Advanced magnetic resonance imaging of chronic whiplash patients: a clinical practice-based feasibility study

Abstract Background Whiplash injury is common following road traffic crashes affecting millions worldwide, with up to 50% of the injured developing chronic symptoms and 15% having a reduced working capability due to ongoing disability. Many of these patients receive treatment in primary care settings based upon clinical and diagnostic imaging findings. Despite the identification of different types of injuries in the whiplash patients, clinically significant relationships between injuries and chronic symptoms remains to be fully established. This study investigated the feasibility of magnetic resonance imaging (MRI) techniques including quantitative diffusion weighted imaging and measurements of cerebrospinal fluid (CSF) flow as novel non-invasive biomarkers in a population of healthy volunteers and chronic whiplash patients recruited from a chiropractic clinic for the purpose of improving our understanding of whiplash injury. Methods Twenty chronic whiplash patients and 18 healthy age- and gender matched control subjects were included [mean age ± SD (sex ratio; females/males), case group: 37.8 years ± 9.1 (1.22), control group: 35.1 years ± 9.2 (1.25)]. Data was collected from May 2019 to July 2020. Data from questionnaires pertaining to the car crash, acute and current symptoms were retrieved and findings from clinical examination and MRI including morphologic, diffusion weighted and phase-contrast images were recorded. The apparent diffusion coefficient and fractional anisotropy were calculated, and measurement and analysis of CSF flow was conducted. Statistical analyses included Fisher’s exact test, Mann Whitney U test and analysis of variance between groups. Results The studied population was described in detail using readily available clinical tools. No statistically significant differences were found between the groups on MRI. Conclusions This study did not show that MRI‐based measures of morphology, spinal cord and nerve root diffusion or cerebrospinal fluid flow are sensitive biomarkers to distinguish between chronic whiplash patients and healthy controls. The detailed description of the chronic whiplash patients using readily available clinical tools may be of great relevance to the clinician. In the context of feasibility, clinical practice-based advanced imaging studies with a technical setup similar to the presented can be expected to have a high likelihood of successful completion.

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Assessment of Cerebrospinal Fluid Hydrodynamics Using Magnetic Resonance Imaging in Postcraniospinal Surgery Patients

Indian Journal of Radiology and Imaging ◽

10.1055/s-0041-1734362 ◽

2021 ◽

Author(s):

Pankaj Arora ◽

Kanica Rawat ◽

Rajiv Azad ◽

Kehkashan Chouhan

Keyword(s):

Magnetic Resonance Imaging ◽

Cerebrospinal Fluid ◽

Magnetic Resonance ◽

Clinical Outcome ◽

Phase Contrast ◽

Flow Dynamics ◽

Resonance Imaging ◽

Csf Flow ◽

Group I ◽

Group Ii

Abstract Objective Aim of this study is to evaluate the effect of craniospinal interventions on cerebrospinal fluid (CSF) flow hydrodynamics and study the correlation of postoperative changes in flow alteration with clinical outcome. Materials and Methods Fifty patients who underwent various craniospinal procedures were studied using conventional and phase-contrast magnetic resonance imaging (PCMRI) protocol. CSF flow quantification was performed at cerebral aqueduct, foramen magnum, C2–3, and D12–L1 vertebral levels with site showing maximal alteration of CSF flow dynamics considered as the region of interest. Velocity encoding was kept at 20 cm/s. Patients with pathology atcraniovertebral junction were considered separately (group I) from others (group II) due to different flow dynamics. Follow-up scans were performed after an interval of 1 month for temporal evaluation of changes in CSF flow dynamics. Results Patients in both groups showed a significant change in peak CSF velocity postoperatively (mean change of 1.34 cm/s in group I and 0.28 cm/s in group II) with bidirectional improvement in flow on cine-phase-contrast qualitative images. Regional pain (82%) and headache (46%) were seen in most of the patients preoperatively. Postoperatively clinical symptoms improved in 59.5%, static in 26.2%, and worsened in 14.3%. In both the groups, an improvement in clinical symptomatology had significant correlation with mean changes in peak CSF velocity postoperatively (p = 0.04 in both groups). Conclusion PCMRI can effectively evaluate changes in CSF flow noninvasively both pre- and postoperatively. This may have potential role in determining clinical outcome and prognosis of patients undergoing procedures in craniospinal axis.

