Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of CSF flow metrics in patients with communicating hydrocephalus and idiopathic intracranial hypertension

  • MAGNETIC RESONANCE IMAGING
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

To search for CSF dynamics of idiopathic intracranial hypertension (IIH) and communicating hydrocephalus and any correlation between MRI findings, CSF metrics and CSF opening pressure in IIH.

Materials and methods

Healthy subjects (30) and subjects with IIH (29) and high-pressure communicating hydrocephalus (43) were enrolled. Nonparametric Kruskal–Wallis test (p = 0.05) was used to compare three groups, Mann–Whitney U test with Bonferroni correction to compare two groups (p = 0.016). Correlation of MRI findings of IIH with CSF metrics and CSF opening pressure was analyzed by Spearman’s Rank correlation coefficient (p = 0.05).

Results

In IIH, no correlation between MRI findings and aqueductal stroke volume (ASV) but statistically significantly CSF opening pressure in the presence of transverse sinus compression was noted. Comparing with healthy subjects, ASV was nonsignificantly lower and standardized diastolic and sum and difference of systolic and diastolic flow durations were statistically significantly lower. Comparing with hydrocephalus, the width of prepontine cistern (PPC)/the width of aqueductus sylvii (AS) was significantly higher and other CSF metrics with standardized systolic and sum of systolic and diastolic flow durations were significantly lower. In hydrocephalus, ASV and peak velocities were significantly higher. Compared with normal group, PPC/AS and reverse/forward flow duration were significantly lower and other CSF metrics were significantly higher.

Conclusion

In hydrocephalus, significant increase in ASV and peak velocities were noted. In IIH, CSF opening pressure was statistically significantly high in the presence of transverse sinus compression and standardized diastolic flow durations were statistically significantly short that are probably effects of increased impedance of CSF flow against increased intracranial pressure and unchanged or even decreased intraventricular CSF volume.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

MRI:

Magnetic resonance imaging

IIH:

Idiopathic intracranial hypertension

CSF:

Cerebrospinal fluid

ASV:

Aqueductal stroke volume

PC-MRI:

Phase contrast magnetic resonance imaging

PPC:

Prepontine cistern

AS:

Aqueductus sylvii

3D-SPACE:

3D sampling perfection with application-optimized contrasts using different flip angle evolutions

3D-CISS:

3D constructive interference in steady state

References

  1. Kartal MG, Algin O (2014) Evaluation of hydrocephalus and other cerebrospinal fluid disorders with MRI: an update. Insights Imaging 5:531–541

    Article  PubMed  PubMed Central  Google Scholar 

  2. Stadlbauer A, Salomonowitz E, Brenneis C et al (2012) Magnetic resonance velocity mapping of 3D cerebrospinal fluid flow dynamics in hydrocephalus: preliminary results. Eur Radiol 22:232–242

    Article  PubMed  Google Scholar 

  3. Rohr AC, Riedel C, Fruehauf MC (2011) MR imaging findings in patients with secondary intracranial hypertension. AJNR Am J Neuroradiol 32:1021–1029

    Article  CAS  PubMed  Google Scholar 

  4. Akay R, Kamisli O, Kahraman A, Oner S, Tecellioglu M (2015) Evaluation of aqueductal CSF flow dynamics with phase contrast cine MR imaging in idiopathic intracranial hypertension patients: preliminary results. Eur Rev Med Pharmacol Sci 19:3475–3479

    CAS  PubMed  Google Scholar 

  5. Alperin N, Ranganathan S, Bagci AM, Adams DJ, Ertl-Wagner B, Saraf-Lavi E, Sklar EM, Lam BL (2013) MRI evidence of impaired CSF homeostasis in obesity-associated idiopathic intracranial hypertension. AJNR Am J Neuroradiol 34:29–34

    Article  CAS  PubMed  Google Scholar 

  6. Brodsky MC, Vaphiades M (1998) Magnetic resonance imaging in pseudotumor cerebri. Ophthalmology 105:1686–1693

    Article  CAS  PubMed  Google Scholar 

  7. Baledent O, Gondry-Jouet C, Meyer ME et al (2004) Relationship between cerebrospinal fluid and blood dynamics in healthy volunteers and patients with communicating hydrocephalus. Investig Radiol 39:45–55

    Article  Google Scholar 

  8. McCoy MR, Klausner F, Weymayr F et al (2013) Aqueductal flow of cerebrospinal fluid (CSF) and anatomical configuration of the cerebral aqueduct (AC) in patients with communicating hydrocephalus–the trumpet sign. Eur J Radiol 82:664–670

