2024 September ; 37(9): e5162. doi:10.1002/nbm.5162. | Adam M. Wright, Yu-Chien Wu, Li Feng, Qiuting Wen
This review article discusses the current techniques and future advancements in diffusion magnetic resonance imaging (MRI) for assessing cerebrospinal fluid (CSF) dynamics. CSF plays a crucial role in metabolic waste clearance from the brain, and its circulation through various pathways, including the ventricular system, subarachnoid spaces, para-arterial spaces, interstitial spaces, and para-venous spaces, is essential for maintaining brain homeostasis. The complexity of CSF circulation has posed challenges in obtaining noninvasive measurements of CSF dynamics. Diffusion MRI, which is sensitive to incoherent water movement across the brain, has become a widely used technique for studying CSF dynamics. The article reviews established and emerging diffusion MRI techniques, including mono-compartment and multi-compartment models, and their clinical applications. It highlights the importance of optimizing acquisition parameters to enhance the sensitivity and specificity of diffusion metrics on underlying CSF dynamics. The review also emphasizes the need for cautious interpretations of diffusion-based imaging, especially when differentiating between tissue- and fluid-related changes or elucidating structural versus functional alterations. The article concludes by discussing the potential of diffusion MRI in studying CSF dynamics in both normal physiology and pathological conditions, such as neurodegenerative diseases.This review article discusses the current techniques and future advancements in diffusion magnetic resonance imaging (MRI) for assessing cerebrospinal fluid (CSF) dynamics. CSF plays a crucial role in metabolic waste clearance from the brain, and its circulation through various pathways, including the ventricular system, subarachnoid spaces, para-arterial spaces, interstitial spaces, and para-venous spaces, is essential for maintaining brain homeostasis. The complexity of CSF circulation has posed challenges in obtaining noninvasive measurements of CSF dynamics. Diffusion MRI, which is sensitive to incoherent water movement across the brain, has become a widely used technique for studying CSF dynamics. The article reviews established and emerging diffusion MRI techniques, including mono-compartment and multi-compartment models, and their clinical applications. It highlights the importance of optimizing acquisition parameters to enhance the sensitivity and specificity of diffusion metrics on underlying CSF dynamics. The review also emphasizes the need for cautious interpretations of diffusion-based imaging, especially when differentiating between tissue- and fluid-related changes or elucidating structural versus functional alterations. The article concludes by discussing the potential of diffusion MRI in studying CSF dynamics in both normal physiology and pathological conditions, such as neurodegenerative diseases.