Assessment of CSF Flow Dynamics Using PC-MRI in Spontaneous Intracranial Hypotension

• Published in: Headache Vol. 52; no. 5; pp. 808 - 819
• Main Authors: Hasiloglu, Zehra Isik, Albayram, Sait, Gorucu, Yasin, Selcuk, Hakan, Cagil, Emin, Erdemli, Halil Eren, Adaletli, Ibrahim
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-05-2012; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Adult; Biological and medical sciences; Cerebrospinal fluid; cerebrospinal fluid flow dynamics; Cerebrospinal Fluid Pressure - physiology; Female; Headache; Humans; Hydrodynamics; Hypotension; Image Processing, Computer-Assisted; Intracranial Hypotension - cerebrospinal fluid; Intracranial Hypotension - diagnosis; Investigative techniques, diagnostic techniques (general aspects); Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Nervous system; Neurology; NMR; Nuclear magnetic resonance; phase-contrast magnetic resonance imaging; Pressure; Radiodiagnosis. Nmr imagery. Nmr spectrometry; spontaneous intracranial hypotension; Stroke; Stroke Volume - physiology; Vascular diseases and vascular malformations of the nervous system; Ventricles (cerebral); Young Adult; Headache; Nervous system diseases; Intracranial hypotension; cerebrospinal fluid flow dynamics; Cerebrospinal fluid; Nuclear magnetic resonance imaging; Cerebral disorder; Pain; Phase contrast; spontaneous intracranial hypotension; Central nervous system disease; phase-contrast magnetic resonance imaging; Neurological disorder; Cerebrovascular disease
• ISSN: 0017-8748; 1526-4610
• DOI: 10.1111/j.1526-4610.2012.02150.x

(Headache 2012;52:808‐819)
Aim.— Spontaneous intracranial hypotension (SIH) is caused by spontaneous cerebrospinal fluid (CSF) leaks and is known to cause orthostatic headaches. Phase‐contrast magnetic resonance imaging (PC‐MRI) is a non‐invasive technique that can be used to quantify variation in CSF flow. The aim of this study was to assess CSF flow dynamics using PC‐MRI in SIH.
Materials and Methods.— Twenty‐five patients with a definitive diagnosis of SIH and 25 healthy subjects were evaluated with PC‐MRI. Magnetic resonance (MR) images were acquired using a 1.5‐T unit with an 8‐channel head coil. Differences between SIH patients and control subjects were assessed statistically using Wilcoxon's rank sum test, Spearman's rho test, or Pearson's chi‐square test, as appropriate.
Results.— CSF flow volumes toward the third ventricle, CSF flow volumes toward the fourth ventricle, the absolute stroke volume, the peak systolic velocity, and the peak diastolic velocity in SIH patients were significantly smaller than those in control subjects (P < .0001). On the other hand, the net CSF flow volume (P = .9227) and the net CSF flow direction (P = .2472) for SIH patients and control subjects were not significantly different.
Conclusions.— The results obtained by CSF flow analysis were directly related to values of CSF opening pressure, determined by lumbar puncture, and clinical findings, such as headache scores. Thus, CSF flow analysis with PC‐MRI, which has a short performance time and is non‐invasive, may contribute to assessment of SIH patients.