normal csf flow measurements at the aqueduct performed at 3t e. kapsalaki, i. tsougos, p. svolou,...
DESCRIPTION
Material and Methods o o15 healthy volunteers aged yo (mean age 24.6 years) o o3Τ HDxT, GE MR system (GE Medical Systems, Milwaukee, USA). o oPhase Contrast cine MRI o oCardiac gated, flow compensated, gradient echo sequences (flow encoding 10cm/sec). o oMeasurements performed on sagittal Τ1 o oROI analysis at three levels of the aqueduct o o ROIs of variable size were concentrically placed to evaluate user dependent variation o o Analysis performed on software provided o o PPV, PNV and AF were evaluatedTRANSCRIPT
Normal CSF Flow Measurements Normal CSF Flow Measurements at the Aqueduct Performed at 3Tat the Aqueduct Performed at 3T
E. Kapsalaki, I. Tsougos, P. Svolou, E. Dardiotis, E. Kapsalaki, I. Tsougos, P. Svolou, E. Dardiotis, G. Hadjigeorgiou, K.N. FountasG. Hadjigeorgiou, K.N. Fountas
University Hospital of LarissaUniversity Hospital of LarissaDepts of Radiology, Physics, Neurology and NeurosurgeryDepts of Radiology, Physics, Neurology and Neurosurgery
XIX Symposium Neuroradiologicum, Bologna 2010
IntroductionIntroduction
o Accurate knowledge of normal CSF flow through Accurate knowledge of normal CSF flow through the aqueduct is important in decision making in the aqueduct is important in decision making in patients with hydrocephaluspatients with hydrocephalus
o Purpose: Purpose: o Evaluate normal CSF flow measurements at 3T Evaluate normal CSF flow measurements at 3T
in healthy volunteers and compare with 1,5T.in healthy volunteers and compare with 1,5T.o Estimation of user dependency with variation Estimation of user dependency with variation
of Region-Of-Interest analysis.of Region-Of-Interest analysis.
Material and MethodsMaterial and Methods
o 15 healthy volunteers aged 15-43 yo (mean age 24.6 years) o 3Τ HDxT, GE MR system (GE Medical Systems, Milwaukee, USA).o Phase Contrast cine MRI o Cardiac gated, flow compensated, gradient echo sequences
(flow encoding 10cm/sec).o Measurements performed on sagittal Τ1 o ROI analysis at three levels of the aqueducto ROIs of variable size were concentrically placed to evaluate
user dependent variationo Analysis performed on software provided o PPV, PNV and AF were evaluated
Material and MethodsMaterial and MethodsCerebral aqueduct is divided anatomically into three parts, separated by two natural constrictions of the aqueductal lumen, one in the middle of the superior colliculus (A) and the other at the level of the intercolliculars sulcus (B) forming the – upper part - pars anterior or inlet, – middle part - ampulla and – inferior part – pars posterior
Lee et al. Korean JLee et al. Korean J.. Radiol Radiol.. 2004 2004
ROI_1= Exactly at the margins of the aqueductROI_2= Slightly larger than the aqueductal margins Baseline= Outside the area of the aqueduct at the midbrain separating (+) from (–) flow.