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351 Diffusion and Cerebrospinal Fluid Flow Magnetic Resonance Imaging in the Evaluation of Cervical Stenosis and Myelopathy: A Prospective Study

Neurosurgery ◽

10.1093/neuros/nyx417.351 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 280-280

Author(s):

Darryl Lau ◽

Cynthia Chin ◽

Philip R Weinstein ◽

John Engstrom ◽

Christopher P Ames

Keyword(s):

Magnetic Resonance Imaging ◽

Cerebrospinal Fluid ◽

Magnetic Resonance ◽

Neurological Status ◽

Cervical Cord ◽

Cervical Stenosis ◽

Resonance Imaging ◽

Csf Flow ◽

Mri Findings ◽

Cord Injury

Abstract INTRODUCTION Diffusion-weighted imaging (DWI) may be more sensitive in detecting early cervical cord injury than abnormal T2-signal. Cerebrospinal fluid (CSF) flow studies may demonstrate degree of stenosis based on cervical cord motion. This study evaluates tests correlation of DWI and cord motion to myelopathy severity and degree of stenosis. METHODS Prospectively, adult patients with concern for cervical stenosis underwent cervical magnetic resonance imaging (MRI) (T2, Cine CSF Flow, and DWI). Images were reviewed neuroradiologists blinded to the patient's clinical condition. Correlation of MRI findings to neurological status and outcomes following surgery were evaluated. RESULTS >Twenty patients were enrolled. Mean age was 66 years, and 40% were male. Eleven presented with myelopathy and 9 had pain, weakness, and/or sensory changes. All patients had radiographic cervical stenosis (14 severe, 5 moderate, and 1 mild). In the presence of cervical stenosis, paradoxical cord motion (moving opposite to the rest of cord) was observed in 79% of severe and 50% of mild/moderate stenosis. The sensitivities of MRI findings to detect clinical myelopathy were 63% for T2 signal, 73% for abnormal DWI, 73% for abnormal cord motion, 91% for abnormal DWI/cord motion, and 100% for abnormal T2/DWI/cord motion. Fourteen patients underwent surgical decompression (4 anterior and 10 posterior). Ten of those 14 patients had improved Nurick myelopathy score. Of the 4 patients who did not improve, their MRI profile revealed that all preoperative MRI had abnormal cord motion (2 with normal T2-signal and DWI) (P = 0.126). Among the 6 patients (1 moderate and 5 severe stenosis) who did not undergo surgery, 1 worsened (abnormal T2-signal/DWI/cord motion) while 5 others had no change in neurological status. CONCLUSION DWI and CSF flow studies are sensitive modalities in detecting myelopathy and evaluating cervical stenosis severity. Abnormal DWI and cord motion are present in myelopathic patients without T2-signal abnormality and maybe useful prognostic indicators.

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CARDIAC-GATED PHASE-CONTRAST MAGNETIC RESONANCE IMAGING OF CEREBROSPINAL FLUID FLOW IN THE DIAGNOSIS OF IDIOPATHIC SYRINGOMYELIA

Neurosurgery ◽

10.1227/01.neu.0000334411.93870.45 ◽

2008 ◽

Vol 63 (6) ◽

pp. 1139-1144 ◽

Cited By ~ 43

Author(s):

Uwe Max Mauer ◽

Gregor Freude ◽

Burkhardt Danz ◽

Ulrich Kunz

Keyword(s):

