Role of Fluid Dynamics in Neurological Diseases
Maria Marcella Laganà1

1IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy

Synopsis

Numerous studies investigated the link between arteriovenous alterations and neurological disorders. The studies involved in vivo data, as well as models of the cerebrospinal flows. An overview of these studies will be illustrated. The theoretic method for computing velocity from the phase contrast will be shown. Then, some exemplificative software used for phase contrast processing will be reported and their results will be compared. In this talk, data from healthy subjects, patients with multiple sclerosis and with migraine will be shown. Finally, the flow estimated through MRI will be used for validating models of the cerebrospinal fluid dynamics.

Target Audience

Neuroradiologists, clinicians and imaging scientists interested in cerebrovascular and cerebrospinal fluid flow imaging; MR physicists and engineers developing new methods for flow quantification (sequences and processing) or who are interested on the methods used in literature.

Objectives

The attendees will:

- Learn about different MR techniques for studying flow;

- Have a general overview of the sequences for imaging and quantifying the flow;

- Learn strategies to process phase contrast images in order to obtain a flow curve as a function of the cardiac cycle;

- Have a summary of the main researches investigating flow disturbances in neurological diseases

Purpose

Numerous studies have recently investigated the link between arterio-venous alterations and neurological disorders. The studies involved in vivo data (1-13), as well as numeric simulations and models of the cerebrospinal flows(14-17). First, the acute effect of arterial impairment (1), the brain perfusion (2-3) and the arterial cross-sectional area (4) have been shown to be altered in different neurologic diseases. Second, venous abnormalities were recently linked to aging (5), and neurological disorders like transient global amnesia (6), transient monocular blindness (7), multiple sclerosis (8), Parkinson’s Disease (9) and Alzheimer's disease (10). Various mechanisms have been proposed to explain the role played by venous abnormalities in central nervous system pathologies, without a definite and final consensus of the scientific community. Finally, increased pulsatility of the aqueduct of Sylvius cerebrospinal fluid flow (CSF) has been associated with normal pressure hydrocephalus (11), multiple sclerosis (MS) (12), and white matter abnormalities (13).

Methods

The cerebrovascular blood and CSF flows are usually quantified over the cardiac cycle, using the cardiac-gated cine phase contrast (PC) MRI sequence. However, acquiring the PC with the cardiac gating hides the respiratory modulation (18) of blood and CSF flow. For this reason, some particular sequences have been recently used in a few works (19-21), with the contemporaneous monitoring of ECG and breathing. These techniques will be illustrated. The theoretic method for computing velocity from the PC magnitude and phase will be illustrated. Then, some exemplificative software used for PC processing will be reported. Finally, it will be illustrated that mathematical and lumped-parameter models have been used during the last decade in order to explain the interaction between the various fluids (arterial, venous, cervical CSF, aqueductal CSF) (14-17). The simulations obtained using these models can be compared with real PC data for validation.

Results

Firstly, an overview of the physiologic mutual relationships between arterial, venous and CSF flows through the cardiac cycle will be illustrated. The respiratory effect will be reported, showing real-time data and the cardiac and breathing modulation of the flow curve (18).

Then, some exemplificative results will be shown:

- The comparison of the results obtained using different software for PC processing;

- The PC-derived measures repeatability;

- The effect of image resolution on flow measures (22).

- The arterial, venous and CSF flow in various group of subjects, such as those with multiple sclerosis (23) and with migraine (24);

- the validation of various cerebrospinal fluid models using PC flow imaging (14-17).

Discussion

The knowledge of the conventional and advanced PC sequences might allow further studies, for clarifying the limits of the current literature.

Information about possible errors due to resolution or image processing is fundamental for the correct study design and interpretation of the results.

Acknowledgements

No acknowledgement found.

References

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Proc. Intl. Soc. Mag. Reson. Med. 27 (2019)