Korean J Radiol.  2018 Feb;19(1):72-78. 10.3348/kjr.2018.19.1.72.

Cerebrospinal Fluid Dynamics in Patients with Multiple Sclerosis: The Role of Phase-Contrast MRI in the Differential Diagnosis of Active and Chronic Disease

• Öner S
• Kahraman A
• Özcan C
• Özdemir Z
• Ãœnlü S
• Kamışlı O
• Öner Z

• KMID: 2425111
• DOI: http://doi.org/10.3348/kjr.2018.19.1.72

Abstract

OBJECTIVE
Multiple sclerosis (MS) is an inflammatory disease characterized by demyelinating plaques in the white matter. Chronic cerebrospinal venous insufficiency (CCSVI) has been proposed as a new hypothesis for the etiopathogenesis of MS disease. MS-CCSVI includes a significant decrease of cerebrospinal fluid (CSF) flow through the cerebral aqueduct secondary to an impaired venous outflow from the central nervous system. This study aimed to determine whether CSF flow dynamics are affected in MS patients and the contributions to differential diagnosis in active and chronic disease using phase-contrast magnetic resonance imaging (PC-MRI).
MATERIALS AND METHODS
We studied 16 MS patients with chronic plaques (group 1), 16 MS patients with active plaques-enhanced on MRI (group 2), and 16 healthy controls (group 3). Quantitatively evaluation of the CSF flow was performed from the level of the cerebral aqueduct by PC-MRI. According to heart rates, 14-30 images were obtained in a cardiac cycle. Cardiac triggering was performed prospectively using finger plethysmography.
RESULTS
No statistically significant difference was found between the groups regarding average velocity, net forward volume and the average flow (p > 0.05). Compared with the controls, group 1 and group 2, showed a higher peak velocity (5.5 ± 1.4, 4.9 ± 1.0, and 4.3 ± 1.3 cm/sec, respectively; p = 0.040), aqueductal area (5.0 ± 1.3, 4.1 ± 1.5, and 3.1 ± 1.2 mm2, respectively; p = 0.002), forward volume (0.039 ± 0.016, 0.031 ± 0.013, and 0.021 ± 0.010 mL, respectively; p = 0.002) and reverse volume (0.027 ± 0.016, 0.018 ± 0.009, and 0.012 ± 0.006 mL, respectively; p = 0.000). There were no statistical significance between the MS patients with chronic plaques and active plaques except for reverse volume. The MS patients with chronic plaques showed a significantly higher reverse volume (p = 0.000).
CONCLUSION
This study indicated that CSF flow is affected in MS patients, contrary to the hypothesis that CCSVI-induced CSF flow decreases in MS patients. These findings may be explained by atrophy-dependent ventricular dilatation, which may occur at every stage of MS.

Keyword

Cerebrospinal fluid dynamics; Multiple sclerosis; Chronic cerebrospinal venous insufficiency; Phase contrast cine MRI

MeSH Terms

Central Nervous System
Cerebral Aqueduct
Cerebrospinal Fluid*
Chronic Disease*
Diagnosis, Differential*
Dilatation
Fingers
Heart Rate
Humans
Magnetic Resonance Imaging*
Multiple Sclerosis*
Plethysmography
Prospective Studies
Venous Insufficiency
White Matter

Figure

• 

  Fig. 1 Measurement of flow of cerebrospinal fluid with phase-contrast MRI.A. Saggital T2 scan showing positioning for cine MRI acquisition. B. Cerebral aqueduct region-of-interest drawing on phase image, after sufficient magnification. C. Peak velocity-time graph obtained for cardiac beat. D. Data table obtained using Argus software.

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