{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:46:01Z","timestamp":1785422761918,"version":"3.56.0"},"reference-count":34,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Science and Technology Council","award":["NSTC 114-2314-B-039-054-MY2"],"award-info":[{"award-number":["NSTC 114-2314-B-039-054-MY2"]}]},{"award":["NSTC 114-2314-B-039-054-MY2"],"award-info":[{"award-number":["NSTC 114-2314-B-039-054-MY2"]}],"id":[{"id":"https:\/\/ror.org\/02kv4zf79","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Spontaneous intracranial hypotension (SIH) is caused by spinal cerebrospinal fluid (CSF) leakage and is typically diagnosed by clinical presentation and characteristic MRI signs; however, objective tools for monitoring physiological changes and treatment response remain limited. Cine phase-contrast MRI (PC-MRI) enables noninvasive quantification of aqueductal CSF dynamics, yet reliable analysis is challenging since the cerebral aqueduct is extremely small and susceptible to low contrast, partial volume effects, and ROI-dependent measurement variability\u2014particularly in SIH where CSF pulsatility is often reduced. Methods: We propose an end-to-end automated framework that integrates (1) a cascade localization\u2013segmentation strategy, consisting of Tiny YOLOv4 detection followed by MultiResUNet segmentation on a YOLOv4-derived cropped ROI; (2) physiology-informed pulsatility-based segmentation (PUBS) to refine anatomical masks into functional flow ROIs; and (3) one-dimensional convolutional neural networks (1D-CNNs) to extract exploratory waveform morphology features from 32-phase cardiac-cycle velocity waveforms. The study includes 39 participants, yielding 59 cine PC-MRI examinations: 11 controls, 28 Pre-treatment SIH scans and 20 Post-treatment Recovery scans. Results: The cascade model significantly improves segmentation robustness compared with a full-image baseline, achieving higher Dice scores and markedly lower boundary errors across cohorts (e.g., Pre-treatment SIH HD95: 1.66 \u00b1 0.74 px vs. 15.37 \u00b1 44.98 px). PUBS refinement reduces quantification deviation from expert manual references in SIH (mean relative error: 7.4% to 5.6%) and improves diagnostic performance for multiple hemodynamic parameters (e.g., downward mean flow AUC: 0.747 to 0.792). For waveform morphology analysis, the end-to-end 1D-CNN classifier was evaluated using repeated-seed participant-level grouped LOOCV. The repeated-seed ensemble prediction showed modest out-of-sample discrimination between Normal controls and Pre-treatment SIH scans, with an AUC of 0.646, a bootstrap 95% confidence interval of 0.455\u20130.826, and a permutation-test p-value of 0.072. Separately, exploratory analysis of the final baseline-trained 1D-CNN latent space showed marked, apparent Normal-versus-SIH separability and an intermediate recovery distribution in PCA space, suggesting that aqueductal waveform morphology may encode SIH-related physiological information. Conclusions: These findings suggest that SIH-related information may be reflected not only in flow magnitude but also in aqueductal CSF waveform morphology. However, the modest and statistically non-significant out-of-sample performance of the end-to-end 1D-CNN classifier indicates that morphology-based AI features should currently be regarded as exploratory biomarker candidates rather than validated stand-alone diagnostic tools. Larger independent cohorts are required to confirm their reproducibility, physiological meaning, and clinical utility.<\/jats:p>","DOI":"10.3390\/diagnostics16121939","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T06:13:37Z","timestamp":1782195217000},"page":"1939","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Automated Aqueductal CSF Flow Analysis in Spontaneous Intracranial Hypotension: Hemodynamic Quantification and Exploratory Waveform Morphology Assessment Using Cine PC-MRI"],"prefix":"10.3390","volume":"16","author":[{"given":"Yi-Jhe","family":"Huang","sequence":"first","affiliation":[{"name":"Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404328, Taiwan"},{"name":"Department of Radiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4028-8697","authenticated-orcid":false,"given":"Wen-Hsien","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan"},{"name":"Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3544-5045","authenticated-orcid":false,"given":"Hung-Chieh","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan"},{"name":"Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan"},{"name":"College of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7955-9234","authenticated-orcid":false,"given":"Da-Chuan","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung 404, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2286","DOI":"10.1001\/jama.295.19.2286","article-title":"Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension","volume":"295","author":"Schievink","year":"2006","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"s138","DOI":"10.1007\/s10072-004-0273-9","article-title":"Headache and intracranial hypotension: Neuroradiological findings","volume":"25","author":"Chiapparini","year":"2004","journal-title":"Neurol. 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