Investigating CSF flow in patients with idiopathic normal pressure hydrocephalus using phase-contrast 7T MRI
(2025) MSFT02 20252Medical Physics Programme
- Abstract
- Introduction: Idiopathic normal pressure hydrocephalus (iNPH) is a treatable but largely
underdiagnosed neurological condition affecting the elderly population. It is characterised
by gait and cognitive impairment, as well as urinary incontinence. For the most part, it is
diagnosed via imaging and clinical assessments. Abnormalities in cerebrospinal (CSF) flow in
the cerebral aqueduct have been linked to iNPH. However, no robust CSF dynamics
biomarker exists to predict treatment responsiveness. Recent findings using real-time (RT)
CSF-flow measurements, particularly at ultra-high field strengths, have shown promising
potential to identify strong predictors for treatment responsiveness in patients with iNPH.
Method: Twenty-one... (More) - Introduction: Idiopathic normal pressure hydrocephalus (iNPH) is a treatable but largely
underdiagnosed neurological condition affecting the elderly population. It is characterised
by gait and cognitive impairment, as well as urinary incontinence. For the most part, it is
diagnosed via imaging and clinical assessments. Abnormalities in cerebrospinal (CSF) flow in
the cerebral aqueduct have been linked to iNPH. However, no robust CSF dynamics
biomarker exists to predict treatment responsiveness. Recent findings using real-time (RT)
CSF-flow measurements, particularly at ultra-high field strengths, have shown promising
potential to identify strong predictors for treatment responsiveness in patients with iNPH.
Method: Twenty-one patients (mean age 75 years) with suspected iNPH underwent RT and
triggered through-plane phase-contrast (2D-PC) 7T MRI before ventriculoperitoneal (VP)
shunt treatment. The CSF-flow measurements were extracted using the software Segment
v4.1 R14708 (Medviso, Lund, Sweden). The computed CSF flow and volume parameters
were compared with surgical outcomes as measured by changes in clinical symptoms. A
significance level of 0.05 or lower was considered in the statistical analysis.
Results: The relationship between RT net flow and patient responsiveness to VP-shunting
was statistically significant (P<.05). RT net flow in the cranial direction (retrograde flow) was
present in patients who responded favourably to the surgery. Nevertheless, there were no
correlations between CSF volume and patient responsiveness to shunting. Similarly, no
correlations were found while analysing triggered net flow and stroke volume with patient's
response to treatment. A comparison of the iNPH RT net flow data with that of healthy
volunteers (mean age 26 years) gave a statistically significant difference (P<.05).
Discussion: Real-time 2D-PC MRI is an emerging technique that is still undergoing validation
for quantification of free-breathing effects on CSF-flow in the cerebral aqueduct.
The clinical usefulness of the technique remains a subject of argument as consensus on data
acquisition and analysis is lacking. In recent years, investigation of potential CSF dynamics
biomarkers in patients with iNPH using RT 2D-PC MRI has become more pertinent. The RT
net flow data obtained from healthy volunteers is consistent with previous studies. In this
study, a statistically significant difference was observed when comparing the obtained RT net
flow of iNPH patients to that of young volunteers. However, it was not possible to determine
whether this difference was in fact due to iNPH, as the difference in age between the groups
is a confounding factor. A main observation is retrograde RT net flow in patients that
responded favourably to shunting. This aligns with previous findings with triggered 2D-PC-
MRI, which reported retrograde net flow in patients with iNPH before surgery.
Conclusion: The observed correlation between post-shunt clinical improvement and RT net
flow at 7T MRI suggest that RT net flow could become a valuable predictor of VP-shunt
responsiveness in patients with iNPH. (Less) - Popular Abstract (Swedish)
- Idiopatisk normaltryckshydrocephalus (iNPH) är en neurologisk sjukdom som påverkar
hjärnans vätskecirkulation och kan leda till symtom som gång- och balanssvårigheter,
kognitiv nedsättning och urininkontinens. Sjukdomen drabbar omkring 1.5 % av 70-åringar,
och prevalensen ökar med åldern. Det är en svårdiagnostiserad sjukdom där hjärnvätska
(CSF) ansamlas i hjärnans hålrum, vilket påverkar hjärnans funktion. Sjukdomen kan
behandlas med en så kallad shuntoperation, där en tunn slang (shunt) opereras in i hjärnan
för att leda bort den överflödiga vätskan till en annan del av kroppen, där den tas upp
naturligt.
Diagnos ställs med hjälp av kognitiva och motoriska tester samt genom bildtagning av
hjärnan med magnetkamera (MR). Trots... (More) - Idiopatisk normaltryckshydrocephalus (iNPH) är en neurologisk sjukdom som påverkar
hjärnans vätskecirkulation och kan leda till symtom som gång- och balanssvårigheter,
kognitiv nedsättning och urininkontinens. Sjukdomen drabbar omkring 1.5 % av 70-åringar,
och prevalensen ökar med åldern. Det är en svårdiagnostiserad sjukdom där hjärnvätska
(CSF) ansamlas i hjärnans hålrum, vilket påverkar hjärnans funktion. Sjukdomen kan
behandlas med en så kallad shuntoperation, där en tunn slang (shunt) opereras in i hjärnan
för att leda bort den överflödiga vätskan till en annan del av kroppen, där den tas upp
naturligt.
Diagnos ställs med hjälp av kognitiva och motoriska tester samt genom bildtagning av
hjärnan med magnetkamera (MR). Trots detta är iNPH fortfarande en underdiagnostiserad
sjukdom och patienter får ofta en felaktig diagnos, då symtomen liknar andra neurologiska
sjukdomar, som Alzheimers sjukdom.
