis of CSF flow in complex regions such as the C2C3 subarachnoid spaces and the pontine cistern. © 2011 Wiley Periodicals, Inc. Int J Imaging Syst Technol, 21, 290–297, 2011;

Cerebrospinal fluid and blood flow in mild cognitive impairment and Alzheimer's disease: a differential diagnosis from idiopathic normal pressure hydrocephalus

BackgroundPhase-contrast magnetic resonance imaging (PC-MRI) enables quantification of cerebrospinal fluid (CSF) flow and total cerebral blood (tCBF) flow and may be of value for the etiological diagnosis of neurodegenerative diseases. This investigation aimed to study CSF flow and intracerebral vascular flow in patients with Alzheimer's disease (AD) and patients with amnesic mild cognitive impairment (a-MCI) and to compare the results with patients with idiopathic normal pressure hydrocephalus (NPH) and with healthy elderly volunteers (HEV).MethodsTen a-MCI and 9 mild AD patients were identified in a comprehensive neurological and neuropsychological assessment. They underwent brain MRI; PC-MRI pulse sequence was performed with the following parameters: two views per segment; flip angle: 25° for vascular flow and 20° for CSF flow; field-of-view (FOV): 14 × 14 mm²; matrix: 256 × 128; slice thickness: 5 mm; with one excitation for exams on the 3 T machine, and 2 excitations for the 1.5 T machine exams. Velocity (encoding) sensitization was set to 80 cm/s for the vessels at the cervical level, 10 or 20 cm/s for the aqueduct and 5 cm/s for the cervical subarachnoid space (SAS). Dynamic flow images were analyzed with in-house processing software. The patients' results were compared with those obtained for HEVs (n = 12), and for NPH patients (n = 13), using multivariate analysis.ResultsArterial tCBF and the calculated pulsatility index were significantly greater in a-MCI patients than in HEVs. In contrast, vascular parameters were lower in NPH patients. Cervical CSF flow analysis yielded similar values for all four populations. Aqueductal CSF stroke volumes (in μl per cardiac cycle) were similar in HEVs (34 ± 17) and AD patients (39 ± 18). In contrast, the aqueductal CSF was hyperdynamic in a-MCI patients (73 ± 33) and even more so in NPH patients (167 ± 89).ConclusionOur preliminary data show that a-MCI patients present with high systolic arterial peak flows, which are associated with higher mean total cerebral arterial flows. Aqueductal CSF oscillations are within normal range in AD and higher than normal in NPH. This study provides an original dynamic vision of cerebral neurodegenerative diseases, consistent with the vascular theory for AD, and supporting primary flow disturbances different from those observed in NPH.

Cerebrospinal fluid dynamics in the human cranial subarachnoid space: an overlooked mediator of cerebral disease. I. Computational model

Abnormal cerebrospinal fluid (CSF) flow is suspected to be a contributor to the pathogenesis of neurodegenerative diseases such as Alzheimer's through the accumulation of toxic metabolites, and to the malfunction of intracranial pressure regulation, possibly through disruption of neuroendocrine communication. For the understanding of transport processes involved in either, knowledge of in vivo CSF dynamics is important. We present a three-dimensional, transient, subject-specific computational analysis of CSF flow in the human cranial subarachnoid space (SAS) based on in vivo magnetic resonance imaging. We observed large variations in the spatial distribution of flow velocities with a temporal peak of 5 cm s(-1) in the anterior SAS and less than 4 mm s(-1) in the superior part. This could reflect dissimilar flushing requirements of brain areas that may show differences in susceptibility to pathological CSF flow. Our methods can be used to compare the transport of metabolites and neuroendocrine substances in healthy and diseased brains.

Cerebrospinal fluid flow waveforms: MR analysis in chronic adult hydrocephalus.

