Respiration and the watershed of spinal CSF flow in humans

The dynamics of human CSF in brain and upper spinal canal are regulated by inspiration and connected to the venous system through associated pressure changes. Upward CSF flow into the head during inspiration counterbalances venous flow out of the brain. Here, we investigated CSF motion along the spinal canal by real-time phase-contrast flow MRI at high spatial and temporal resolution. Results reveal a watershed of spinal CSF dynamics which divides flow behavior at about the level of the heart. While forced inspiration prompts upward surge of CSF flow volumes in the entire spinal canal, ensuing expiration leads to pronounced downward CSF flow, but only in the lower canal. The resulting pattern of net flow volumes during forced respiration yields upward CSF motion in the upper and downward flow in the lower spinal canal. These observations most likely reflect closely coupled CSF and venous systems as both large caval veins and their anastomosing vertebral plexus react to respiration-induced pressure changes.

[1]  Jens Frahm,et al.  Advances in real‐time phase‐contrast flow MRI using asymmetric radial gradient echoes , 2016, Magnetic resonance in medicine.

[2]  J Bittoun,et al.  Origin of subarachnoid cerebrospinal fluid pulsations: a phase-contrast MR analysis. , 2000, Magnetic resonance imaging.

[3]  D. Greitz,et al.  A proposed model of cerebrospinal fluid circulation: observations with radionuclide cisternography. , 1996, AJNR. American journal of neuroradiology.

[4]  B Williams,et al.  Simultaneous cerebral and spinal fluid pressure recordings , 1981, Acta Neurochirurgica.

[5]  G. di Chiro,et al.  Spinal descent of cerebrospinal fluid in man , 1976, Neurology.

[6]  G. Chiro.  Movement of the Cerebrospinal Fluid in Human Beings , 1964, Nature.

[7]  G. di Chiro.  Observations on the circulation of the cerebrospinal fluid. , 1966, Acta radiologica: diagnosis.

[8]  J. Shah.  Influence of cerebrospinal fluid on epidural pressure , 1981, Anaesthesia.

[9]  N J Pelc,et al.  Normal flow patterns of intracranial and spinal cerebrospinal fluid defined with phase-contrast cine MR imaging. , 1991, Radiology.

[10]  G. Crelier,et al.  Magnetic resonance 4D flow characteristics of cerebrospinal fluid at the craniocervical junction and the cervical spinal canal , 2011, European Radiology.

[11]  Jens Frahm,et al.  Real‐time flow MRI of the aorta at a resolution of 40 msec , 2014, Journal of magnetic resonance imaging : JMRI.

[12]  U Klose,et al.  Detection of a relation between respiration and CSF pulsation with an echoplanar technique , 2000, Journal of magnetic resonance imaging : JMRI.

[13]  Jens Frahm,et al.  Real‐time MRI at a resolution of 20 ms , 2010, NMR in biomedicine.

[14]  M. Stringer,et al.  The vertebral venous plexuses: The internal veins are muscular and external veins have valves , 2012, Clinical anatomy.

[15]  J. Usubiaga,et al.  Effect of thoracic and abdominal pressure changes on the epidural space pressure. , 1967, British journal of anaesthesia.

[16]  Jens Frahm,et al.  Real‐time phase‐contrast MRI of cardiovascular blood flow using undersampled radial fast low‐angle shot and nonlinear inverse reconstruction , 2012, NMR in biomedicine.

[17]  U. Klose,et al.  II. Physiology of respiration-related pulsations , 1992 .

[18]  Jens Frahm,et al.  Identification of the Upward Movement of Human CSF In Vivo and its Relation to the Brain Venous System , 2017, The Journal of Neuroscience.

[19]  Jens Frahm,et al.  Inspiration Is the Major Regulator of Human CSF Flow , 2015, The Journal of Neuroscience.

[20]  Jens Frahm,et al.  Context-based segmentation and analysis of multi-cycle real-time cardiac MRI , 2014, 2014 IEEE 11th International Symposium on Biomedical Imaging (ISBI).

[21]  F. Ståhlberg,et al.  Pulsatile brain movement and associated hydrodynamics studied by magnetic resonance phase imaging , 2004, Neuroradiology.

[22]  C. Q. Henriques.  The veins of the vertebral column and their role in the spread of cancer. , 1962, Annals of the Royal College of Surgeons of England.

[23]  U Klose,et al.  The Influence of Pulse and Respiration on Spinal Cerebrospinal Fluid Pulsation , 2004, Investigative radiology.

[24]  W. W.,et al.  OBSERVATIONS ON THE EPIDURAL SPACE , 1947, Anaesthesia.

[25]  D. Greitz,et al.  On the Pulsatile Nature of Intracranial and Spinal CSF-Circulation Demonstrated by MR Imaging , 1993, Acta radiologica.