    Article  CAS  PubMed  Google Scholar 

  9. Fin L, Grebe R (2003) Three dimensional modelling of the cerebrospinal fluid dynamics and brain interactions in the aqueduct of sylvius. Comput Methods Biomech Biomed Eng 6:163–170

    Article  Google Scholar 

  10. Wagshul ME, Chen JJ, Egnor MR et al (2006) Amplitude and phase of cerebrospinal fluid pulsations: experimental studies and review of the literature. J Neurosurg 104:810–819

    Article  PubMed  Google Scholar 

  11. Greitz D (1993) Cerebrospinal fluid circulation and associated intracranial dynamics: a radiologic investigation using MR imaging and radionuclide cisternography. Acta Radiol Suppl 386:1–23

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  13. Bateman GA, Levi CR, Schofield P et al (2005) The pathophysiology of the aqueduct stroke volume in normal pressure hydrocephalus: Can co-morbidity with other forms of dementia be excluded? Neuroradiology 47:741–748

    Article  PubMed  Google Scholar 

  14. Lee JH, Lee HK, Kim JK, Kim HJ (2004) CSF flow quantification of the cerebral aqueduct in normal volunteers using phase contrast cine MR imaging. Korean J Radiol 5:81–86

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hingwala DR, Kesavadas C, Thomas B, Kapilamoorthy TR, Sarma PS (2013) Imaging signs in idiopathic intracranial hypertension: Are these signs seen in secondary intracranial hypertension too? Ann Indian Acad Neurol 16:229–233

    Article  PubMed  PubMed Central  Google Scholar 

  16. Riggeal BD, Bruce BB, Saindane AM et al (2013) Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis. Neurology 80:289–295

    Article  PubMed  PubMed Central  Google Scholar 

  17. Bono F, Giliberto C, Mastrandrea C et al (2005) Transverse sinus stenoses persist after normalization of the CSF pressure in IIH. Neurology 65:1090–1093

    Article  CAS  PubMed  Google Scholar 

  18. Métellus P, Levrier O, Fuentes S, Adetchessi T, Dufour H, Donnet A, Grisoli F (2005) Endovascular treatment of benign intracranial hypertension by stent placement in the transverse sinus. Therapeutic and pathophysiological considerations illustrated by a case report]. Neurochirurgie 51:113–120

    Article  PubMed  Google Scholar 

  19. Abbey P, Singh P, Khandelwal N, Mukherjee KK (2009) Shunt surgery effects on cerebrospinal fluid flow across the aqueduct of Sylvius in patients with communicating hydrocephalus. J Clin Neurosci 16:514–518

    Article  PubMed  Google Scholar 

  20. Chiang WW, Takoudis CG, Lee SH, Weis-McNulty A, Glick R, Alperin N (2009) Relationship between ventricular morphology and aqueductal cerebrospinal fluid flow in healthy and communicating hydrocephalus. Invest Radiol 44:192–199

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, BezmialemVakif University, Istanbul, Turkey

    Temel Fatih Yılmaz, Ayse Aralasmak, Huseyin Toprak, Elnur Mehdi, Serpil Kurtcan & Alpay Alkan

  2. Department of Neurology, BezmialemVakif University, Istanbul, Turkey

    Gulsen Kocaman

  3. Department of Biostatistics, BezmialemVakif University, Istanbul, Turkey

    Mehmet Onur Kaya

Authors
  1. Temel Fatih Yılmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ayse Aralasmak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Huseyin Toprak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elnur Mehdi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gulsen Kocaman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Serpil Kurtcan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mehmet Onur Kaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alpay Alkan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TFY and HT contributed to data collection, data archiving, manuscript writing; AA was involved in project development, data collection, data archiving, manuscript writing; EM contributed to data collection, data archiving; GK, Neurologist, took care of the patients; SK and AA were involved in project development; MOK contributed to biostatistical analysis.

Corresponding author

Correspondence to Ayse Aralasmak.

Ethics declarations

Conflict of interest

The authors have declared no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yılmaz, T.F., Aralasmak, A., Toprak, H. et al. Evaluation of CSF flow metrics in patients with communicating hydrocephalus and idiopathic intracranial hypertension. Radiol med 124, 382–391 (2019). https://doi.org/10.1007/s11547-018-0979-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-018-0979-z

Keywords

Search

Navigation