Age-related Decline of Intrinsic Cerebrospinal Fluid Outflow in Healthy Humans Detected with Non-contrast Spin-labeling MR Imaging

• Published in: Magnetic Resonance in Medical Sciences Vol. 23; no. 1; pp. 66 - 79
• Main Authors: Malis, Vadim, Bae, Won C., Yamamoto, Asako, McEvoy, Linda K., McDonald, Marin A., Miyazaki, Mitsue
• Format: Journal Article
• Language: English
• Published: Japan Japanese Society for Magnetic Resonance in Medicine 01.01.2024; Japan Science and Technology Agency
• Subjects: Adult; Age; Aged; Aging; Brain; Cerebrospinal fluid; Cerebrospinal Fluid - diagnostic imaging; cerebrospinal fluid outflow; Contrast agents; Contrast media; Dura Mater; glymphatic system; Humans; Informed consent; Labeling; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Major Paper; Medical imaging; Meninges; Middle Aged; Neurodegenerative Diseases; Neuroimaging; non-contrast spin-labeling magnetic resonance imaging; Outflow; parasagittal dura; Spin labeling; Spin Labels; Superior sagittal sinus; Toxins; Young Adult; cerebrospinal fluid outflow; non-contrast spin-labeling magnetic resonance imaging; glymphatic system; parasagittal dura; dura mater
• ISSN: 1347-3182; 1880-2206
• DOI: 10.2463/mrms.mp.2022-0117

Purpose: Clearance of cerebrospinal fluid (CSF) is important for the removal of toxins from the brain, with implications for neurodegenerative diseases. Imaging evaluation of CSF outflow in humans has been limited, relying on venous or invasive intrathecal injections of contrast agents. The objective of this study was to introduce a novel spin-labeling MRI technique to detect and quantify the movement of endogenously tagged CSF, and then apply it to evaluate CSF outflow in normal humans of varying ages.Methods: This study was performed on a clinical 3-Tesla MRI scanner in 16 healthy subjects with an age range of 19–71 years with informed consent. Our spin-labeling MRI technique applies a tag pulse on the brain hemisphere, and images the outflow of the tagged CSF into the superior sagittal sinus (SSS). We obtained 3D images in real time, which was analyzed to determine tagged-signal changes in different regions of the meninges involved in CSF outflow. Additionally, the signal changes over time were fit to a signal curve to determine quantitative flow metrics. These were correlated against subject age to determine aging effects.Results: We observed the signal of the tagged CSF moving from the dura mater and parasagittal dura, and finally draining into the SSS. In addition, we observed a possibility of another pathway which is seen in some young subjects. Furthermore, quantitative CSF outflow metrics were shown to decrease significantly with age.Conclusion: We demonstrate a novel non-invasive MRI technique identifying two intrinsic CSF clearance pathways, and observe an age-related decline of CSF flow metrics in healthy subjects. Our work provides a new opportunity to better understand the relationships of these CSF clearance pathways during the aging process, which may ultimately provide insight into the age-related prevalence of neurodegenerative diseases.