Pulsatile brain movement and associated hydrodynamics studied by magnetic resonance phase imaging

The Monro-Kellie doctrine revisited


Brain tissue movements were studied in axial, sagittal and coronal planes in 15 healthy volunteers, using a gated spin echo MRI sequence. All movements had characteristics different from those of perfusion and diffusion. The highest velocities occurred during systole in the basal ganglia (maximum 1.0 mm/s) and brain stem (maximum 1.5 mm/s). The movements were directed caudally, medially and posteriorly in the basal ganglia, and caudally-anteriorly in the pons. Caudad and anterior motion increased towards the foramen magnum and towards the midline. The resultant movement occurred in a funnelshaped fashion as if the brain were pulled by the spinal cord. This may be explained by venting of brain and cerebrospinal fluid (CSF) through the tentorial notch and foramen magnum. The intracranial volume is assumed to be always constant by the Monro-Kellie doctrine. The intracranial dynamics can be viewed as an interplay between the spatial requirements of four main components: arterial blood, capillary blood (brain volume), venous blood and CSF. These components could be characterized, and the expansion of the arteries and the brain differentiated, by applying the Monro-Kellie doctrine to every moment of the cardiac cycle. The arterial expansion causes a remoulding of the brain that enables its piston-like action. The arterial expansion creates the prerequisites for the expansion of the brain by venting CSF to the spinal canal. The expansion of the brain is, in turn, responsible for compression of the ventricular system and hence for the intraventricular flow of CSF.

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  1. 1.

    Singer JR (1978) NMR diffusion and flow measurements and an introduction to spin phase graphing. J Phys E Sci Instrum 11: 281–291

    Google Scholar 

  2. 2.

    Moran PR (1982) A flow velocity zeugmatographic interlace for NMR imaging in humans. Magn Reson Imaging 1: 197–203

    Google Scholar 

  3. 3.

    Axel L (1984) Blood flow effects in magnetic resonance imaging. AJR 143: 1157–1166

    Google Scholar 

  4. 4.

    Dumoulin CL, Souza SP, Walker MF, Wagle W (1989) Three-dimensional phase contrast angiography. Magn Reson Med 9: 139–149

    Google Scholar 

  5. 5.

    Nayler GL, Firmin DN, Longmore DB (1986) Blood flow imaging by cine magnetic resonance. J Comput Assist Tomogr 10: 715–722

    Google Scholar 

  6. 6.

    Bergstrand G, Bergström M, Nordell B, Ståhlberg F, Ericsson A, Hemmingsson A, Sperber G, Thuomas KA, Jung B (1985) Cardiac gated MR imaging of cerebrospinal fluid flow. J Comput Assist Tomogr 9: 1003–1006

    Google Scholar 

  7. 7.

    Bergstrand G, Nordell B, Ståhlberg F, Ericsson A, Hemmingson A, Sperber G, Thuomas KA, Jung B (1986) Cerebrospinal fluid flow studied with gated magnetic resonance imaging during various parts of the cardiac cycle. Acta Radiol (Stockh) [Suppl] 369: 490–491

    Google Scholar 

  8. 8.

    Feinberg DA, Mark AS (1987) Human brain motion and cerebrospinal circulation demonstrated with MR velocity imaging. Radiology 163: 793–799

    Google Scholar 

  9. 9.

    Mascalchi M, Ciraolo L, Tanfani G, Taverni N, Inzitari D, Siracusa GF, Dal Pozzo GC (1988) Cardiac-gated phase MR imaging of aqueductal CSF flow. J Comput Assist Tomogr 12: 923–926

    Google Scholar 

  10. 10.

    Thomsen C, Ståhlberg F, Stubgaard M, Nordell B and The Scandinavian Flow Group (1990) Fourier analysis of cerebrospinal fluid flow velocities: MR imaging study. Radiology 177: 659–665

    Google Scholar 

  11. 11.

    Greitz D, Nordell B, Ericsson A, Ståhlberg F, Thomsen C (1991) Notes on the driving forces of the CSF circulation with special emphasis on the piston action of the brain. Neuroradiology 33 [Suppl]: 178–181

    Google Scholar 

  12. 12.

    Thomsen C, Henriksen O, Ring P (1987) In vivo measurement of water self diffusion in the human brain by magnetic resonance imaging. Acta Radiol Diagn 28: 353–361

    Google Scholar 

  13. 13.

    de Vlieger M, Ridder HJ (1959) Use of echo-encephalography. Neurology 9: 216–223

    Google Scholar 

  14. 14.

    Clark JM, White DN, Curry GR, Stevenson RJ, Campell JK, Jenkins CO (1971) The measurement of intracranial echo pulsations. Med Biol Eng 9: 263–287

    Google Scholar 

  15. 15.

    Campell JK, Clark JM, White DN, Jenkins CO (1970) Pulsatile echoencephalografy. Acta Neurol Scand 46 [Suppl 45]: 1–57

    Google Scholar 

  16. 16.

