Mechanisms in hydrocephalus revealed by neuroimaging

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CP Measurement by MRI: MR-ICP • MR-ICP is a non-empirical measure based on first principles of craniospinal physiology, and fluid dynamics. • It utilizes MR velocity imaging of the pulsatile blood and CSF flows to and from the brain. • It does not require an injection of a contrast. • MR-ICP scan (< 4 minutes) is used as an add-on for a diagnostic brain MRI exam. Diagnostic MR-ICP Related References: 1. Alperin et al, Magn. Reson. in Med. 1996 2. Alperin et. al. Radiology. 2000 3. Loth FM, Yardimici MA, Alperin N. Jour. of Biomechan. Eng. 2001 4. Alperin N and Lee SH. Magn. Reson. in Med. 2003 5. Alperin et al. Current Medical Imaging Reviews. 2006 6. Tain R and Alperin N. Jour. of Magn. Reson. Img. 2009 Credit: Noam Alperin, U. of Miami
The Physiologic Basis of MR-ICP ICP is a mono-exponential function of intracranial volume. At low ICP, a small change in volume (dV) causes a small change in pressure (dP). At high ICP, the same small volume change (dV) causes a larger pressure change (dP). The ratio dV/dP (compliance) is inversely related to ICP. MRICP measures dV and dP, to derive intracranial compliance and pressure from imaging of the blood and CSF flows to and from the cranial vault. Credit: Noam Alperin, U. of Miami
Page 1 and 2: Neuroimaging approaches for elucida
Page 3 and 4: Neurology. 2012 Jul 3. [Epub ahead
Page 5 and 6: CSF flow Techniques • Cine phase
Page 7 and 8: There is abundant literature on the
Page 9 and 10: Toward mechanisms - Relationship be
Page 11 and 12: Changes Is there a in relationship
Page 13 and 14: Possible confounds - Physiological
Page 15 and 16: 4D phase contrast imaging - but wha
Page 17 and 18: time Real-time CSF flow during phys
Page 19: How is Compliance Measured Invasive
Page 23 and 24: How is dP Measured? • The pressur
Page 25 and 26: MR Elastography Freimann et al, Neu
Page 27 and 28: … but no change in compliance wit
Page 29 and 30: CBF Techniques - 133 Xe-CT - 15 O
Page 31 and 32: CBF by PET (NPH) CBF decreased, glo
Page 33 and 34: CBF by PCMRI • Increased with shu
Page 35 and 36: CBF by SPECT CBF marginally changed
Page 37 and 38: Diffusion Techniques • MRI - Dif
Page 39 and 40: Why would diffusion NOT be isotropi
Page 41 and 42: First demonstration of DTI changes
Page 43 and 44: ↓ FA increased, ↑MD in iNPH not
Page 45 and 46: FA/MD in corticospinal tract Correl
Page 47 and 48: Increased FA in caudate … improve
Page 49 and 50: Liliefeld et al, JNSPeds 2009
Page 51 and 52: Functional MRI ???
Page 53: Acknowledgements Pat McAllister, Ph

Mechanisms in hydrocephalus revealed by neuroimaging

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