ISNVD Abstract Book

Evaluation of Cerebrospinal Fluid Flow in Multiple
Sclerosis with Phase Contrast MRI
Laganà MM 1 , Balagurunathan D 2 , Chaudhary A 2 , Utriainen D 2 , Hubbard D 3 , Haacke EM 2,4 .
1
Magnetic Resonance Laboratory, Fondazione Don Gnocchi, IRCCS Santa Maria Nascente, 20148 Milan, Italy; 2 Magnetic Resonance Innovations, Inc., Detroit,
MI 48202; 3 Applied fMRI Institute, San Diego, CA 92131; 4 Departments of Radiology and Biomedical Engineering, Wayne State University Detroit MI 48201.
INTRODUCTION AND AIMS
The relationship between the cerebrospinal fluid (CSF) flow, blood flow
and pulsatile brain movement have been modeled for 20 years as a
hemodynamic phenomena consequent to the systolic arterial inflow to the
brain [1], [2]. Phase Contrast (PC) Magnetic Resonance (MR) allows for
the investigation and quantification of arterial, venous, CSF flow and,
therefore, provides the potential for understanding their mechanical
coupling. It has been used for the study of healthy volunteers [3]-[6] and
pathological diseases [7]-[9]. An unbalance in the temporal coupling and
amplitude changes of the flow curves has been evaluated as responsible for
pathological disease, such as normal-pressure hydrocephalus [8] and
Alzheimer’s Disease [7] and to be able to predict the treatment outcome of
Arnold-Chiari I malformation [9]. Recent pilot studies have investigated
aqueduct CSF amplitude modifications in Multiple Sclerosis (MS) patients
[10]-[12], showing different results. This work investigates CSF, arterial and
venous dynamics (in terms of amplitude and mutual timing) at the level of
the upper cervical cord in a large cohort of MS patients and in a group of
healthy controls.
MATERIAL AND METHODS
Subjects: 92 MS patients [males/females=26/66, mean age(SD)= 49(10) years]
(47 Relapsing-Remitting (RR), 28 Secondary-Progressive (SP), 17 Primary
Progressive (PP) and 28 healthy controls (HC) [males/females=13/15, mean
age(SD)= 42(11) years].
MRI protocol: Brain axial FLAIR, TOF of the neck and axial 2D PC positioned at
C2 level were obtained from all the MS patients with a 3T Siemens scanner and
from the healthy subjects with a 3T or a 1.5T Siemens scanner. PC sequence
was acquired twice, with VENC=15cm/s (PC15) for the CSF flow measure and
with VENC=50cm/s (PC50) for the vessels of the neck flow measures, with pulse
triggering for cardiac gating.
MRI processing: In-house software (FlowQ) was used for the flow quantification.
Regions Of Interest (ROIs) were manually drawn for the CSF area (sequence
PC15) and the for the vessels as shown in Figure 1 (sequence PC50). Phase
values of every pixel inside the ROIs were mapped to velocity (offset correction
with ROIs in the muscle area). Siemens convention: caudal velocities are
negative, cranial velocities are positive.
Flow parameters and statistical analysis: Estimation of: flow rates as a function of
the cardiac cycle (CC); peaks amplitude and timing (%CC) of Internal Carotid
Arteries (ICAs), Internal Jugular Veins (IJVs) and CSF flow rates; CSF stroke
volumes (separate integration of the positive and negative CSF flow rate curves);
Cerebral Blood Flow (CBF) as the sum of all the measured arterial flows.
Independent t-tests were used for group comparisons. Correlations between
variables have been assessed with Spearman’s rank correlation coefficient.
Figure 1 – 1: Magnitude image; 2: Phase image; A: localization of 1-2 images at C2 level for the flow quantification of the main
arteries and veins. 3: Magnitude image; 4: Phase image; B: localization of 3-4 images at C2 level for the CSF flow quantification.
Cranial
Caudal
Outflow
onset
Systolic peak
CSF negative
peak
Systolic IJVs peaks
End of
Outflow
Figure 2 – Parameters computed by the CSF, ICAs and IJVs flow curves.
RESULTS
CSF flow curves showed the usual bimodal pattern for both MS and
controls, but with different CSF caudal peak flow rate (p