27th ISMRM Annual Meeting • 11-16 May 2019 • Montréal, QC, Canada

Weekend Educational Session
Neurofluids & Brain Lymphatics: From Bench to MRI

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Neurofluids & Brain Lymphatics: From Bench to MRI
Weekend Course

ORGANIZERS: Nivedita Agarwal, Kei Yamada

Sunday, 12 May 2019
Room 516C-E  08:00 - 11:50 Moderators:  Nivedita Agarwal, Kei Yamada

Skill Level: Basic to Advanced

Session Number: WE-20

This course aims to provide an overview of basic CNS fluid physiology and identify MRI tools to image fluids and brain vessels. International experts will outline the current understanding of CNS fluid dynamics and CSF circulation. A mathematical modeling approach to understand physiology will be discussed, useful to infer possible pathological conditions due to pressure/volume changes in the brain and the spine. The recent discovery of the glymphatic system and the possibility of visualizing brain lymphatic system will be put into context. Lastly, novel MR techniques in pathology will be discussed. 

Target Audience
Clinicians, neuroscientists, researchers, mathematicians, and computer scientists.

Educational Objectives
As a result of attending this course, participants should be able to:
- Identify evolving concepts around basic CNS fluid physiology;
- Recognize brain lymphatic channels and glymphatic flow;
- Interpret idiopathic diseases in the light of neurofluid dynamic changes; and
- Apply knowledge gained to develop novel MR methods.



  Basic CNS Fluid Physiology
Andreas Linninger
  Interacting Fluid Compartments of the Central Nervous System: A Holistic Mathematical Modelling Approach
Eleuterio Toro
We first describe all major fluid compartments of the central nervous system, their connections and their relevance to understand some neurological diseases. We then present a full-body, global mathematical model for the fluid dynamics includind heart, pulmonary circulation, respiration, arterial and venous trees, miscrovasculature, brain parenchyma and cerebrospinal fluid, We outline the equations and algorithms to solve these on a computer to produce subject-specific predictions. Validation of predictions against MRI measurements and is presented. We then apply the methods to study intra and extracranial venous outflow anomalies and their impact on cerebral haemodynamics in terms of increased intracranial pressure, reverse flow, altered shear stresses, altered fluid transport, altered perfusion. 

  Role of Fluid Dynamics in Neurological Diseases
Maria Marcella Laganà
Numerous studies investigated the link between arteriovenous alterations and neurological disorders. The studies involved in vivo data, as well as models of the cerebrospinal flows. An overview of these studies will be illustrated. The theoretic method for computing velocity from the phase contrast will be shown. Then, some exemplificative software used for phase contrast processing will be reported and their results will be compared. In this talk, data from healthy subjects, patients with multiple sclerosis and with migraine will be shown. Finally, the flow estimated through MRI will be used for validating models of the cerebrospinal fluid dynamics. 

  MR Imaging of CSF Spaces
Shigeki Yamada, Masatsune Ishikawa, Makoto Yamaguchi, Kazuo Yamamoto

We have studied how to visualize “neurofluids” three-dimensionally by using transparency and perspective technologies with shading and texture mapping from volumetric magnetic resonance imaging. The mean volume of the intracranial cerebrospinal fluid (CSF) in healthy individuals aged ≥70 years was estimated at more than 300 mL. CSF movement with cardiac pulsation was reduced with increasing age, although the dynamics of neurofluids has not been elucidated. By developing fluid dynamics-related technology, the 3D movement of CSF can be measured quantitatively. CSF dynamic theory has been renewed; the CSF does not exhibit unidirectional bulk flow and moves in a pulsatile fashion.

  Break & Meet the Teachers
  Mechanisms of Brain Drain: Glymphatics
Helene Benveniste
The glymphatic system (GS) is described as a perivascular transit passageway for cerebrospinal fluid (CSF) and interstitial fluid exchange that facilitate metabolic waste drainage from the brain in a manner dependent on aquaporin 4 (AQP4) water channels on glial cells and vascular pulsatility. In this presentation I will present the fundamentals of the GS concept (including current controversies) and focus on MRI methods to quantify GS transport in normal and diseased brain. Evidence for its existence in human brain will also be highlighed.

  Drainage of fluids from the brain
Roxane Carare
Interstitial fluid of the brain drains along the walls of capillaries and arteries as intramural periarterial drainage (IPAD). This process fails with ageing and possession of APOE4 genotype, resulting in cerebral amyloid angiopathy (CAA). There is convective influx/glymphatic entry of cerebrospinal fluid (CSF) along the pial glial basement membranes into the brain parenchyma.

  From Magnetic Resonance to Mathematical Models for Flow Dynamics
John Vardakis, Liwei Guo, Dean Chou, Yiannis Ventikos
  Imaging Brain Lymphatics
Toshiaki Taoka
In recent years, mass transport system in the brain by cerebrospinal fluid or interstitial fluid has been clarified from the researches until now. Glymphatic system is the waste clearance pathway system by cerebrospinal fluid through perivascular space and interstitial space in the brain. To visualize or evaluate the waste clearance system of the brain, tracer studies are mostly applied and findings on the system has been accumulated. There are several approaches other than tracer studies to evaluate the dynamics of the interstitial fluid within the brain including diffusion images. Findings from these studies will be discussed in this lecture.

  Lunch & Meet the Teachers
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