0.4 ml/min, 500-600 ml/24 h), almost 20% by the brain interstitium (brain parenchyma), and the smallest amount by ependymal lining of the brain ventricles and lining of subarachnoid space. Eighty per cent of total CSF is produced by the choroid plexus (approx. Physiology of cerebrospinal fluid circulationĬSF is produced and absorbed simultaneously, occupying the ventricles, central canal of the spinal cord, and subarachnoid spaces.
The purpose of this paper was to review and evaluate recent applications and limitations of PC-MRI, regarding physical and technical fundamentals and the most up-to-date articles, with a special focus on normal pressure hydrocephalus (NPH), Chiari type I malformation (CMI), and a few other conditions. Constant development of magnetic resonance sequences enables new applications and improves knowledge of previously unknown CSF flow mechanisms. Currently, PC-MRI is the best-known method and the only technique for both qualitative and quantitative evaluation. phase-contrast magnetic resonance imaging (PC-MRI), arterial spin labelling (ASL), or 3D-SPACE. Recently, rapid advances in imaging techniques have provided non-invasive methods for flow assessment, e.g. The results of these examinations have become a keystone for the most well-known concepts about CSF physiology and pathophysiology. Traditionally, evaluation of cerebrospinal fluid (CSF) was based mainly on invasive procedures such as lumbar puncture, myelographies, radioisotope studies, or intracranial pressure monitoring, which yielded important information about CSF abnormalities in different disorders of the central nervous system (CNS). The aim of this review is to highlight the significance of CSF as a multifunctional entity, to outline both the physical and technical background of PC-MRI, and to state current applications of this technique, not only in the diagnosis of central nervous system disorders, but also in the further clinical monitoring and prognosis after treatment. Another indication for PC-MRI may be assessment of post-surgical CSF flow normalisation. Patients with CMI show abnormalities in CSF dynamics within the subarachnoid space, which are pronounced even further if syringomyelia coexists. In NPH precisely performed PC-MRI provides reliable clinical information useful for differential diagnosis and selection of patients benefiting from surgical operation. PC-MRI is widely used to evaluate CSF hydrodynamics in normal pressure hydrocephalus (NPH), Chiari type I malformations (CMI), syringomyelia, and after neurosurgical procedures. In recent years knowledge about CSF has expended due to numerous applications of phase-contrast magnetic resonance imaging (PC-MRI) in CSF flow evaluation, leading to the revision of former theories and new concepts about pathophysiology of CSF disorders, which are caused either by alterations in CSF production, absorption, or its hydrodynamics.Īlthough alternative non-invasive techniques have emerged in recent years, PC-MRI is still a fundamental sequence that provides both qualitative and quantitative CSF assessment. Cerebrospinal fluid (CSF) is a dynamic compartment of the brain, constantly circulating through the ventricles and subarachnoid space.
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