Simultaneous measurement of cerebral blood flow and cerebrospinal fluid flow using pseudo-continuous arterial spin labeling

In the brain clearance system, the movement of cerebrospinal fluid (CSF) plays a key role in processing waste products. Previous studies have shown that CSF flow interacts significantly with cerebral blood flow (CBF) during brain waste clearance, but there are no simultaneous measurements and comparisons of these two metrics in humans. This study introduces a novel method for simultaneously measuring CSF pulsatile movement and CBF using pseudo-continuous arterial spin labeling (pCASL) MRI. We conducted a comparative analysis of the correlation between CBF and CSF pulsatile movement in human subjects during breath-holding and motor task conditions. Our findings demonstrate the effectiveness of our proposed technique in measuring CSF pulsatile movement, as validated by comparing results with phase-contrast MRI at corresponding locations. Importantly, we observed a robust positive correlation between CBF and CSF pulsation concurrently measured through pCASL during breath-holding. Furthermore, through inter-subject comparisons of regional CBF and CSF pulsation, we established that higher blood perfusion in putamen, caudate, and pallidum regions, which are included in basal ganglia structure, corresponds to greater CSF pulsatile movement. Our motor tasks significantly increased CBF in the motor cortex, and CSF pulsation measured in the dorsal part around cisterna magna showed a decreasing tendency in the motor condition compared to the resting state, aligning with the Monroe-Kelly doctrine. Accordingly, these results demonstrate the feasibility of simultaneous measurement of CBF and CSF pulsation using the proposed pCASL technique in humans, which warrants further investigation.