    White DN, Wilson KC, Curry GR, Stevenson RJ (1979) The limitation of pulsatile flow through the aqueduct of Sylvius as a cause of hydrocephalus. J Neurol Sci 42: 11–51

    Google Scholar 

  17. 17.

    Nordell B, Ståhlberg F, Ericsson A, Ranta C (1988) A rotating phantom for the study of flow effects in MR imaging. Magn Reson Imaging 6: 695–705

    Google Scholar 

  18. 18.

    O'Connell JEA (1943) Vascular factor in intracranial pressure and maintenance of cerebrospinal fluid circulation. Brain 66: 204–228

    Google Scholar 

  19. 19.

    Du Boulay G (1972) Further investigation of the pulsatile movements in the cerebrospinal fluid pathways. Acta Radiol Diagn 13: 496–523

    Google Scholar 

  20. 20.

    Levy LM, Di Chiro G, MacCullough D, Dwyer AJ, Johnson DL, Yang SSL (1988) Fixed spinal cord: diagnosis with MR imaging. Radiology 169: 773–778

    Google Scholar 

  21. 21.

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

    Google Scholar 

  22. 22.

    Le Bihan D, Breton E, Laliemand D, Grenier P, Cabanis E, Laval-Jeantet M (1986) MR imaging of intravoxel incoherent motion: application to diffusion and perfusion in neurologic disorders. Radiology 161: 401–407

    Google Scholar 

  23. 23.

    Le Bihan D, Breton E, Lallemand D, Aubin ML, Vignaud J, Laval-Jeantet M (1988) Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology 168: 497–505

    Google Scholar 

  24. 24.

    Le Bihan D (1990) Magnetic resonance imaging of perfusion. Magn Reson Med 14: 283–292

    Google Scholar 

  25. 25.

    Young IR, Hall AS, Bryant DJ, Thomas DGT, Gill SS, Dubowitz LMS, Cowan F, Pennock JM, Bydder GM (1988) Assessment of brain perfusion with MR imaging. J Comput Assist Tomogr 12: 721–727

    Google Scholar 

  26. 26.

    Feinberg DA, Jakab PD (1990) Tissue perfusion in humans studied by Fourier velocity distribution, line scan, and echo-planar imaging. Magn Reson Med 16: 280–293

    Google Scholar 

  27. 27.

    Merboldt KD, Hanicke W, Gyngell ML, Frahm J, Bruhn H (1989) The influence of flow and motion in MRI of diffusion using a modified CE-FAST sequence. Magn Reson Med 12: 198–208

    Google Scholar 

  28. 28.

    Madden A, Leach MO (1990) A simulation study of the effects of SNR and motion in IVIM images: investigation of the feasibility of NMR perfusion measurements (abstract). Soc Magn Reson Med, 9th annual meeting, New York, p 383

  29. 29.

    Chenevert TL, Pipe JG, Williams DM, Brunberg JA (1991) Quantitative measurements of tissue perfusion and diffusion in vivo. Magn Reson Med 17: 197–212

    Google Scholar 

  30. 30.

    Chien D, Buxton RB, Kwong KK, Brady TJ, Rosen BR (1990) MR diffusion of the human brain. J Comput Assist Tomogr 14: 514–520

    Google Scholar 

  31. 31.

    Doran M, Bydder GM (1990) Magnetic resonance: perfusion and diffusion imaging. Neuroradiology 32: 392–398

    Google Scholar 

  32. 32.

    McDonald DA (1953) Lateral pulsatile expansion of arteries. J Physiol (Lond) 119: 28P

  33. 33.

    Weed LH (1929) Some limitation of the Monro-Kellie hypothesis. Arch Surg 18: 1049–1068

    Google Scholar 

  34. 34.

    Weed LH, Flexner LB, Clark JH (1932) The effect of dislocation of cerebrospinal fluid upon its pressure. Am J Physiol 100: 246–261

    Google Scholar 

  35. 35.

    Flexner LB, Clark JH, Weed LH (1932) The elasticity of the dural sac and its contents. Am J Physiol 101: 292–303

    Google Scholar 

  36. 36.

    Enzmann DR, Rubin JR, Pelc N (1989) Cine phase contrast maps of cervical cerebrospinal fluid motion (abstract). 75th annual meeting of RSNA, 28 November 1989, Chicago. In: Neuroradiology (1990) 32: 371–391

  37. 37.

    Monro A (1783) Observations on the structure and functions of the nervous system. Creech and Johnson, Edinburgh

    Google Scholar 

  38. 38.

    Kellie G (1824) Appearances observed in the dissection of two individuals; death from cold and congestion of the brain. Trans Med-Chir Soc Edin 1: 84

    Google Scholar 

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Greitz, D., Wirestam, R., Franck, A. et al. Pulsatile brain movement and associated hydrodynamics studied by magnetic resonance phase imaging. Neuroradiology 34, 370–380 (1992). https://doi.org/10.1007/BF00596493

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Key words

  • Magnetic resonance imaging
  • Brain motion
  • Brain volume
  • Arterial expansion
  • Pulsation