Normal flow patterns of intracranial and spinal cerebrospinal fluid defined with phase-contrast cine MR imaging

A phase-contrast cine magnetic resonance (MR) imaging technique was used to study normal dynamics of cerebrospinal fluid (CSF) in 10 healthy volunteers and four patients with normal MR images. This pulse sequence yielded 16 quantitative flow-encoded images per cardiac cycle (peripheral gating). Flow encoding depicted craniocaudal flow as high signal intensity and caudo-cranial flow as low signal intensity. Sagittal and axial images of the head, cervical spine, and lumbar spine were obtained, and strategic sites were analyzed for quantitative CSF flow. The onset of CSF systole in the subarachnoid space was synchronous with the onset of systole in the carotid artery. CSF systole and diastole at the foramen of Monro and aqueduct were essentially simultaneous. The systolic and diastolic components were different in the subarachnoid space, where systole occupied approximately 40% and diastole 60% of the cardiac cycle, compared with the ventricular system, where they were equal. This difference results in systole in the intracranial and spinal subarachnoid spaces preceding that in the ventricular system; the same is true for diastole. The fourth ventricle and cisterna magna serve as mixing chambers. The high-velocity flow in the cervical spine and essentially no flow in the distal lumbar sac indicate that a portion of the capacitance necessary in this essentially closed system resides in the distal spinal canal.