Upload
nathan-tyler
View
220
Download
3
Tags:
Embed Size (px)
Citation preview
Arterial Spin Labeled Brain Perfusion in Patients with Disorders of Intracranial Pressure:
A Prospective Study of Changes Related to Measured Cerebrospinal Fluid PressureASNR 53rd Annual Meeting – Poster EP-39, Control # 1239
Amit M. Saindane, M.D.
Deqiang Qiu, Ph.D.
John F. Holbrook, M.D.
John Oshinski, Ph.D.
Department of Radiology and Imaging Sciences
Emory University School of Medicine
Disclosures
The authors have no relevant disclosures.
Background: Idiopathic Intracranial Hypertension (IIH)
Friedman DI et al. Neurology. 2002;59:1492-1495
Syndrome with elevated intracranial pressure (ICP) without
identifiable cause
Associated orbital and skull base MRI findings
Background: Spontaneous Intracranial Hypotension (SIH)
Orthostatic headaches with low ICP due to CSF leak
Associated imaging signs of “brain sag”
Background:
ICP estimated through lumbar puncture
(LP) and CSF manometry to measure an
opening pressure (OP).
If OP elevated, therapeutic CSF removal
performed to decrease ICP, with a closing
pressure (CP) checked.
If clinical diagnosis of SIH (generally will
have low OP), therapeutic epidural blood
patch may be performed to increase ICP.
Purpose:
To assess changes in arterial spin labeled (ASL) brain
perfusion following lumbar puncture with CSF removal in
patients with know or suspected disorders of ICP (IIH and
SIH).
Methods: Patients
IRB Approved prospective study
5 women with known/suspected ICP disorders
2 with known diagnosis of IIH under treatment
2 with suspected IIH
1 with suspected SIH
Methods: Patient Protocol
MRI Part 1(with ASL Perfusion)
<15 min
LP with OP Measurement
<15 min
n=4 TherapeuticCSF Removal
and CP Measurement
MRI Part 2(with ASL Perfusion)
n=1 2 hours
TherapeuticEpidural
Blood Patch
MRI Part 2(with ASL Perfusion)
Methods: MR Imaging
3.0-T Siemens Trio MRI Unit
3D GRASE ASL sequence
Whole brain mean cerebral blood flow (CBF) calculated
Results: Known/Suspected IIH
Patients 1 and 2 with known medically treated IIH had normal OP
Patients 3 and 4 with suspected IIH had elevated OP
OP (cm water)
CSF Removed (ml)
CP (cm water)
Pre-LP CBF (ml/100g/min)
Post-LP CBF (ml/100g/min)
% Change from Baseline
Patient 1 13 11 12 35.6 33.6 -5.6%
Patient 2 16 7 11 46.3 43.6 -5.8%
Patient 3 35 14 20 29.1 31.1 +6.9%
Patient 4 26 11 12 47.4 47.7 +0.6%
Results: SIH Patient
Patient 5 met diagnostic criteria for SIH
OP=14.5 cm water. No CSF withdrawn. CP not measured.
CBF increased from 34.2 ml/100g/min to 43.9 ml/100g/min (28%)
following blood patch with resolution of positional headaches.
Limitations
Small number of patients.
Closing pressure not available for SIH patient.
Medical treatment of IIH patients may impact effect of CSF
removal on CBF.
Optimal timing for post-LP MRI is unknown. It may take greater
time for brain CBF to adapt to removal of CSF.
Conclusions
In IIH patients immediately following LP and CSF removal, there
is not a substantial change in brain CBF. This may reflect chronic
adaptation to high ICP or insufficient time for the CBF to re-
equilibrate after LP and CSF removal
In one SIH patient 2 hours following therapeutic epidural blood
patching, we observed an large (28%) increase in CBF.