Total ROI area Total ROI area (mm2)(mm2)
INLETINLET
ROI_1ROI_1 3.32 3.32 ± ± 1.3591.359ROI_2ROI_2 4.55 4.55 ± ± 1.7021.702
BaselineBaseline 0.48 0.48 ± ± 0.1740.174
AMPULLAAMPULLAROI_1ROI_1 3.453.45 ± ± 1.2041.204ROI_2ROI_2 4.87 4.87 ± ± 1.6481.648
BaselineBaseline 0.53 0.53 ± ± 0.3050.305PARS PARS
POSTERIPOSTERIOROR
ROI_1ROI_1 4.13 4.13 ± ± 1.3061.306ROI_2ROI_2 5.83 5.83 ± ± 1.8351.835
BaselineBaseline 0.50 0.50 ± ± 0.2730.273
Flow quantification was carried out using the software provided by the manufacturer (GE Report Card version 3.6)
Create our own database
C
A
B
Anatomical Level
ROI (mm2)
Mean AF (±SD)
(ml/beat)
Mean PPV (±SD) (cm/sec)
Mean PNV (±SD) (cm/sec)
Mean ROI Area (±SD) (mm2)
Inlet ROI_1ROI_2
0.034 ± 0.0180.055 ± 0.022
9.46 ± 0.6719.46 ± 0.671
-8.24 ± 2.011* -8.24 ± 2.011
3.66 ± 1.3435.97 ± 1.810
Baseline 0.004 ± 0.003 1.78 ± 0.267 -0.01 ± 0.014 0.53 ± 0.286
Ampulla ROI_1ROI_2
0.036 ± 0.0160.055 ± 0.016
8.71 ± 1.1348.71 ±1.134
-7.02 ± 2.825 -7.02 ± 2.825
3.61 ± 0.5525.47 ± 0.949
Baseline 0.004 ± 0.002 1.85 ± 0.090 -0.00 ± 0.00 0.42 ± 0.186
Pars Posterior ROI_1ROI_2
0.031 ± 0.0160.047 ± 0.021
8.01 ± 1.4708.01 ± 1.470
-5.54 ± 2.915 -5.54 ± 2.915
4.33 ± 1.8026.68 ± 2.647
Baseline 0.003 ± 0.002 1.57 ± 0.274 -0.07 ± 0.101 0.46 ± 0.274
RESULTSAnatomical
Level
ROI (mm2)
Mean AF (±SD)
(ml/beat)
Mean PPV (±SD) (cm/sec)
Mean PNV (±SD) (cm/sec)
Mean ROI Area (±SD) (mm2)
Inlet ROI_1ROI_2
0.034 ± 0.0180.055 ± 0.022
9.46 ± 0.6719.46 ± 0.671
-8.24 ± 2.011* -8.24 ± 2.011
3.66 ± 1.3435.97 ± 1.810
Baseline 0.004 ± 0.003 1.78 ± 0.267 -0.01 ± 0.014 0.53 ± 0.286
Ampulla ROI_1ROI_2
0.036 ± 0.0160.055 ± 0.016
8.71 ± 1.1348.71 ±1.134
-7.02 ± 2.825 -7.02 ± 2.825
3.61 ± 0.5525.47 ± 0.949
Baseline 0.004 ± 0.002 1.85 ± 0.090 -0.00 ± 0.00 0.42 ± 0.186
Pars Posterior ROI_1ROI_2
0.031 ± 0.0160.047 ± 0.021
8.01 ± 1.4708.01 ± 1.470
-5.54 ± 2.915 -5.54 ± 2.915
4.33 ± 1.8026.68 ± 2.647
Baseline 0.003 ± 0.002 1.57 ± 0.274 -0.07 ± 0.101 0.46 ± 0.274
Anatomical Level
ROI (mm2)
Mean AF (±SD)
(ml/beat)
Mean PPV (±SD) (cm/sec)
Mean PNV (±SD) (cm/sec)
Mean ROI Area (±SD) (mm2)
Inlet ROI_1ROI_2
0.034 ± 0.0180.055 ± 0.022
9.46 ± 0.6719.46 ± 0.671
-8.24 ± 2.011* -8.24 ± 2.011
3.66 ± 1.3435.97 ± 1.810
Baseline 0.004 ± 0.003 1.78 ± 0.267 -0.01 ± 0.014 0.53 ± 0.286
Ampulla ROI_1ROI_2
0.036 ± 0.0160.055 ± 0.016
8.71 ± 1.1348.71 ±1.134
-7.02 ± 2.825 -7.02 ± 2.825
3.61 ± 0.5525.47 ± 0.949
Baseline 0.004 ± 0.002 1.85 ± 0.090 -0.00 ± 0.00 0.42 ± 0.186
Pars Posterior ROI_1ROI_2
0.031 ± 0.0160.047 ± 0.021
8.01 ± 1.4708.01 ± 1.470
-5.54 ± 2.915 -5.54 ± 2.915
4.33 ± 1.8026.68 ± 2.647
Baseline 0.003 ± 0.002 1.57 ± 0.274 -0.07 ± 0.101 0.46 ± 0.274
Anatomical Level
ROI (mm2)
Mean AF (±SD)
(ml/beat)
Mean PPV (±SD) (cm/sec)
Mean PNV (±SD) (cm/sec)
Mean ROI Area (±SD) (mm2)
Inlet ROI_1ROI_2
0.034 ± 0.0180.055 ± 0.022
9.46 ± 0.6719.46 ± 0.671
-8.24 ± 2.011* -8.24 ± 2.011
3.66 ± 1.3435.97 ± 1.810
Baseline 0.004 ± 0.003 1.78 ± 0.267 -0.01 ± 0.014 0.53 ± 0.286
Ampulla ROI_1ROI_2
0.036 ± 0.0160.055 ± 0.016
8.71 ± 1.1348.71 ±1.134
-7.02 ± 2.825 -7.02 ± 2.825
