Spinal CSF flow in response to forced thoracic and abdominal respiration

2019 | journal article. A publication of Göttingen

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​Spinal CSF flow in response to forced thoracic and abdominal respiration​
Aktas, G.; Kollmeier, J. M.; Joseph, A. A.; Merboldt, K.-D.; Ludwig, H.-C.; Gärtner, J.   & Frahm, J.  et al.​ (2019) 
Fluids and Barriers of the CNS16(1) art. 10​.​ DOI: https://doi.org/10.1186/s12987-019-0130-0 

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12987_2019_Article_130.pdf1.65 MBAdobe PDFRegions‑of‑interest along spinal CSF space and aqueduct. Sagittal T2‑weighted image of the whole spine indicating selected cross‑sections for ROI placements.198.65 kBimage/pngAdherence to the breathing protocol. Upper part: CSF flow (ml s−1) (black line) closely follows movements of the abdominal wall (a.u.) (blue dotted line) (subject #18).379.29 kBimage/pngReal‑time MRI of forced thoracic respiration at 30 fps. Sagittal plane through right diaphragmatic dome. The thoracic cavity enlarges during inspiration because of elevation of frontal thorax wall and lowering of the diaphragm. The space between the diaphragm and the rear thoracic wall (costodiaphragmatic recess) increases.17.96 MBUnknownReal‑time MRI of forced abdominal respira‑tion at 30 fps. Sagittal plane through right diaphragmatic dome. Down‑ward movement of the diaphragm is more pronounced during forced inspiration.17.65 MBUnknownMean CSF volumes during 4 cycles (20 s) of forced in‑ and expiration (ml). Mean CSF flow volumes averaged across 4 cycles of forced inspiration and expiration, respectively, for all 18 subjects.27.92 kBMicrosoft Word XMLTime courses of ROI areas (mm2) for CSF analysis. Color‑coded mean areas averaged across subjects show no significant change over time during forced thoracic (upper part) and abdominal (lower part) breathing.112.14 kBimage/pngMinimal and maximal CSF flow velocities (cm s−1) during 20 s of forced in‑ and expiration. Minimum and maximum velocities of all 18 subjects at all levels obtained during 20 s of forced tho‑racic and abdominal breathing, respectively.14.43 kBMicrosoft Word XML


Published Version

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Aktas, Gökmen; Kollmeier, Jost M.; Joseph, Arun A.; Merboldt, Klaus-Dietmar; Ludwig, Hans-Christoph; Gärtner, Jutta ; Frahm, Jens ; Dreha-Kulaczewski, Steffi
Background Respiration-induced pressure changes represent a powerful driving force of CSF dynamics as previously demonstrated using flow-sensitive real-time magnetic resonance imaging (MRI). The purpose of the present study was to elucidate the sensitivity of CSF flow along the spinal canal to forced thoracic versus abdominal respiration. Methods Eighteen subjects without known illness were studied using real-time phase-contrast flow MRI at 3 T in the aqueduct and along the spinal canal at levels C3, Th1, Th8 and L3. Subjects performed a protocol of forced breathing comprising four cycles of 2.5 s inspiration and 2.5 s expiration. Results The quantitative results for spinal CSF flow rates and volumes confirm previous findings of an upward movement during forced inspiration and reversed downward flow during subsequent exhalation—for both breathing types. However, the effects were more pronounced for abdominal than for thoracic breathing, in particular at spinal levels Th8 and L3. In general, CSF net flow volumes were very similar for both breathing conditions pointing upwards in all locations. Conclusions Spinal CSF dynamics are sensitive to varying respiratory performances. The different CSF flow volumes in response to deep thoracic versus abdominal breathing reflect instantaneous adjustments of intrathoracic and intraabdominal pressure, respectively. Real-time MRI access to CSF flow in response to defined respiration patterns will be of clinical importance for patients with disturbed CSF circulation like hydrocephalus, pseudotumor cerebri and others.
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Fluids and Barriers of the CNS 



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