Korean J Radiol.  2004 Jun;5(2):81-86. 10.3348/kjr.2004.5.2.81.

CSF Flow Quantification of the Cerebral Aqueduct in Normal Volunteers Using Phase Contrast Cine MR Imaging

• Lee JH
• Lee HK
• Kim JK
• Kim HJ
• Park JK
• Choi CG

• KMID: 753986
• DOI: http://doi.org/10.3348/kjr.2004.5.2.81

Abstract

OBJECTIVE
To evaluate whether the results of cerebrospinal fluid (CSF) flow quantification differ according to the anatomical location of the cerebral aqueduct that is used and the background baseline region that is selected. MATERIALS AND METHODS: The CSF hydrodynamics of eleven healthy volunteers (mean age = 29.6 years) were investigated on a 1.5T MRI system. Velocity maps were acquired perpendicular to the cerebral aqueduct at three different anatomical levels: the inlet, ampulla and pars posterior. The pulse sequence was a prospectively triggered cardiac-gated flow compensated gradient-echo technique. Region-of-interest (ROI) analysis was performed for the CSF hydrodynamics, including the peak systolic velocity and mean flow on the phase images. The selection of the background baseline regions was done based on measurements made in two different areas, namely the anterior midbrain and temporal lobe, for 10 subjects. RESULTS: The mean peak systolic velocities showed a tendency to increase from the superior to the inferior aqueduct, irrespective of the background baseline region, with the range being from 3.30 cm/sec to 4.08 cm/sec. However, these differences were not statistically significant. In the case of the mean flow, the highest mean value was observed at the mid-portion of the ampulla (0.03 cm3/sec) in conjunction with the baseline ROI at the anterior midbrain. However, no other differences were observed among the mean flows according to the location of the cerebral aqueduct or the baseline ROI. CONCLUSION: We obtained a set of reference data of the CSF peak velocity and mean flow through the cerebral aqueduct in young healthy volunteers. Although the peak systolic velocity and mean flow of the CSF differed somewhat according to the level of the cerebral aqueduct at which the measurement was made, this difference was not statistically significant.

Keyword

Cerebrospinal fluid, MR studies; Cerebrospinal fluid, flow dynamics; Cerebrospinal fluid, cine study

MeSH Terms

Adult
Cerebral Aqueduct/anatomy & histology/*physiology
Cerebrospinal Fluid/*physiology
Female
Human
*Magnetic Resonance Imaging, Cine
Male
Reference Values
Rheology

Figure

• 

  Fig. 1 A. Normal anatomy of the cerebral aqueduct as viewed in the sagittal plane. The two arrows indicate the proximal and the distal ends of the cerebral aqueduct. The solid lines indicated by an A (the middle of the superior colliculus) and by a B (the level of the intercollicular sulcus) divide the aqueduct into the pars anterior, ampulla and pars posterior, craniocaudally, with the ampulla having the widest diameter and the pars posterior having the narrowest diameter. B. Midline sagittal T2-weighted image showing the positions of the localizers for the velocity map at each level of the cerebral aqueduct. The solid lines indicate the different positions of the localizers of the oblique axial images set perpendicular to the aqueduct of Sylvius. A; the inlet, B; the ampulla, C; the pars posterior.

• 

  Fig. 2 Selection of ROIs for the cerebral aqueduct (single arrow) and background stationary tissue (double arrows) just lateral to the aqueduct in the medial temporo-occipital gyrus (A) and anterior to the aqueduct in the midbrain (B).

• 

  Fig. 3 Axial phase-contrast MR images obtained at the three different levels of the cerebral aqueduct. The background baseline region was located at a position anterior to the aqueduct in the midbrain. The high signal intensities (arrows) represent systolic CSF flow through the inlet (A), the ampulla (B) and the pars posterior (C), respectively.

Reference

1. Ohara S, Negai H, Matsumoto T, Banno T. MR imaging of CSF pulsatory flow and its relation to intracranial pressure. J Neurosurg. 1988. 69:675–682.

2. Quencer RM, Post MJ, Hinks RS. Cine MR in the evaluation of normal and abnormal CSF flow: intracranial and intraspinal studies. Neuroradiology. 1990. 32:371–391.

3. Nitz WR, Bradley WG Jr, Wantanabe AS, et al. Flow dynamics of cerebrospinal fluid: assessment with phase-contrast velocity MR imaging performed with retrospective cardiac gating. Radiology. 1992. 183:395–405.

4. Henry-Feugeas MC, Idy-Peretti I, Blanchet B, Hassine D, Zannoli G, Schouman-Claeys E. Temporal and spatial assessment of normal cerebrospinal fluid dynamics with MR imaging. Magn Reson Imaging. 1993. 11:1107–1118.

