MRI Evidence of Impaired CSF Homeostasis in Obesity-Associated Idiopathic Intracranial Hypertension
MRI Evidence of Impaired CSF Homeostasis in Obesity-Associated Idiopathic Intracranial Hypertension
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DOI：
10.3174/ajnr.a3171
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发表时间：
2013-01-01
影响因子：
3.5
通讯作者：
Lam, B. L.
中科院分区：
文献类型：
--
作者：
Alperin, N.;Ranganathan, S.;Lam, B. L.
背景和目的：CSF稳态受损和静脉血流动力学改变被认为是IIH血压升高的机制。然而，心室扩张的缺乏使人们不再关注IIH的CSF稳态。本研究的目的是测量颅内CSF容量和脑静脉引流与磁共振成像，以确定是否增加CSF容量受损的CSF稳态和静脉血液动力学发生在肥胖相关IIH.MATERIALS和方法：两个同质队列的11个新诊断的预处理超重妇女IIH和11超重的健康妇女进行了前瞻性研究。3D体积MR成像的大脑被用来量化CSF和脑组织的体积，和动态相位对比被用来测量相对脑引流通过颈内静脉vein.RESULTS：调查结果证实正常脑室容量IIH。然而，IIH的脑室外CSF体积显著增加（290 +/- 52 vs 220 +/- 24 mL，P = .001）。在颅内体积正常化后，这一点更加显著（P = 0.0007）。IIH患者GM间质液量也增加（602 +/- 57 vs 557 +/- 31 mL，P = .037）。总动脉流入正常，但IIH患者通过IJV的相对静脉引流显著减少（65 +/- 7%对81 +/-10%，P = 0.001）。结论：脑室外蛛网膜下腔累积的颅内CSF体积增加为肥胖相关IIH患者CSF稳态受损提供了直接证据。较大的GM间质液量的发现与脑静脉引流的总体阻力增加一致，这从通过IJV的相对脑引流减少中可以看出。目前的研究证实，受损的CSF稳态和静脉血流动力学共存于肥胖相关的IIH。
BACKGROUND AND PURPOSE: Impaired CSF homeostasis and altered venous hemodynamics are proposed mechanisms for elevated pressure in IIH. However, the lack of ventricular expansion steered the focus away from CSF homeostasis in IIH. This study aims to measure intracranial CSF volumes and cerebral venous drainage with MR imaging to determine whether increased CSF volume from impaired CSF homeostasis and venous hemodynamics occur in obesity-related IIH.MATERIALS AND METHODS: Two homogeneous cohorts of 11 newly diagnosed pretreatment overweight women with IIH and 11 overweight healthy women were prospectively studied. 3D volumetric MR imaging of the brain was used to quantify CSF and brain tissue volumes, and dynamic phase contrast was used to measure relative cerebral drainage through the internal jugular veins.RESULTS: Findings confirm normal ventricular volume in IIH. However, extraventricular CSF volume is significantly increased in IIH (290 +/- 52 versus 220 +/- 24 mL, P = .001). This is even more significant after normalization with intracranial volume (P = .0007). GM interstitial fluid volume is also increased in IIH (602 +/- 57 versus 557 +/- 31 mL, P = .037). Total arterial inflow is normal, but relative venous drainage through the IJV is significantly reduced in IIH (65 +/- 7% versus 81 +/- 10%, P = .001).CONCLUSIONS: Increased intracranial CSF volume that accumulates in the extraventricular subarachnoid space provides direct evidence for impaired CSF homeostasis in obesity-associated IIH. The finding of larger GM interstitial fluid volume is consistent with increased overall resistance to cerebral venous drainage, as evident from reduced relative cerebral drainage through the IJV. The present study confirms that both impaired CSF homeostasis and venous hemodynamics coexist in obesity-associated IIH.