Quantification of Pulsatile Cerebrospinal Fluid Flow within the Prepontine Cistern
Background: Phase-contrast MRI (PC-MRI) has previously been used for the quantification of CSF and blood flow throughout the body. We propose a new method of semi-automated segmentation for the prepontine cistern based on anatomical and pulsatility inform
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Abstract Background: Phase-contrast MRI (PC-MRI) has previously been used for the quantification of CSF and blood flow throughout the body. We propose a new method of semiautomated segmentation for the prepontine cistern based on anatomical and pulsatility information. Methods: Scans were conducted on 48 patients (69.83 ± 14.28 years) ranging in age from 32 to 88 years along with an additional 11 controls (51.91 ± 21.13 years) ranging in age from 22 to 72 years. The segmentation algorithm developed consists of four stages: anatomical, flow quantification for the aqueduct and prepontine cistern, and blood vessel detection. Results: Complete results are presented in Table 1, the 37 preoperative patients and controls had a prepontine cistern stroke volume of 464.32 ± 202.30 and 447.38 ± 75.49 respectively. Conclusion: Reliable quantification of volumetric CSF flow in complex cisternal spaces is possible using a methodology combining known anatomical features with the pulsatile nature of CSF flow.
R. Hamilton, X. Hu () and M. Bergsneider Neural Systems and Dynamics Laboratory, Department of Neurosurgery, David Geffen School of Medicine, University of California, NPI 18-265, Los Angeles, CA 90095, USA Biomedical Engineering Graduate Program, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, CA 90095, USA e-mail: [email protected] J. Dye and K. Baldwin Neural Systems and Dynamics Laboratory, Department of Neurosurgery, David Geffen School of Medicine, University of California, NPI 18-265, Los Angeles, CA 90095, USA A. Frew Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, David Geffen School of Medicine at the University of California Los Angeles (UCLA), Los Angeles, CA, USA
Keywords Phase contrast MRI • Hydrocephalus • Aqueduct of Sylvius • Cerebrospinal fluid (CSF)
Introduction Although first described nearly half a century ago, the treatment and/or diagnosis of normal pressure hydrocephalus (NPH) remains complicated. The pathophysiological mechanisms underlying NPH include altered hydrodynamics within the cerebrospinal fluid (CSF) system causing changes in CSF flow, reduced absorption, and changes in compliance of the cerebral vasculature. Traditionally, NPH is characterized clinically by the presence of dementia, gait disturbance, and urinary incontinence, along with radiological evidence of ventriculomegaly. Cine phase contrast MRI (PC-MRI) has become a fundamental component of clinical practice, providing a wide range of clinical applications for characterization of flow dynamics non-invasively. Commonly used for quantification of blood flow throughout the body [1], PC-MRI has been extended to cerebrospinal fluid (CSF) for possible diagnosis and treatment of hydrocephalus and Chiari malformation, along with non-invasive measurements of elastance and intracranial pressure [2–4]. Initially described as a flow void [5], CSF flow was characterized as pulsatile within the aqueduct of Sylvius as early as the late 1980s [6]. The pulsatile movement of cerebro
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