arterial spin labeled brain perfusion in patients with disorders of intracranial pressure: a...
TRANSCRIPT
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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
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Disclosures
The authors have no relevant disclosures.
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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
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Background: Spontaneous Intracranial Hypotension (SIH)
Orthostatic headaches with low ICP due to CSF leak
Associated imaging signs of “brain sag”
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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.
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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).
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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
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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)
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Methods: MR Imaging
3.0-T Siemens Trio MRI Unit
3D GRASE ASL sequence
Whole brain mean cerebral blood flow (CBF) calculated
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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%
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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.
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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.
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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.