Quantifying brain-wide cerebrospinal fluid flow dynamics using slow-flow-sensitized phase-contrast MRI

Cerebrospinal fluid (CSF) flow is a key component of the brain's waste clearance system. However, our understanding of CSF flow in the human brain, particularly within the brain-wide subarachnoid space (SAS), is limited due to a lack of non-invasive tools for measuring slow flow. Here, we propose a CSF flowmetry technique using phase-contrast MRI combined with a slow-flow-sensitized acquisition. It achieves high sensitivity in measuring slow CSF flow (e.g., 100 μm/s), and enables quantitative measurement of the velocity and direction with whole-brain coverage, spanning from ventricles to SAS. Our proof-of-concept results demonstrate repeatable flow measurements and show that cardiac pulsation induces coherent CSF flow changes within the SAS. Our data also suggest that cardiac pulsation has a stronger driving effect on brain-wide CSF flow compared to respiration. This technique provides a valuable tool for investigating CSF dynamics and pathways to advance a holistic understanding of brain-wide CSF flow.