Magnetic Resonance Imaging ◽

Cerebrospinal Fluid ◽

Magnetic Resonance ◽

Phase Contrast ◽

Spinal Injury ◽

Resonance Imaging ◽

Csf Flow ◽

Cerebrospinal Fluid Flow ◽

Flow Blockage ◽

Idiopathic Syringomyelia

Abstract OBJECTIVE Syringomyelia without an obvious cause, such as a Chiari malformation, a tumor, or a spinal injury, is rare and may be associated with an arachnoid web or cyst. In the literature, conventional myelography is the diagnostic method of choice. In this retrospective study, we evaluated the diagnostic value of magnetic resonance imaging (MRI) cerebrospinal fluid (CSF) flow studies as compared with conventional myelography in patients with syringomyelia. METHODS From early 2003 to late 2006, 320 patients with syringomyelia underwent cardiac-gated phase-contrast MRI of CSF flow in the brain and spine. We assessed the presence of CSF flow blockage as well as syrinx site, shape, and size. Additional myelography was performed in 8 patients. CSF flow blockage and progressive neurological symptoms or progression of syringomyelia were indications for surgery. RESULTS Syringomyelia without an obvious cause was found in 125 patients. CSF flow blockage was detected in 33 patients. Seven of these patients underwent cyst wall resection and decompression of the subarachnoid space via a unilateral approach without laminectomy. Myelography revealed CSF flow blockage in only 2 of 8 cases. In the other 6 patients, MRI detected a blockage and surgery revealed arachnoid cysts or webs. Postoperative CSF flow studies revealed free CSF flow in all 10 surgically treated patients. In 6 of these patients, syrinx size was reduced after surgery. CONCLUSION Myelography should not be the method of choice for the diagnosis of idiopathic syringomyelia. MRI CSF flow studies were found to be more reliable.

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Dynamic magnetic resonance imaging of the cerebrospinal fluid flow within the cerebral aqueduct by different FISIP 2D sequences

Vojnosanitetski pregled ◽

10.2298/vsp1005357l ◽

2010 ◽

Vol 67 (5) ◽

pp. 357-363

Author(s):

Milos Lucic ◽

Katarina Koprivsek ◽

Viktor Till ◽

Zoran Vesic

Keyword(s):

Magnetic Resonance Imaging ◽

Cerebrospinal Fluid ◽

Fluid Flow ◽

Magnetic Resonance ◽

Cine Mri ◽

Cerebral Aqueduct ◽

Resonance Imaging ◽

Csf Flow ◽

Cerebrospinal Fluid Flow ◽

Technical Parameters

Background/Aim. A vast majority of current radiogical techniques, such as computerized tomography (CT) and magnetic resonance imaging (MRI) have great potential of visualization and delineation of cerebrospinal fluid spaces morphology within cerebral aqueduct. The aim of this study was to determine the possibilities of two differently acquired FISP (Fast Imaging with Steady State Precession) 2D MR sequences in the estimation of the pulsatile cerebrospinal fluid (CSF) flow intensity through the normal cerebral aqueduct. Methods. Sixty eight volunteers underwent brain MRI on 1.5T MR imager with additionally performed ECG retrospectively gated FISP 2D sequences (first one, as the part of the standard software package, with following technical parameters: TR 40, TE 12, FA 17, Matrix: 192 ? 256, Acq 1, and the second one, experimentally developed by our investigation team: TR 30, TE 12, FA 70, Matrix: 192 ? 256, Acq 1) respectively at two fixed slice positions - midsagittal and perpendicular to cerebral aqueduct, displayed and evaluated by multiplegated images in a closed-loop cinematographic (CINE) format. Results. Normal brain morphology with preserved patency of the cerebral aqueduct in all of 68 healthy volunteers was demonstrated on MRI examination. Cerebrospinal fluid flow within the cerebral aqueduct was distinguishable on both CINE MRI studies in midsagittal plane, but the estimation of intraaqueductal CSF flow in perpendicular plane was possible on CINE MRI studies acquired with experimentally improved FISP 2D (TR 30, FA 70) sequence only. Conclusion. Due to the changes of technical parameters CINE MRI study acquired with FISP 2D (TR 30, FA 70) in perpendicular plane demonstrated significantly higher capability in the estimation of the CSF pulsation intensity within the cerebral aqueduct. .

