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Cerebrospinal fluid dynamics in idiopathic normal pressure hydrocephalus on four-dimensional flow imaging

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Abstract

Objectives

To evaluate complex CSF movements and shear stress in patients with idiopathic normal pressure hydrocephalus (iNPH) on four-dimensional (4D) flow MRI.

Methods

Three-dimensional velocities and volumes of the reciprocating CSF movements through 12 ROIs from the foramen of Monro to the upper cervical spine were measured in 41 patients with iNPH, 23 patients with co-occurrence of iNPH and Alzheimer’s disease (AD), and 9 age-matched controls, using 4D flow imaging and application. Stroke volume, reversed-flow rate, and shear stress were automatically calculated. Relationships between flow-related parameters and morphological measurements were also assessed.

Results

Stroke volumes, reversed-flow rates, and shear stress at the cerebral aqueduct were significantly higher in patients with iNPH than in controls. Patients with pure iNPH had significantly higher shear stress at the ventral aspect of the cerebral aqueduct than those with co-occurrence of iNPH and AD. The stroke volume at the upper end of the cerebral aqueduct had the strongest association with the anteroposterior diameter of the lower end of the cerebral aqueduct (r = 0.52). The stroke volume at the foramen of Monro had significant associations with the indices specific to iNPH. The shear stress at the dorsal aspect of the cerebral aqueduct had the strongest association with the diameter of the foramen of Magendie (r = 0.52).

Conclusions

Stroke volumes, reversed-flow rates, and shear stress through the cerebral aqueduct on 4D flow MRI are useful parameters for iNPH diagnosis. These findings can aid in elucidating the mechanism of ventricular enlargement in iNPH.

Key Points

• The CSF stroke volume and bimodal shear stress at the cerebral aqueduct were considerably higher in patients with iNPH.

• The patients with pure iNPH had significantly higher shear stress at the ventral aspect of the cerebral aqueduct than those with co-occurrence of iNPH and AD.

• The shear stress at the cerebral aqueduct was significantly associated with the diameter of the foramen of Magendie.

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Abbreviations

AD:

Alzheimer’s disease

BVR:

Brain per ventricle ratio

D:

Dimensional

DESH:

Disproportionately enlarged subarachnoid space hydrocephalus

iNPH:

Idiopathic normal pressure hydrocephalus

PC:

Phase contrast

SPACE:

Sampling perfection with the application of optimized contrast using the variable flip-angle evolution

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Acknowledgments

We would like to thank the staff at the Department of Radiology in the Rakuwakai Otowa Hospital. We would like to thank Editage (www.editage.com) for English language editing.

Funding

This study has received funding of 500,000 yen/year x 2 years by FUJIFILM Corporation in Japan.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan

    Shigeki Yamada & Kazuhiko Nozaki

  2. Department of Neurosurgery and Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Japan

    Shigeki Yamada, Masatsune Ishikawa, Kazuo Yamamoto & Makoto Yamaguchi

  3. Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, Tokyo, Japan

    Shigeki Yamada & Marie Oshima

  4. Rakuwa Villa Ilios, Kyoto, Japan

    Masatsune Ishikawa

  5. Medical System Research & Development Center, FUJIFILM Corporation, Tokyo, Japan

    Hirotaka Ito

Authors
  1. Shigeki Yamada
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  2. Masatsune Ishikawa
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  3. Hirotaka Ito
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  4. Kazuo Yamamoto
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  5. Makoto Yamaguchi
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  6. Marie Oshima
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  7. Kazuhiko Nozaki
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Corresponding author

Correspondence to Shigeki Yamada.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Shigeki Yamada who is assistant professor at the Department of Neurosurgery, Shiga University of Medical Science.

Conflict of interest

Some authors of this manuscript declare the relationship with FUJIFILM Corporation because this study used the SYNAPSE 3D workstation (FUJIFILM Corporation; Tokyo, Japan). Shigeki Yamada (the first author) received speakers’ honoraria from Fujifilm Medical Systems. Hirotaka Ito (the third author) is a main developer of the 4D flow application and had substantial contributions to the development of the programing code for data management on the SYNAPSE 3D workstation.

The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Shigeki Yamada (the first author) has statistical expertise. He learned biostatistics at the Department of Health and Environmental Sciences, Kyoto University School of Public Health, from 2001 to 2004. Since 2003, he was responsible for the statistical analysis in more than 30 major papers.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained. The study design and protocol were first approved by the ethics committee for human research at Rakuwakai Otowa Hospital in 2017 (IRB Number: Rakuoto-Rin-17-041). In addition, it was further approved by the ethics committee at Shiga University of Medical Science on October 11, 2019 (IRB Number: R2019-227).

Study subjects or cohorts overlap

Although all the contents of this manuscript have not been published or presented elsewhere in part or in entirety and are not under consideration by another journal, study subjects overlap in the following publication:

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Yamada, S., Ishikawa, M., Ito, H. et al. Cerebrospinal fluid dynamics in idiopathic normal pressure hydrocephalus on four-dimensional flow imaging. Eur Radiol 30, 4454–4465 (2020). https://doi.org/10.1007/s00330-020-06825-6

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  • DOI: https://doi.org/10.1007/s00330-020-06825-6

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