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01-08-2020 | Stroke | Neuro

Cerebrospinal fluid dynamics in idiopathic normal pressure hydrocephalus on four-dimensional flow imaging

Authors: Shigeki Yamada, Masatsune Ishikawa, Hirotaka Ito, Kazuo Yamamoto, Makoto Yamaguchi, Marie Oshima, Kazuhiko Nozaki

Published in: European Radiology | Issue 8/2020

Abstract

Objectives

To evaluate complex CSF movements and shear stress in patients with idiopathic normal pressure hydrocephalus (iNPH) on four-dimensional (4D) flow MRI.

Methods

Three-dimensional velocities and volumes of the reciprocating CSF movements through 12 ROIs from the foramen of Monro to the upper cervical spine were measured in 41 patients with iNPH, 23 patients with co-occurrence of iNPH and Alzheimer’s disease (AD), and 9 age-matched controls, using 4D flow imaging and application. Stroke volume, reversed-flow rate, and shear stress were automatically calculated. Relationships between flow-related parameters and morphological measurements were also assessed.

Results

Stroke volumes, reversed-flow rates, and shear stress at the cerebral aqueduct were significantly higher in patients with iNPH than in controls. Patients with pure iNPH had significantly higher shear stress at the ventral aspect of the cerebral aqueduct than those with co-occurrence of iNPH and AD. The stroke volume at the upper end of the cerebral aqueduct had the strongest association with the anteroposterior diameter of the lower end of the cerebral aqueduct (r = 0.52). The stroke volume at the foramen of Monro had significant associations with the indices specific to iNPH. The shear stress at the dorsal aspect of the cerebral aqueduct had the strongest association with the diameter of the foramen of Magendie (r = 0.52).

Conclusions

Stroke volumes, reversed-flow rates, and shear stress through the cerebral aqueduct on 4D flow MRI are useful parameters for iNPH diagnosis. These findings can aid in elucidating the mechanism of ventricular enlargement in iNPH.

Key Points

• The CSF stroke volume and bimodal shear stress at the cerebral aqueduct were considerably higher in patients with iNPH.

• The patients with pure iNPH had significantly higher shear stress at the ventral aspect of the cerebral aqueduct than those with co-occurrence of iNPH and AD.

• The shear stress at the cerebral aqueduct was significantly associated with the diameter of the foramen of Magendie.

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Title: Cerebrospinal fluid dynamics in idiopathic normal pressure hydrocephalus on four-dimensional flow imaging
Authors: Shigeki Yamada
Masatsune Ishikawa
Hirotaka Ito
Kazuo Yamamoto
Makoto Yamaguchi
Marie Oshima
Kazuhiko Nozaki
Publication date: 01-08-2020
Publisher: Springer Berlin Heidelberg
Keywords: Stroke
Hydrocephalus
Hydrocephalus
Hydrocephalus
Alzheimer's Disease
Alzheimer's Disease
Published in: European Radiology / Issue 8/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-06825-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cerebrospinal fluid dynamics in idiopathic normal pressure hydrocephalus on four-dimensional flow imaging

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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