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Diffusion-weighted magnetic resonance imaging in the diagnosis of pancreatic insulinoma: a clinical case

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2018-46-3-289-295 ◽

2018 ◽

Vol 46 (3) ◽

pp. 289-295

Author(s):

M. Yu. Yukina ◽

N. F. Nuralieva ◽

E. A. Troshina ◽

A. V. Vorontsov ◽

V. P. Vladimirova ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Clinical Practice ◽

Magnetic Resonance ◽

Contrast Agents ◽

Clinical Case ◽

Malignant Neoplasms ◽

Resonance Imaging ◽

Topical Diagnosis ◽

Diffusion Weighted ◽

Weighted Magnetic Resonance Imaging

The topical diagnosis of insulinoma continues to be an actual problem of modern medicine due to low detection rate of the tumor (about 75%) and inconsistent data on its localization when using various methods of visualization (more than in 50% of cases), as well as the lack of a single diagnostic algorithm. In the clinical practice, many different imaging assessments are conducted, including those with the administration of contrast agents and associated with radiation load, as well as invasive studies, associated with risk of various complications, high costs and duration of the examination. Thus, the search for highly sensitive and safe methods of topical diagnosis of the insulin-producing pancreatic tumor seems relevant. In the presented clinical case, the diagnosis of insulinoma is verified by diffusion-weighted magnetic resonance imaging (DW-MRI). It is an accurate and non-invasive method that does not involve exposure to ionizing radiation and does not require any administration of contrast agents. This technology, based on microstructural pathological changes, allows to identify small tumors and to make a differential diagnosis of benign and malignant neoplasms. However, at present the experience of DW-MRI use for the diagnosis of an insulin-producing neuroendocrine tumor is limited. Evaluation of its effectiveness in a large patient cohort would be necessary to assess the prospects for its introduction into clinical practice.

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Magnetic Resonance Imaging Cerebrospinal Fluid Hydrodynamics in Patients with Meningitis

Journal of Clinical Imaging Science ◽

10.25259/jcis_24_2020 ◽

2020 ◽

Vol 10 ◽

pp. 29

Author(s):

Devkant Lakhera ◽

Rajiv Kumar Azad ◽

Sheenam Azad ◽

Ragini Singh ◽

Rohitash Sharma

Keyword(s):

Magnetic Resonance Imaging ◽

Cerebrospinal Fluid ◽

Magnetic Resonance ◽

Stroke Volume ◽

Peak Velocity ◽

Viral Meningitis ◽

Flow Dynamics ◽

Resonance Imaging ◽

Csf Flow ◽

Group Ii

Objective: The objective of the study was to evaluate the cerebrospinal fluid (CSF) flow alterations in meningitis using phase-contrast magnetic resonance imaging (PCMRI). Materials and Methods: Fifty patients with clinically confirmed or strongly suspected infectious meningitis and 20 controls were evaluated with MRI. Quantitative CSF analysis was performed at the level of cerebral aqueduct using cardiac-gated PCMRI. Velocity encoding (Venc) was kept at 20 cm/s. Patients were subdivided into Group I (patients with hydrocephalus [n = 21]) and Group II (patients without hydrocephalus [n = 29]). Results: The mean peak velocity and stroke volume in controls were 2.49 ± 0.86 cm/s and 13.23 ± 6.84 µl and in patients were 2.85 ± 2.90 cm/s and 16.30 ± 20.02 µl, respectively. A wide variation of flow parameters was noted in meningitis irrespective of the degree of ventricular dilatation. A significant difference in peak velocity and stroke volume was noted in Group II as compared to controls. Viral meningitis showed milder alteration of CSF flow dynamics as compared to bacterial and tuberculous etiologies. At a cutoff value of 3.57 cm/s in peak CSF velocity, the specificity was 100% and sensitivity was 22.7% to differentiate between viral and non-viral meningitis. Conclusion: Alteration of CSF flow dynamics on PCMRI can improve segregation of patients into viral and non- viral etiologies, especially in those in whom contrast is contraindicated or not recommended. This may aid in institution of appropriate clinical treatment.

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