3.61 ± 0.5525.47 ± 0.949
Baseline 0.004 ± 0.002 1.85 ± 0.090 -0.00 ± 0.00 0.42 ± 0.186
Pars Posterior ROI_1ROI_2
0.031 ± 0.0160.047 ± 0.021
8.01 ± 1.4708.01 ± 1.470
-5.54 ± 2.915 -5.54 ± 2.915
4.33 ± 1.8026.68 ± 2.647
Baseline 0.003 ± 0.002 1.57 ± 0.274 -0.07 ± 0.101 0.46 ± 0.274
Conclusions IConclusions I ROI size
– has no effect on PPV and PNV– Affects flow
PPV PNV slight decrease caudally No significant variation between measurements of
flow in the different parts of the aqueduct
Select ampulla for measurementsUsually wider and better reproducibility
Normal measurements at 1.5Treported <0.044ml/sec at the ampulla
AMPULLA
Peak Positive Velocity
(cm/s)
Average Flow
(ml/beat)
No AGE SEX 1st 2nd Baseline 1st 2nd Baseline
1 15 M 6.11 6.11 1.34 0.014 0.019 0.001
2 39 F 6.92 6.92 1.98 0.050 0.066 0.012
3 43 F 4.87 4.87 1.61 0.017 0.024 0.002
4 19 F 3.44 3.44 1.71 0.035 0.048 0.002
5 27 F 8.17 8.17 1.97 0.033 0.042 0.005
6 19 F 9.83 9.83 1.81 0.057 0.088 0.006
7 19 F 3.41 3.41 1.71 0.040 0.056 0.002
8 19 F 2.95 2.95 1.52 0.017 0.022 0.002
9 19 F 9.44 9.44 1.92 0.041 0.053 0.003
10 27 M 9.95 9.95 2.29 0.055 0.077 0.007
11 19 F 4.24 4.24 1.39 0.012 0.019 0.002
12 28 F 8.21 8.22 1.62 0.032 0.035 0.003
13 25 M 3.45 3.445 1.56 0.024 0.030 0.002
14 59 M 7.06 7.06 1.58 0.041 0.060 0.006
RESULTS
0.036±0.016 ml/beat0.036±0.016 ml/beat
Max 0.057Max 0.057 ml/beatml/beat
Min 0.014Min 0.014
AMPULLA
2.2. Stoquart-ElSankari, S., O. Baledent, et al. (2007). "Aging effects on Stoquart-ElSankari, S., O. Baledent, et al. (2007). "Aging effects on cerebral blood and cerebrospinal fluidcerebral blood and cerebrospinal fluid flows." J Cereb Blood Flow Metab flows." J Cereb Blood Flow Metab 27(9): 1563-72.27(9): 1563-72.
19 19 healthy volunteers healthy volunteers ((mean age 2mean age 27 7 yearsyears) και 12 ) και 12 elderly normal volunteers elderly normal volunteers ((m.a. 71 y)m.a. 71 y) 1.5Τ 1.5Τ MR System (Signa; General Electric Medical System, Milwaukee, USA)MR System (Signa; General Electric Medical System, Milwaukee, USA) ROI measurements at the level of the ampulla and at various levels of the cervical spine ROI measurements at the level of the ampulla and at various levels of the cervical spine
REFERENCESREFERENCES
Conclusions II Conclusions II
o ROI size affects average flowROI size affects average flowo ROI should be placed at the margins of the aqueduct ROI should be placed at the margins of the aqueduct
in order to obtain the most accurate measurementsin order to obtain the most accurate measurementso Normal average CSF flow at the level of the aqueduct Normal average CSF flow at the level of the aqueduct
at 3T was 0.036±0.016 ml/beatat 3T was 0.036±0.016 ml/beato Measurements at 3T do not show significant variability Measurements at 3T do not show significant variability
compared to measurements reported at 1.5Tcompared to measurements reported at 1.5To Creation of database, age matched, to evaluate Creation of database, age matched, to evaluate
patients with dilated ventricular systempatients with dilated ventricular system
