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. 2013 Dec 27;10(1):36.
doi: 10.1186/2045-8118-10-36.

Influence of respiration on cerebrospinal fluid movement using magnetic resonance spin labeling

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Free PMC article

Influence of respiration on cerebrospinal fluid movement using magnetic resonance spin labeling

Shinya Yamada et al. Fluids Barriers CNS. .
Free PMC article

Abstract

Background: Magnetic resonance imaging (MRI) cardiac gated phase contrast (PC) cine techniques have non-invasively shown the effect of the cardiac pulse on cerebrospinal fluid (CSF) movement. Echo planar imaging (EPI) has shown CSF movement as influenced by both cardiac pulsation and respiration. Previously, it has not been possible to visualize CSF movement in response to respiration non-invasively. The present study was undertaken to do so.

Methods: The effect of respiration on CSF movement was investigated using a non-contrast time-spatial labeling inversion pulse (Time-SLIP) with balanced steady-state free precession (bSSFP) readout. CSF movement was observed in the intracranial compartment in response to respirations in ten normal volunteers. To elucidate the respiration effect, the acquisition was triggered at the beginning of deep inhalation, deep exhalation and breath holding.

Results: By employing this respiration-induced spin labeling bSSFP cine method, we were able to visualize CSF movement induced by respiratory excursions. CSF moved cephalad (16.4 ± 7.7 mm) during deep inhalation and caudad (11.6 ± 3.0 mm) during deep exhalation in the prepontine cisternal area. Small but rapid cephalad (3.0 ± 0.4 mm) and caudad (3.0 ± 0.5 mm) movement was observed in the same region during breath holding and is thought to reflect cardiac pulsations.

Conclusions: The Time-SLIP bSSFP cine technique allows for non-invasive visualization of CSF movement associated with respiration to a degree not previously reported.

Figures

Figure 1
Spin magnetization (top) and sequence diagram (bottom). The sequence diagram (bottom) shows Time-SLIP with two-dimensional cine bSSFP. The corresponding magnetization states (top) of signals covered by the non-selective pulse (A) and the selective tagged pulse (B) are presented. An initial non-selective pulse (A) inverts all magnetizations within a radiofrequency coil, followed by a selective pulse (B) that restores the magnetization at + Mz in a plane that can be placed freely in any orientation. The untagged background signals, receiving only the non-selective inversion recovery (IR) pulse return to + Mz by following T1 recovery relaxation, as shown in the dotted line. After waiting, a TI, cine bSSFP read-out is acquired. When the untagged signals reach a null point, the tagged signals and the untagged signals have maximum contrast and thus they are well differentiated.
Figure 2
Time-SLIP bSSFP cine images during inhalation and exhalation. The results of the MRI cine images are shown in sagittal views of a healthy 44-year-old male volunteer. The Time-SLIP pulse was applied perpendicular to the sagittal plane to encompass the red dotted rectangle. a) On the sagittal image during inhalation, a caudo-cranial movement of CSF was observed at the aqueduct of Sylvius (blue arrows) and the prepontine subarachnoid space toward the suprasellar cistern and the third ventricle (red arrows). This CSF movement was noted during the initiation of inhalation lasting for about 2.5 seconds. b) On the sagittal image, during the period of exhalation, a cranio-caudad movement of CSF to the prepontine subarachnoid space (red arrows) was observed. Note that the movement of CSF is predominately observed in the ventral side of the subarachnoid space, which may be due to a pressure difference between the dorsal and ventral sides of the volunteer in the supine position.
Figure 3
Graph showing distance (mm) CSF in the pre-pontine cistern moved with deep inspiration and expiration. Each of the 10 volunteers was imaged on 3 occasions. Each point on the graph shows the average maximum distance with standard deviation. For the group as a whole, CSF in the pre-pontine subarachnoid space moved cephalad 16.5 ± 7.7 mm with inspiration and caudad 11.6 ± 3.0 with expiration. Average Maximum CSF movement during deep inspiration and expiration.
Figure 4
Time-SLIP bSSFP cine images during breath holding. The Time-SLIP pulse was applied perpendicular to the sagittal plane to encompass the red dotted rectangle. In the prepontine region, only a small amount of cephalad and caudad CSF movements were observed in the mid sagittal view. The color scale was used as an arbitrary signal intensity to highlight CSF movement. With breath holding, the small to and fro CSF movement is produced by cardiac pulsations.
Figure 5
Graph showing distance (mm) CSF in the pre-pontine cistern moved with breath holding. Each of the 10 volunteers was imaged on 3 occasions. Each point on the graph shows the average maximum cephalad and caudad distance with standard deviation that CSF moved in the pre-pontine subarachnoid space during one cardiac cycle and is thought to reflect the systolic and diastolic components of the cardiac cycle. For the group as a whole, CSF in the pre-pontine subarachnoid space moved cephalad 3.0 ± 0.4 mm and caudad 3.0 ± 0.5 mm. CSF movement during breath holding.

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