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Direction and magnitude of cerebrospinal fluid flow vary substantially across central nervous system diseases

BACKGROUND: Several central nervous system diseases are associated with disturbed cerebrospinal fluid (CSF) flow patterns and have typically been characterized in vivo by phase-contrast magnetic resonance imaging (MRI). This technique is, however, limited by its applicability in space and time. Phas...

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Autores principales: Eide, Per Kristian, Valnes, Lars Magnus, Lindstrøm, Erika Kristina, Mardal, Kent-Andre, Ringstad, Geir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017867/
https://www.ncbi.nlm.nih.gov/pubmed/33794929
http://dx.doi.org/10.1186/s12987-021-00251-6
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author Eide, Per Kristian
Valnes, Lars Magnus
Lindstrøm, Erika Kristina
Mardal, Kent-Andre
Ringstad, Geir
author_facet Eide, Per Kristian
Valnes, Lars Magnus
Lindstrøm, Erika Kristina
Mardal, Kent-Andre
Ringstad, Geir
author_sort Eide, Per Kristian
collection PubMed
description BACKGROUND: Several central nervous system diseases are associated with disturbed cerebrospinal fluid (CSF) flow patterns and have typically been characterized in vivo by phase-contrast magnetic resonance imaging (MRI). This technique is, however, limited by its applicability in space and time. Phase-contrast MRI has yet to be compared directly with CSF tracer enhanced imaging, which can be considered gold standard for assessing long-term CSF flow dynamics within the intracranial compartment. METHODS: Here, we studied patients with various CSF disorders and compared MRI biomarkers of CSF space anatomy and phase-contrast MRI at level of the aqueduct and cranio-cervical junction with dynamic intrathecal contrast-enhanced MRI using the contrast agent gadobutrol as CSF tracer. Tracer enrichment of cerebral ventricles was graded 0–4 by visual assessment. An intracranial pressure (ICP) score was used as surrogate marker of intracranial compliance. RESULTS: The study included 94 patients and disclosed marked variation of CSF flow measures across disease categories. The grade of supra-aqueductal reflux of tracer varied, with strong reflux (grades 3–4) in half of patients. Ventricular tracer reflux correlated with stroke volume and aqueductal CSF pressure gradient. CSF flow in the cerebral aqueduct was retrograde (from 4th to 3rd ventricle) in one third of patients, with estimated CSF net flow volume about 1.0 L/24 h. In the cranio-cervical junction, net flow was cranially directed in 78% patients, with estimated CSF net flow volume about 4.7 L/24 h. CONCLUSIONS: The present observations provide in vivo quantitative evidence for substantial variation in direction and magnitude of CSF flow, with re-direction of aqueductal flow in communicating hydrocephalus, and significant extra-cranial CSF production. The grading of ventricular reflux of tracer shows promise as a clinical useful method to assess CSF flow pattern disturbances in patients. GRAPHIC ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12987-021-00251-6.
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spelling pubmed-80178672021-04-05 Direction and magnitude of cerebrospinal fluid flow vary substantially across central nervous system diseases Eide, Per Kristian Valnes, Lars Magnus Lindstrøm, Erika Kristina Mardal, Kent-Andre Ringstad, Geir Fluids Barriers CNS Research BACKGROUND: Several central nervous system diseases are associated with disturbed cerebrospinal fluid (CSF) flow patterns and have typically been characterized in vivo by phase-contrast magnetic resonance imaging (MRI). This technique is, however, limited by its applicability in space and time. Phase-contrast MRI has yet to be compared directly with CSF tracer enhanced imaging, which can be considered gold standard for assessing long-term CSF flow dynamics within the intracranial compartment. METHODS: Here, we studied patients with various CSF disorders and compared MRI biomarkers of CSF space anatomy and phase-contrast MRI at level of the aqueduct and cranio-cervical junction with dynamic intrathecal contrast-enhanced MRI using the contrast agent gadobutrol as CSF tracer. Tracer enrichment of cerebral ventricles was graded 0–4 by visual assessment. An intracranial pressure (ICP) score was used as surrogate marker of intracranial compliance. RESULTS: The study included 94 patients and disclosed marked variation of CSF flow measures across disease categories. The grade of supra-aqueductal reflux of tracer varied, with strong reflux (grades 3–4) in half of patients. Ventricular tracer reflux correlated with stroke volume and aqueductal CSF pressure gradient. CSF flow in the cerebral aqueduct was retrograde (from 4th to 3rd ventricle) in one third of patients, with estimated CSF net flow volume about 1.0 L/24 h. In the cranio-cervical junction, net flow was cranially directed in 78% patients, with estimated CSF net flow volume about 4.7 L/24 h. CONCLUSIONS: The present observations provide in vivo quantitative evidence for substantial variation in direction and magnitude of CSF flow, with re-direction of aqueductal flow in communicating hydrocephalus, and significant extra-cranial CSF production. The grading of ventricular reflux of tracer shows promise as a clinical useful method to assess CSF flow pattern disturbances in patients. GRAPHIC ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12987-021-00251-6. BioMed Central 2021-04-01 /pmc/articles/PMC8017867/ /pubmed/33794929 http://dx.doi.org/10.1186/s12987-021-00251-6 Text en © The Author(s) 2021 Open AccessThis 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's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Eide, Per Kristian
Valnes, Lars Magnus
Lindstrøm, Erika Kristina
Mardal, Kent-Andre
Ringstad, Geir
Direction and magnitude of cerebrospinal fluid flow vary substantially across central nervous system diseases
title Direction and magnitude of cerebrospinal fluid flow vary substantially across central nervous system diseases
title_full Direction and magnitude of cerebrospinal fluid flow vary substantially across central nervous system diseases
title_fullStr Direction and magnitude of cerebrospinal fluid flow vary substantially across central nervous system diseases
title_full_unstemmed Direction and magnitude of cerebrospinal fluid flow vary substantially across central nervous system diseases
title_short Direction and magnitude of cerebrospinal fluid flow vary substantially across central nervous system diseases
title_sort direction and magnitude of cerebrospinal fluid flow vary substantially across central nervous system diseases
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017867/
https://www.ncbi.nlm.nih.gov/pubmed/33794929
http://dx.doi.org/10.1186/s12987-021-00251-6
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