Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2024; 34(02): 208-213
DOI: 10.1055/s-0043-1776413
Original Article

Cerebrospinal Fluid Flow Parameters in Normal Subjects above 40 Years of Age

Seema Rohilla 
1   Department of Radiodiagnosis, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
,
Pradeep Kumar
1   Department of Radiodiagnosis, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
,
Ishwar Singh
2   Department of Neurosurgery, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Background Cerebrospinal fluid (CSF) flow is altered in many conditions like normal pressure hydrocephalus (NPH), aqueduct stenosis, or Chiari malformation. It is very important to know the normal CSF flow parameters for properly diagnosing these conditions. No data on CSF flow parameters of the Indian population are available. Hence, this study was undertaken to generate normative CSF flow parameters in the Indian population.

Aim Our aim was to estimate normal CSF flow parameters across the cerebral aqueduct in Indian subjects over 40 years of age.

Settings and Design This observational study was done in the tertiary care institute on subjects undergoing magnetic resonance imaging (MRI) for indications like headache and having normal MRI.

Methods Phase-contrast quantitative flow sequence was done in 100 subjects perpendicular to the cerebral aqueduct on 3.0T MRI (Discovery 750w with GEM suit, GE, Milwaukee, WI, United States) using a dedicated 32-channel head coil with 10 cm/s velocity encoding. The region of interest was kept at the cerebral aqueduct in cross-section. The inbuilt software calculated flow-time and velocity-time graphs and calculated peak systolic velocity (PSV), peak diastolic velocity (PDV), systolic flow (SF), and diastolic flow (DF). Stroke volume (SV) was calculated by averaging systolic and DFs. p-Value < 0.05 was considered significant.

Results Mean age was 53.72 ± 10.53 (40–78) years with 41 males and 59 females. PSV, PDV, SF, DF, and SV all showed a significant linear correlation with age with p-values of 0.001, 0.004, 0.009, <0.001, and <0.001, respectively. Only PDV (p = 0.035) and DF (p = 0.045) varied significantly with sex, values being higher in males.

Conclusion All five CSF flow parameters studied vary positively with age, and this variation is linear. Normal decadal median values calculated for these parameters can act as baseline values for the local population and help in defining conditions like NPH.

Keywords

CSF flow - phase-contrast quantitative flow sequence - stroke volume

Ethical Approval

The study was approved by the institutional ethics committee and was in accordance with the Helsinki Declaration of 1975, as revised in 2000.




Publication History

Article published online:
20 November 2023

© 2023. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Lakhera D, Azad RK, Azad S, Singh R, Sharma R. Magnetic resonance imaging cerebrospinal fluid hydrodynamics in patients with meningitis. J Clin Imaging Sci 2020; 10: 29
    CrossrefPubMedGoogle Scholar
  • 2 Markenroth Bloch K, Töger J, Ståhlberg F. Investigation of cerebrospinal fluid flow in the cerebral aqueduct using high-resolution phase contrast measurements at 7T MRI. Acta Radiol 2018; 59 (08) 988-996
    CrossrefPubMedGoogle Scholar
  • 3 Horie T, Kajihara N, Matsumae M. et al. Magnetic resonance imaging technique for visualization of irregular cerebrospinal fluid motion in the ventricular system and subarachnoid space. World Neurosurg 2017; 97: 523-531
    CrossrefPubMedGoogle Scholar
  • 4 Yamada S, Tsuchiya K, Bradley WG. et al. Current and emerging MR imaging techniques for the diagnosis and management of CSF flow disorders: a review of phase-contrast and time-spatial labeling inversion pulse. Am J Neuroradiol 2015; 36 (04) 623-630
    CrossrefPubMedGoogle Scholar
  • 5 Bradley WG, Scalza D, Quencett J, Nitz WN, Allison DJ, Wong P. Normal-pressure hydrocephalus: evaluation with cerebrospinal fluid flow measurements at MR imaging. Radiology 1996; 198 (02) 523-529
    CrossrefPubMedGoogle Scholar
  • 6 Sartoretti T, Wyss M, Sartoretti E. et al. Sex and age dependencies of aqueductal cerebrospinal fluid dynamics parameters in healthy subjects. Front Aging Neurosci 2019; 11: 199
    CrossrefPubMedGoogle Scholar
  • 7 Brinker T, Stopa E, Morrison J, Klinge P. A new look at cerebrospinal fluid circulation. Fluids Barriers CNS 2014; 11: 10
    CrossrefPubMedGoogle Scholar
  • 8 Lee JH, Lee HK, Kim JK, Kim HJ, Park JK, Choi CG. CSF flow quantification of the cerebral aqueduct in normal volunteers using phase contrast cine MR imaging. Korean J Radiol 2004; 5 (02) 81-86
    CrossrefPubMedGoogle Scholar
  • 9 Ichikawa S, Motosugi U, Okumura A, Shimizu T, Onishi H. Measurement of cerebrospinal fluid flow dynamics using phase contrast MR imaging with bilateral jugular vein compression: a feasibility study in healthy volunteers. Magn Reson Med Sci 2018; 17 (03) 265-268
    CrossrefPubMedGoogle Scholar
  • 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 (03) 534-543 , discussion 543–544
    PubMedGoogle Scholar
  • 11 Sharma AK, Gaikwad S, Gupta V, Garg A, Mishra NK. Measurement of peak CSF flow velocity at cerebral aqueduct, before and after lumbar CSF drainage, by use of phase-contrast MRI: utility in the management of idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg 2008; 110 (04) 363-368
    CrossrefPubMedGoogle Scholar
  • 12 Yousef MI, Abd El Mageed AE, Abd Ellah NY, Shaaban MH. Use of cerebrospinal fluid flow rates measured by phase-contrast MR to differentiate normal pressure hydrocephalus from involutional brain changes. Egypt J Radiol Nucl Med 2016; 47 (03) 999-1008
    CrossrefGoogle Scholar
  • 13 Korbecki A, Zimny A, Podgórski P, Sąsiadek M, Bladowska J. Imaging of cerebrospinal fluid flow: fundamentals, techniques, and clinical applications of phase-contrast magnetic resonance imaging. Pol J Radiol 2019; 84: e240-e250
    CrossrefPubMedGoogle Scholar
  • 14 Hussein AA, Ahmed MM, Mostafa MM, Youssef AT, Gamal EL-DINMD. Prognostic value of MRI-CSF flowmetry for shunt responsiveness in patients with idiopathic normal pressure hydrocephalus. Med J Cairo Univ 2022; 90 (03) 403-408
    CrossrefGoogle Scholar
  • 15 Bradley WG. Normal pressure hydrocephalus: new concepts on etiology and diagnosis. Am J Neuroradiol 2000; 21 (09) 1586-1590
    PubMedGoogle Scholar
  • 16 Tawfik AM, Elsorogy L, Abdelghaffar R, Naby AA, Elmenshawi I. Phase-contrast MRI CSF flow measurements for the diagnosis of normal-pressure hydrocephalus: observer agreement of velocity versus volume parameters. Am J Roentgenol 2017; 208 (04) 838-843
    CrossrefPubMedGoogle Scholar