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Sass LR, Khani M, Romm J, Schmid Daners M, McCain K, Freeman T, Carter GT, Weeks DL, Petersen B, Aldred J, Wingett D, Martin BA. Non-invasive MRI quantification of cerebrospinal fluid dynamics in amyotrophic lateral sclerosis patients. Fluids Barriers CNS 2020; 17:4. [PMID: 31959193 PMCID: PMC6971921 DOI: 10.1186/s12987-019-0164-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023] Open
Abstract
Background Developing novel therapeutic agents to treat amyotrophic lateral sclerosis (ALS) has been difficult due to multifactorial pathophysiologic processes at work. Intrathecal drug administration shows promise due to close proximity of cerebrospinal fluid (CSF) to affected tissues. Development of effective intrathecal pharmaceuticals will rely on accurate models of how drugs are dispersed in the CSF. Therefore, a method to quantify these dynamics and a characterization of differences across disease states is needed. Methods Complete intrathecal 3D CSF geometry and CSF flow velocities at six axial locations in the spinal canal were collected by T2-weighted and phase-contrast MRI, respectively. Scans were completed for eight people with ALS and ten healthy controls. Manual segmentation of the spinal subarachnoid space was performed and coupled with an interpolated model of CSF flow within the spinal canal. Geometric and hydrodynamic parameters were then generated at 1 mm slice intervals along the entire spine. Temporal analysis of the waveform spectral content and feature points was also completed. Results Comparison of ALS and control groups revealed a reduction in CSF flow magnitude and increased flow propagation velocities in the ALS cohort. Other differences in spectral harmonic content and geometric comparisons may support an overall decrease in intrathecal compliance in the ALS group. Notably, there was a high degree of variability between cases, with one ALS patient displaying nearly zero CSF flow along the entire spinal canal. Conclusion While our sample size limits statistical confidence about the differences observed in this study, it was possible to measure and quantify inter-individual and cohort variability in a non-invasive manner. Our study also shows the potential for MRI based measurements of CSF geometry and flow to provide information about the hydrodynamic environment of the spinal subarachnoid space. These dynamics may be studied further to understand the behavior of CSF solute transport in healthy and diseased states.
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Affiliation(s)
- Lucas R Sass
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Mohammadreza Khani
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Jacob Romm
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA.,University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Kyle McCain
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Tavara Freeman
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Gregory T Carter
- St. Luke's Rehabilitation Institute, 711 South Cowley St., Spokane, WA, 99202, USA
| | - Douglas L Weeks
- St. Luke's Rehabilitation Institute, 711 South Cowley St., Spokane, WA, 99202, USA
| | - Brian Petersen
- Inland Imaging PS and LLC, 801 South Stevens St., Spokane, WA, 99204, USA
| | - Jason Aldred
- Selkirk Neurology, 610 South Sherman St. #201, Spokane, WA, 99202, USA
| | - Dena Wingett
- Inland Imaging LLC, 801 South Stevens St., Spokane, WA, 99204, USA
| | - Bryn A Martin
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA. .,Biological Engineering, University of Idaho, 875 Perimeter Dr. MS0904, Moscow, ID, 83844-0904, USA.
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