Non-invasive MRI measurements in idiopathic intracranial hypertension
Florian Volz (Freiburg i. Br.), Amir El Rahal (Freiburg i. Br.), Wolf Lagreze (Freiburg i. Br.), Marco Reisert (Freiburg i. Br.), Alexandra Camp (Freiburg i. Br.), Tim Bleul (Freiburg i. Br.), Mukesch Shah (Freiburg i. Br.), Hansjörg Mast (Freiburg i. Br.), Sebastian Küchlin (Freiburg i. Br.), Samer Elsheikh (Freiburg i. Br.), Niklas Lützen (Freiburg i. Br.), Jürgen Beck (Freiburg i. Br.), Horst Urbach (Freiburg i. Br.), Katharina Wolf (Freiburg i. Br.)
Patients with idiopathic intracranial hypertension (IIH) typically present with positional headaches and visual disturbances. Commonly, therapy is monitored by the course of the papilloedema. However, mounting evidence of IIH patients displaying CSF leaks, IIH without papilledema, rebound hypertension following CSF leak closure, chronic headaches unrelated to ICP evolution, underscores the need for noninvasive patient monitoring. Spinal cord motion mainly reflects the pulsatile changes of different pressure gradients derived from CSF, blood and breathing. It can be measured by non-invasive phase-contrast MRI. A recent study showcased raised spinal cord motion using MRI-based assessments in patients with CSF leaks (Wolf et al. 2023). We hypothesized decreased spinal cord motion in patients with raised ICP.
We performed a prospective, controlled study on 20 IIH patients, 100% female, with proven elevated CSF pressure ³25cmH2O and papilloedema without loss of visual acuity (age: 36 ± 9 years), and 30 female healthy controls (age: 38 ± 12 years). All subjects received ECG-triggered phase-contrast MRI measurements at the spinal level C2/C3. Analysis was fully automated (www.nora-imaging.org). The velocity range (mm/s) and the total displacement (mm) of the time-resolved velocity curve was used as the main parameter. Additionally, comparison was conducted using parameters adjusted to age based on previously reported data (Beltran et al. 2023) Pairwise comparisons were made by Mann-Whitney U test; correlation was determined using regression models.
Spinal cord velocity range and total displacement was significantly lower in IIH patients as compared to controls: 3.9 ± 1.5 mm/s vs. 5.4 ± 1.1 mm/s, p=0.002; 0.5 ± 0.1 mm vs. 0.7 ± 0.2 mm, p=0.002 (Figure), adjusted velocity range and adjusted total displacement: 6.3 ± 1.3 mm/s vs. 7.7 ± 1.1 mm/s, p=0.002; 1.0 ± 0.2 mm vs. 1.3 ± 0.2 mm, p<0.001. Opening pressure and BMI showed no significant impact on dynamic parameters in IIH patients.
We present evidence that in conditions associated with heightened ICP, the natural oscillations of the spinal cord are subdued. Consequently, this non-invasive method could aid in resolving clinical and diagnostic uncertainties and further studies are warranted.
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