Shuntoperation är framgångsrik i ungefär 80 % av patienterna som behandlas. Samtidigt
finns det en ökad risk för komplikationer, både vid shuntoperationen och efter den. I
dagsläget finns det inga pålitliga metoder för att förutse vilka patienter som skulle ha nytta
av behandlingen. Därför finns det ett stort behov för att hitta diagnostiska och prognostiska
biomarkörer som kan vägleda kliniken i beslutet. Pålitliga biomarkörer kan fungera som
tydligare vägskyltar i att hjälpa vården att hitta rätt väg när det gäller vem som ska få
behandling.
Faskontrast-MR är en bildteknik som används för att kvantifiera CSF-flöde och hastighet i
hjärnakvedukten. Sedan 1980-talet har forskning påvisat att CSF är naturligt pulserande, och
att pulsationen drivs av fysiologiska processer. Denna egenskap har undersökts i syfte att
hitta potentiella biomarkörer för CSF-dynamisk med hjälp av en triggad faskontrast-MR, dvs.
synkroniserad med hjärtcykeln. Resultaten har dock varit motsägelsefulla, och en tydlig
samsyn saknas. Nyare forskning har visat att andningen spelar en betydande roll i CSF-
dynamiken. En ny teknik, kallad för realtids-faskontrast-MR, har utvecklats för att utforska
andningens effekter på flödet.
I det här arbetet har olika CSF-flödesparametrar med potential att predicera kliniskt utfall av
shuntoperationer i iNPH-patienter undersökts med hjälp av triggad- och realtids-faskontrast-
MR. Förutom patienter med iNPH har även unga friska frivilliga undersökts med samma MR-
metoder. Samtliga patienter har även genomgått kognitiva och motoriska tester före och
efter shuntoperation. Förändringar i testresultaten analyserades statistiskt och korrelerades
till de dynamiska CSF-parametrarna.
Resultaten visar att det finns en statistiskt signifikant korrelation mellan kliniskt utfall av
shunt-operationen och flödesmätningar utförda med realtids-faskontrast MR. Detta tyder på
att realtids-flödesmätningar är mer lämpliga än triggade flödesmätningar för att identifiera
nya biomarkörer för shuntrespons hos denna patientgrupp. (Less)
Please use this url to cite or link to this publication:
http://lup.lub.lu.se/student-papers/record/9207791
- author
- Calafiore, Federica Isabelle
- supervisor
- organization
- course
- MSFT02 20252
- year
- 2025
- type
- H2 - Master's Degree (Two Years)
- subject
- language
- English
- id
- 9207791
- date added to LUP
- 2025-07-02 10:32:48
- date last changed
- 2025-07-02 10:32:48
@misc{9207791,
abstract = {{Introduction: Idiopathic normal pressure hydrocephalus (iNPH) is a treatable but largely
underdiagnosed neurological condition affecting the elderly population. It is characterised
by gait and cognitive impairment, as well as urinary incontinence. For the most part, it is
diagnosed via imaging and clinical assessments. Abnormalities in cerebrospinal (CSF) flow in
the cerebral aqueduct have been linked to iNPH. However, no robust CSF dynamics
biomarker exists to predict treatment responsiveness. Recent findings using real-time (RT)
CSF-flow measurements, particularly at ultra-high field strengths, have shown promising
potential to identify strong predictors for treatment responsiveness in patients with iNPH.
Method: Twenty-one patients (mean age 75 years) with suspected iNPH underwent RT and
triggered through-plane phase-contrast (2D-PC) 7T MRI before ventriculoperitoneal (VP)
shunt treatment. The CSF-flow measurements were extracted using the software Segment
v4.1 R14708 (Medviso, Lund, Sweden). The computed CSF flow and volume parameters
were compared with surgical outcomes as measured by changes in clinical symptoms. A
significance level of 0.05 or lower was considered in the statistical analysis.
Results: The relationship between RT net flow and patient responsiveness to VP-shunting
was statistically significant (P<.05). RT net flow in the cranial direction (retrograde flow) was
present in patients who responded favourably to the surgery. Nevertheless, there were no
correlations between CSF volume and patient responsiveness to shunting. Similarly, no
correlations were found while analysing triggered net flow and stroke volume with patient's
response to treatment. A comparison of the iNPH RT net flow data with that of healthy
volunteers (mean age 26 years) gave a statistically significant difference (P<.05).
Discussion: Real-time 2D-PC MRI is an emerging technique that is still undergoing validation
for quantification of free-breathing effects on CSF-flow in the cerebral aqueduct.
The clinical usefulness of the technique remains a subject of argument as consensus on data
acquisition and analysis is lacking. In recent years, investigation of potential CSF dynamics
biomarkers in patients with iNPH using RT 2D-PC MRI has become more pertinent. The RT
net flow data obtained from healthy volunteers is consistent with previous studies. In this
study, a statistically significant difference was observed when comparing the obtained RT net
flow of iNPH patients to that of young volunteers. However, it was not possible to determine
whether this difference was in fact due to iNPH, as the difference in age between the groups
is a confounding factor. A main observation is retrograde RT net flow in patients that
responded favourably to shunting. This aligns with previous findings with triggered 2D-PC-
MRI, which reported retrograde net flow in patients with iNPH before surgery.
Conclusion: The observed correlation between post-shunt clinical improvement and RT net
flow at 7T MRI suggest that RT net flow could become a valuable predictor of VP-shunt
responsiveness in patients with iNPH.}},
author = {{Calafiore, Federica Isabelle}},
language = {{eng}},
note = {{Student Paper}},
title = {{Investigating CSF flow in patients with idiopathic normal pressure hydrocephalus using phase-contrast 7T MRI}},
year = {{2025}},
}