MRI CSF-Flowmetry: An innovative method in differentiation of normal pressure hydrocephalus and involutional cerebral atrophy

Background: MRI CSF-flowmetry imaging is a non-invasive and quick method, valuable for distinguishing between normal pressure hydrocephalus (NPH) and involutional cerebral atrophy (ICA). Aim of the Study: This study aimed to assess the value of phase-contrast MRI CSF-flowmetry in differentiating between NPH and ICA. Patients and Methods: A descriptive case-control study was conducted at Martyr Ghazi Al-Hariri Specialized Surgical Hospital, Baghdad, Iraq, from April to December 2023. It included 28 patients and 25 control individuals. Conventional brain MRI was performed, followed by an assessment of CSF flow dynamics at the aqueduct of Sylvius. Results: The 28 patients had an average age of 57.6 years (range: 50-87 years) and included 19 males and 9 females. MRI CSF-flowmetry differentiated NPH and ICA based on stroke volume, peak systolic velocity, peak diastolic velocity, and mean flux (flow). Control group mean values were 19.40 µL, 3.83 cm/sec, 3.49 cm/sec, and 0.03 ml/sec, respectively. ICA cases showed significantly lower mean values (9.42 µL, 1.72 cm/sec, 1.45 cm/sec, and 0.01 ml/sec). Conversely, NPH cases exhibited significantly elevated mean values (69.33 µL, 7.92 cm/sec, 6.66 cm/sec, and 0.05 ml/sec), indicating hyperdynamic CSF flow in NPH and hypodynamic flow in ICA. Conclusion: Phase-contrast MRI CSF-flowmetry is a beneficial tool for distinguishing between normal pressure hydrocephalus and involutional cerebral atrophy.