Altered CSF Pseudo-diffusivity in Preterm Infants with Intra-Ventricular Hemorrhage
Helia Hosseini1, David Limbrick5, Jennifer Strahle2, Barbara Warner3, Nicholas Reinhold6, Diego Morales2, Thanda Meehan2, Laura Linneman3, Dimitrios Alexopoulos4, David Loseille4, Caleb Gardner4, Christopher Smyser4, Arash Nazeri1
1Mallinckrodt Institute of Radiology, 2Department of Neurosurgery, 3Department of Pediatrics, 4Department of Neurology, Washington University School of Medicine, 5Department of Neurosurgery, Virginia Commonwealth University, 6University of Rochester School of Medicine and Dentistry
Objective:
To evaluate the alterations in cerebrospinal fluid (CSF) circulation and its physical properties in infants suffering from Intraventricular hemorrhage (IVH).
Background:
IVH and subsequent post-hemorrhagic hydrocephalus (PHH) represent significant neurological complications in preterm infants. IVH alters the composition of cerebrospinal fluid (CSF), impacting its physical properties and initiating inflammatory and cellular responses that could alter CSF space microstructure and/or CSF hydrodynamics.
Design/Methods:
Diffusion-weighted MRI at low b-values (low-b dMRI) is sensitive to both the intrinsic diffusivity and effective motility of CSF. Using this method, whole-brain maps of CSF mean pseudo-diffusivity (MΨ) were generated. Region of interest analysis was conducted using the CSF Water Ways (CWW) atlas.
Results:
The study included 62 preterm infants: 38 without IVH (NL), 16 with grade 1/2 IVH (low-grade IVH), and 8 with grade 3/4 IVH (high-grade IVH). Compared to the NL group, CSF MΨ was significantly decreased in the extra-axial subarachnoid space and supracerebellar cistern in infants with low-grade IVH (p < 0.05). In contrast, infants with high-grade IVH exhibited a significant increase in CSF MΨ in the superior pre-medullary cistern compared to both the low-grade IVH and NL groups (p < 0.05).
Conclusions:
Decreased MΨ in lower grades of IVH within slow-flow CSF spaces may reflect increased viscosity due to the admixture of blood, which has a higher viscosity than normal CSF. Alternatively, this may indicate secondary microstructural changes in the subarachnoid space, such as scarring or thickening of the arachnoid trabeculae, resulting in increased non-CSF tissue partial volume. In higher grades of IVH, hydrodynamic changes likely predominate, leading to higher MΨ.
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