PT  - JOURNAL ARTICLE
AU  - A. Wåhlin
AU  - K. Ambarki
AU  - R. Birgander
AU  - N. Alperin
AU  - J. Malm
AU  - A. Eklund
TI  - Assessment of Craniospinal Pressure-Volume Indices
AID  - 10.3174/ajnr.A2166
DP  - 2010 Oct 01
TA  - American Journal of Neuroradiology
PG  - 1645--1650
VI  - 31
IP  - 9
4099  - http://www.ajnr.org/content/31/9/1645.short
4100  - http://www.ajnr.org/content/31/9/1645.full
SO  - Am. J. Neuroradiol.2010 Oct 01; 31
AB  - BACKGROUND AND PURPOSE: The PVICC of the craniospinal compartment defines the shape of the pressure-volume curve and determines the damping of cyclic arterial pulsations. Despite no reports of direct measurements of the PVICC among healthy elderly, it is believed that a change away from adequate accommodation of cardiac-related pulsations may be a pathophysiologic mechanism seen in neurodegenerative disorders such as Alzheimer disease and idiopathic normal pressure hydrocephalus. In this study, blood and CSF flow measurements are combined with lumbar CSF infusion measurements to assess the craniospinal PVICC and its distribution of cranial and spinal compartments in healthy elderly. MATERIALS AND METHODS: Thirty-seven healthy elderly were included (60–82 years of age). The cyclic arterial volume change and the resulting shift of CSF to the spinal compartment were quantified by PC-MR imaging. In addition, each subject underwent a lumbar CSF infusion test in which the magnitude of cardiac-related pulsations in intracranial pressure was quantified. Finally, the PVI was calculated by using a mathematic model. RESULTS: After excluding 2 extreme values, the craniospinal PVICC was calculated to a mean of 9.8 ± 2.7 mL and the estimated average 95% confidence interval of individual measurements was ± 9%. The average intracranial and spinal contributions to the overall compliance were 65% and 35% respectively (n = 35). CONCLUSIONS: Combining lumbar CSF infusion and PC-MR imaging proved feasible and robust for assessment of the craniospinal PVICC. This study produced normative values and showed that the major compensatory contribution was located intracranially. ECGelectrocardiogramΔICPintracranial pulse pressure magnitudeΔPVICCrelative width of the 95% confidence interval of the calculated PVICCΔRPPCwidth of the 95% confidence interval of the calculated RPPCΔVARTarterial volume changeΔVbolusvolume infused in a lumbar CSF bolus infusion testΔVICvolume accommodated by the intracranial compartmentΔVSCvolume displaced to the spinal compartmentICPintracranial pressureICPendICP after lumbar CSF bolus infusion testICPstartICP before lumbar CSF bolus infusion testP1 and P0pressure constantsPC-MR imagingphase contrast MR imagingPVIpressure-volume indexPVIbolusPVI of the craniospinal cavity estimated from a lumbar CSF bolus infusion testPVICCPVI of the craniospinal cavityPVIICPVI of the intracranial compartmentPVISCPVI of the spinal compartmentRPPCrelative pulse-pressure coefficient