Spinal cord motion and CSF flow in the cervical spine of 70 healthy participants

Saúl Beltrán; Marco Reisert; Axel J Krafft; Sibylle Frase; Hansjoerg Mast; Horst Urbach; Niklas Luetzen; Marc Hohenhaus; Katharina Wolf

doi:10.1002/nbm.5013

Spinal cord motion and CSF flow in the cervical spine of 70 healthy participants

NMR Biomed. 2023 Aug 3:e5013. doi: 10.1002/nbm.5013. Online ahead of print.

Authors

Saúl Beltrán¹, Marco Reisert², Axel J Krafft², Sibylle Frase¹, Hansjoerg Mast³, Horst Urbach³, Niklas Luetzen³, Marc Hohenhaus⁴, Katharina Wolf¹

Affiliations

¹ Department of Neurology and Neurophysiology, Medical Center-Faculty of Medicine, University of Freiburg, Freiburg, Germany.
² Department of Radiology, Medical Physics, Medical Center-Faculty of Medicine, University of Freiburg, Freiburg, Germany.
³ Department of Neuroradiology, Medical Center-Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁴ Department of Neurosurgery, Medical Center-Faculty of Medicine, University of Freiburg, Freiburg, Germany.

PMID: 37533376
DOI: 10.1002/nbm.5013

Abstract

Pulsatile spinal cord and CSF velocities related to the cardiac cycle can be depicted by phase-contrast MRI. Among patients with spontaneous intracranial hypotension, we have recently described relevant differences compared with healthy controls in segment C2/C3. The method might be a promising tool to solve clinical and diagnostic ambiguities. Therefore, it is important to understand the physiological range and the effects of clinical and anatomical parameters in healthy volunteers. Within a prospective study, 3D T₂ -weighted MRI for spinal canal anatomy and cardiac-gated phase-contrast MRI adapted to CSF flow and spinal cord motion for time-resolved velocity data and derivatives were performed in 70 participants (age 20-79 years) in segments C2/C3 and C5/C6. Correlations were analyzed by multiple linear regression models; p < 0.01 was required to assume a significant impact of clinical or anatomical data quantified by the regression coefficient B. Data showed that in C2/C3, the CSF and spinal cord craniocaudal velocity ranges were 4.5 ± 0.9 and 0.55 ± 0.15 cm/s; the total displacements were 1.1 ± 0.3 and 0.07 ± 0.02 cm, respectively. The craniocaudal range of the CSF flow rate was 8.6 ± 2.4 mL/s; the CSF stroke volume was 2.1 ± 0.7 mL. In C5/C5, physiological narrowing of the spinal canal caused higher CSF velocity ranges and lower stroke volume (C5/C6 B = +1.64 cm/s, p < 0.001; B = -0.4 mL, p = 0.002, respectively). Aging correlated to lower spinal cord motion (e.g., B = -0.01 cm per 10 years of aging, p < 0.001). Increased diastolic blood pressure was associated with lower spinal cord motion and CSF flow parameters (e.g., C2/C3 CSF stroke volume B = -0.3 mL per 10 mmHg, p < 0.001). Males showed higher CSF flow and spinal cord motion (e.g., CSF stroke volume B = +0.5 mL, p < 0.001; total displacement spinal cord B = +0.016 cm, p = 0.002). We therefore propose to stratify data for age and sex and to adjust for diastolic blood pressure and segmental narrowing in future clinical studies.

Keywords: CSF; IIH; NPH; SIH; phase-contrast MRI; spinal cord motion.

Abstract

Grants and funding