Henry-Feugeas MC, Idy-Peretti I, Baledent O, et al. Cerebrospinal fluid flow waveforms: MR analysis in chronic adult hydrocephalus. Invest Radiol 2001;36:146-154. To analyze changes in cerebrospinal fluid (CSF) hydrodynamics in chronic adult hydrocephalus. Phase-contrast cine-MR acquisitions were used to explore the ventricular system and the upper ventral cervical spaces of 16 patients. The aqueductal jet was explored in 32 control subjects. The duration of pulsatile caudal CSF flow (ie, CSF systole) was abnormally short in patients with active idiopathic and obstructive hydrocephalus. The duration of CSF cervical systole was normal in patients with stable hydrocephalus. The aqueductal stroke volume could be increased in stable communicating hydrocephalus. Patients who responded to shunting had shortened CSF systoles and hyperpulsatile ventricular patterns. Successful CSF diversion resulted in longer CSF systoles and CSF ventricular patterns that were no longer hyperpulsatile. Magnetic resonance analysis of CSF flow can show craniospinal dissociation and limitation of CSF outflow from the ventricles in both obstructive and communicating hydrocephalus; it should help determine the response to shunting in communicating hydrocephalus.

Quantitative analysis of cerebrospinal fluid flow in patients with cervical spondylosis using cine phase-contrast magnetic resonance imaging.

To investigate changes in the cerebrospinal fluid flow in patients with cervical spondylosis using cine phase-contrast magnetic resonance (MR) imaging. The participants included 44 healthy volunteers, 11 asymptomatic patients with evidence of degenerative changes of the cervical spine revealed by MR imaging but no neurological symptoms referable to those abnormalities, and 23 symptomatic patients with myelopathy who underwent surgery. Cervical spondylotic myelopathy was evaluated using the Japanese Orthopedic Association scores, and the percentage reduction of the transverse cord area at the level of maximum cord compression was measured on T1-weighted magnetic resonance images. A cine phase-contrast MR pulse sequence with peripheral gating was used to measure the cerebrospinal fluid flow direction and velocity in the ventral subarachnoid spaces at the C1 and T1 levels. The velocity waveforms produced by plotting flow velocity at 16 intervals during one cardiac cycle significantly differed among the healthy volunteers, asymptomatic patients, and preoperative symptomatic patients. However, velocity waveforms did not differ between the healthy volunteers and the postoperative patients at the C1 level. Decreases of flow velocity were significantly correlated with the severity of myelopathy and the percentage reduction of cord area. Patients with severe myelopathy (Japanese Orthopedic Association score of 0-9 points) or greater than 30% reduction of cord area showed significantly decreased flow velocity compared with those with mild myelopathy (Japanese Orthopedic Association score of 10-17 points) or less than 30% reduction of cord area. Changes in flow velocity were not correlated with multiplicity of the lesion or the level of maximum cord compression. Postoperative improvement of flow velocity was not correlated with neurological recovery. Cine phase-contrast MR imaging allows quantitative and noninvasive assessment of changes in cerebrospinal fluid flow in patients with cervical spondylosis.

Quantitative Analysis of Cerebrospinal Fluid Flow in Patients with Cervical Spondylosis Using Cine Phase-Contrast Magnetic Resonance Imaging

Quantitative Analysis of Cerebrospinal Fluid Flow in Patients with Cervical Spondylosis Using Cine Phase-Contrast Magnetic Resonance Imaging

Quantitative Analysis of Cerebrospinal Fluid Flow in Patients with Cervical Spondylosis Using Cine Phase-Contrast Magnetic Resonance Imaging

Quantitative Analysis of Cerebrospinal Fluid Flow in Patients with Cervical Spondylosis Using Cine Phase-Contrast Magnetic Resonance Imaging

Quantitative Analysis of Cerebrospinal Fluid Flow in Patients with Cervical Spondylosis Using Cine Phase-Contrast Magnetic Resonance Imaging

Quantitative Analysis of Cerebrospinal Fluid Flow in Patients with Cervical Spondylosis Using Cine Phase-Contrast Magnetic Resonance Imaging

A quantitative analysis of cerebrospinal fluid flow in post-traumatic syringomyelia

Cerebrospinal fluid (CSF) flow within the syrinx in post-traumatic syringomyelia was studied by cardiac-triggered phase images of magnetic resonance imaging (MRI) to investigate the relationship between CSF flow in the syrinx and patients' symptoms.