5. Bhadelia RA, Bogdan AR, Wolpaert SM. Analysis of cerebrospinal fluid flow waveforms with gated phase-contrast MR velocity measurements. AJNR Am J Neuroradiol. 1995. 16:389–400.

6. Bhadelia RA, Bogdan AR, Kaplan RF, et al. Cerebrospinal fluid pulsation amplitude and its quantitative relationship to cerebral blood flow pulsations: a phase-contrast MR flow imaging study. Neuroradiology. 1997. 39:258–264.

7. Levy LM, Di Chiro G. MR phase imaging and cerebrospinal fluid flow in the head and spine. Neuroradiology. 1990. 32:399–406.

8. Naidich TP, Altman NR, Conzalez-Arias SM. Phase contrast cine magnetic resonance imaging: normal cerebrospinal fluid oscillation and applications to hydrocephalus. Neurosurg Clin N Am. 1993. 4:677–705.

9. 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.

10. Luetmer PH, Huston J, Friedman JA, et al. Measurement of cerebrospinal fluid flow at the cerebral aqueduct by use of phase-contrast magnetic resonance imaging: technique validation and utility in diagnosing idiopathic normal pressure hydrocephalus. Neurosurgery. 2002. 50:534–543.

11. Mascalchi M, Arnetoli G, Inzitari D, et al. Cine-MR imaging of aqueductal CSF flow in normal pressure hydrocephalus syndrome before and after CSF shunt. Acta Radiol. 1993. 34:586–592.

12. Schroeder HWS, Schweim C, Schweim H, Gaab MR. Analysis of aqueductal cerebrospinal fluid flow after endoscopic aqueductoplasty by using cine phase-contrast magnetic resonance imaging. J Neurosurg. 2000. 93:237–244.

13. Bradely WG Jr, Scalzo D, Queralt J, et al. Normal-pressure hydrocephalus: evaluation with cerebrospinal fluid flow measurements at MR imaging. Radiology. 1996. 198:523–529.

14. Gideon P, Stahlberg F, Thomsen C, et al. Cerebrospinal fluid flow and production in patients with normal pressure hydrocephalus studied by MRI. Neuroradiology. 1994. 36:210–215.

15. Kadowaki C, Hara M, Numoto M, et al. Cine magnetic resonance imaging of aqueductal stenosis. Childs Nerv Syst. 1995. 11:107–111.

16. Kolbitsch C, Schocke M, Lorenz IH, Kremser C, Zschiegner F, Pfeiffer KP, et al. Phase-contrast MRI measurement of systolic cerebrospinal fluid peak velocity (CSFV(peak)) in the aqueduct of Sylvius: a noninvasive tool for measurement of cerebral capacity. Anesthesiology. 1999. 90:1546–1550.

17. Gideon P, Thomsen C, Stahlberg F, Henriksen O. Cerebrospinal fluid production and dynamics in normal aging: a MRI phase-mapping study. Acta Neurol Scand. 1994. 89:362–366.

18. Barkhof F, Kouwenhoven M, Scheltens P, Sprenger M, Algra P, Valk J. Phase-contrast cine MR imaging of normal aqueductal CSF flow. Acta Radiol. 1994. 35:123–130.

19. Barkhof F, Kouwenhoven M, Scheltens P, Sprenger M, Algra P, Valk J. Phase-contrast cine MR imaging of normal aqueductal CSF flow. Acta Radiol. 1994. 35:123–130.

20. Baledent O, Henry-Feugeas MC, Idy-Peretti I. Cerebrospinal fluid dynamics and relation with blood flow. A magnetic resonance study with semiautomated cerebrospinal fluid segmentation. Invest Radiol. 2001. 36:368–377.

21. Enzmann DR, Pelc NJ. Normal flow patterns of intracranial and spinal cerebrospinal fluid defined with phase-contrast cine MR imaging. Radiology. 1991. 178:467–474.

22. Alperin N, Vikingstad EM, Gomez-Anson B, et al. Hemodynamically independent analysis of cerebrospinal fluid and brain motion observed with dynamic phase contrast MRI. Magn Reson Med. 1996. 35:741–754.

23. Schroth G, Klose U. Cerebrospinal fluid flow. II. Physiology of respiration-related pulsations. Neuroradiology. 1992. 35:10–15.

24. Nathan BR. Goetz CG, Pappert EJ, editors. Cerebrospinal fluid and intracranial pressure. Textbook of Clinical Neurology. 1999. 1st ed. St. Louis: W. B. Saunders;475–486.

25. Frayne R, Steinman DA, Ethier R, Rutt BK. Accuracy of MR phase contrast velocity measurements for unsteady flow. J Magn Reson Imaging. 1995. 4:428–431.

26. Ku DN, Biancheri CL, Pettigrew RI, Peifer JW, Markou CP, Engles H. Evaluation of magnetic resonance velocimetry for steady flow. J Biomech Eng. 1990. 112:464–472.