Background Several small cross-sectional studies have investigated cerebrospinal fluid (CSF) flow dynamics in multiple sclerosis (MS) patients and have reported mixed results. Currently, there are no longitudinal studies that investigate CSF dynamics in MS patients. Objective To determine longitudinal changes in CSF dynamics measured at the level of aqueduct of Sylvius (AoS) in MS patients and matched healthy controls (HCs). Materials and methods Forty (40) MS patients and 20 HCs underwent 3T MRI cine phase contrast imaging with velocity-encoded pulse-gated sequence at baseline and 5-year follow-up. For atrophy determination, MS patients underwent additional high-resolution 3D T1-weighted imaging. Measures of AoS cross-sectional area (CSA), average systolic and diastolic velocity peaks, maximal systolic and diastolic velocity peaks and average CSF flow rates were determined. Brain atrophy and ventricular CSF (vCSF) expansion rates were determined. Cross-sectional and longitudinal changes were derived by analysis of covariance (ANCOVA) and paired repeated tests. Confirmatory general linear models were also performed. False discovery rate (FDR)-corrected p-values lower than 0.05 were considered significant. Results The MS population demonstrated significant increase in maximal diastolic peak (from 7.23 to 7.86 cm/s, non-adjusted p = 0.037), diastolic peak flow rate (7.76 ml/min to 9.33 ml/min, non-adjusted p = 0.023) and AoS CSA (from 3.12 to 3.69 mm 2 , adjusted p = 0.001). The only differentiator between MS patients and HCs was the greater AoS CSA (3.58 mm 2 vs. 2.57 mm 2 , age- and sex-adjusted ANCOVA, p = 0.045). The AoS CSA change was associated with vCSF expansion rate (age- and sex-adjusted Spearman’s correlation r = 0.496, p = 0.019) and not with baseline nor change in maximal velocity. The expansion rate of the vCSF space explained an additional 23.8% of variance in change of AoS CSA variance when compared to age and sex alone (R 2 = 0.273, t = 2.557, standardized β = 0.51, and p = 0.019). Conclusion MS patients present with significant longitudinal AoS enlargement, potentially due to regional atrophy changes and ex-vacuo expansion of the aqueduct.

中文翻译：

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脑导水管血流测量纵向分析：脑萎缩驱动的多发性硬化血流变化

背景 几项小型横断面研究调查了多发性硬化症 (MS) 患者的脑脊液 (CSF) 流动动力学，并报告了不同的结果。目前，没有纵向研究调查 MS 患者的脑脊液动力学。目的 确定在 MS 患者和匹配的健康对照 (HC) 的 Sylvius 导水管 (AoS) 水平测量的 CSF 动力学的纵向变化。材料和方法四十 (40) 名 MS 患者和 20 名 HC 在基线和 5 年随访时接受了具有速度编码脉冲门控序列的 3T MRI 电影相衬成像。为了确定萎缩，MS 患者接受了额外的高分辨率 3D T1 加权成像。AoS 横截面积 (CSA)、平均收缩和舒张速度峰值的测量值，测定最大收缩和舒张速度峰值和平均脑脊液流速。确定了脑萎缩和心室 CSF (vCSF) 扩张率。通过协方差分析 (ANCOVA) 和配对重复检验得出横截面和纵向变化。还进行了验证性一般线性模型。低于 0.05 的错误发现率 (FDR) 校正的 p 值被认为是显着的。结果 MS 群体表现出最大舒张峰（从 7.23 至 7.86 cm/s，未调整 p = 0.037）、舒张峰流速（7.76 ml/min 至 9.33 ml/min，未调整 p = 0.023）显着增加和 AoS CSA（从 3.12 到 3.69 mm 2，调整后的 p = 0.001）。MS 患者和 HC 之间的唯一区别是更大的 AoS CSA（3.58 mm 2 与 2.57 mm 2 ，年龄和性别调整的 ANCOVA，p = 0.045）。AoS CSA 变化与 vCSF 扩张率（年龄和性别调整的 Spearman 相关性 r = 0.496，p = 0.019）相关，与基线和最大速度变化无关。与单独的年龄和性别相比，vCSF 空间的扩展率解释了 AoS CSA 方差变化的额外 23.8%（R 2 = 0.273，t = 2.557，标准化 β = 0.51，p = 0.019）。结论 MS 患者出现显着的纵向 AoS 扩大，可能是由于区域萎缩变化和导水管的前真空扩张。与单独的年龄和性别相比，AoS CSA 方差变化的方差为 8%（R 2 = 0.273，t = 2.557，标准化 β = 0.51，p = 0.019）。结论 MS 患者出现显着的纵向 AoS 扩大，可能是由于区域萎缩变化和导水管的前真空扩张。与单独的年龄和性别相比，AoS CSA 方差变化的方差为 8%（R 2 = 0.273，t = 2.557，标准化 β = 0.51，p = 0.019）。结论 MS 患者呈现显着的纵向 AoS 扩大，可能是由于区域萎缩变化和导水管的前真空扩张。