Magnetic resonance 4D flow analysis of cerebrospinal fluid dynamics in Chiari I malformation with and without syringomyelia

Bunck, Alexander C.; Kroeger, Jan Robert; Juettner, Alena; Brentrup, Angela; Fiedler, Barbara; Crelier, Gérard; Martin, Bryn A.; Heindel, Walter; Maintz, David; Schwindt, Wolfram; Niederstadt, Thomas

doi:10.1007/s00330-012-2457-7

Cited by 75 publications

(97 citation statements)

References 32 publications

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“…Tonsillar motion reflects displaced volume from the cranial cavity during the cardiac cycle and is a balance of 2 parameters: cranial volume and cardiac output (to the cranium). Morphometric and anatomical studies indicate no differences in cranial volume between CM-I patients with and without syringes, as demonstrated by similar degrees of crowding (reflected by the posterior fossa/intracranial volume ratio), 54 cross-sectional CSF area at the foramen magnum, 5 and degree of tonsillar ectopia (as demonstrated in the current study). 5,34 No anecdotal or experimental data suggest that cardiac output differs between CM-I patients with and without syringomyelia.…”

Section: Association Between Cerebellar Tonsillar Motion and Syringomsupporting

confidence: 71%

“…6,11 The recent improvements in cine MRI technology have also enabled the first comparisons between CM-I patients with and without syringomyelia. Cousins and Haughton 11 reported cerebellar tonsillar motion to be 22% greater in CM-I patients with syrinx than in those without syrinx (no p values were calculated), whereas Bunck et al 5 found no significant differences between groups. The small sample sizes of both studies (11 CM-I and 20 CM-I patients, respectively) limited the study power, and both assumed that tonsillar motion only occurs in the superoinferior direction.…”

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confidence: 95%

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Cerebellar and hindbrain motion in Chiari malformation with and without syringomyelia

Leung

Magnussen

Stoodley

et al. 2016

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OBJECTIVE The pathogenesis of syringomyelia associated with Chiari malformation type I (CM-I) is unclear. Theories of pathogenesis suggest the cerebellar tonsils may obstruct CSF flow or alter pressure gradients, or their motion might act as a piston to increase CSF pressure in the spinal subarachnoid space. This study was performed to measure cerebellar tonsillar and hindbrain motion in CM-I and assess the potential contributions to syrinx formation. METHODS Sixty-four CM-I patients and 25 controls were retrospectively selected from a clinical database, and all subjects had undergone cardiac-gated cine balanced fast-field echo MRI. There were a total of 36 preoperative CM-I scans, which consisted of 15 patients with and 21 patients without syringomyelia. Nineteen patients underwent paired pre- and postoperative imaging. Anteroposterior (AP) and superoinferior (SI) movements of the tip of the cerebellar tonsils, obex, fastigium of the fourth ventricle, pontomedullary junction, and cervicomedullary junction were measured. The distance between the fastigium and tip of the tonsils was used to calculate tonsillar tissue strain (Δi/i0). RESULTS CM-I patients had significantly greater cerebellar tonsillar motion in both the AP and SI directions than controls (AP +0.34 mm [+136%], p < 0.001; SI +0.49 mm [+163%], p < 0.001). This motion decreased after posterior fossa decompression (AP −0.20 mm [−33%], p = 0.001; SI −0.29 mm [−36%]; p < 0.001), but remained elevated above control levels (AP +56%, p = 0.021; SI +67%, p = 0.015). Similar trends were seen for all other tracked landmarks. There were no significant differences in the magnitude or timing of motion throughout the hindbrain between CM-I patients with and without syringomyelia. Increased tonsillar tissue strain correlated with Valsalva headaches (p = 0.03). CONCLUSIONS Cerebellar tonsillar motion may be a potential marker of CM-I and may have use in tailoring surgical procedures. The lack of association with syringomyelia suggests that tonsillar motion alone is not the driver of syrinx formation. Tonsillar tissue strain may play a part in the pathophysiology of Valsalva headaches.

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Section: Association Between Cerebellar Tonsillar Motion and Syringomsupporting

confidence: 71%

mentioning

confidence: 95%

Cerebellar and hindbrain motion in Chiari malformation with and without syringomyelia

Leung

Magnussen

Stoodley

et al. 2016

SPI

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“…At present, MRI techniques are being developed to measure CSF pressure gradients noninvasively [14], but these methods are not in standard use and have not been validated. In principle, changes in CSF pressure gradients are related to alterations in impedance to CSF motion, CSF velocities [15][16][17][18][19][20][21][22], neural tissue motion [23][24][25], and craniospinal compliance [26][27][28]. We suspect that alterations in each of these biomechanical parameters could prove useful to quantify the biomechanical environment near the CVJ in CMI.…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal Fluid Flow Impedance is Elevated in Type I Chiari Malformation

Shaffer

Martin

Rocque

et al. 2014

Journal of Biomechanical Engineering

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Diagnosis of Type I Chiari malformation (CMI) is difficult because the most commonly used diagnostic criterion, cerebellar tonsillar herniation (CTH) greater than 3-5 mm past the foramen magnum, has been found to have little correlation with patient symptom severity. Thus, there is a need to identify new objective measurement(s) to help quantify CMI severity. This study investigated longitudinal impedance (LI) as a parameter to assess CMI in terms of impedance to cerebrospinal fluid motion near the craniovertebral junction. LI was assessed in CMI patients (N ¼ 15) and age-matched healthy controls (N ¼ 8) using computational fluid dynamics based on subject-specific magnetic resonance imaging (MRI) measurements of the cervical spinal subarachnoid space. In addition, CTH was measured for each subject. Mean LI in the CMI group (551 6 66 dyn/cm 5 ) was significantly higher than in controls (220 6 17 dyn/cm 5 , p < 0.001). Mean CTH in the CMI group was 9.0 6 1.1 mm compared to À0.4 6 0.5 mm in controls. Regression analysis of LI versus CTH found a weak relationship (R 2 ¼ 0.46, p < 0.001), demonstrating that CTH was not a good indicator of the impedance to CSF motion caused by cerebellar herniation. These results showed that CSF flow impedance was elevated in CMI patients and that LI provides different information than a standard CTH measurement. Further research is necessary to determine if LI can be useful in CMI patient diagnosis.

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“…Inertial properties of fluid may in some geometries create a pattern of flow called "flow separation," which results in eddy currents and vortices (Fig 4). 6 Flow not aligned with the spinal axis can be demonstrated by computational fluid dynamics (Fig 5) 7 and by PCMR when multiple gradient directions are used. 6 The anatomy of the subarachnoid space increases the complexity of CSF flow patterns in the spine.…”

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confidence: 98%

“…6 Flow not aligned with the spinal axis can be demonstrated by computational fluid dynamics (Fig 5) 7 and by PCMR when multiple gradient directions are used. 6 The anatomy of the subarachnoid space increases the complexity of CSF flow patterns in the spine. The flow velocities in any axial section of the spine have nonuniform distributions throughout the cardiac cycle, as PCMR and flow simulations show (Figs 6 and 7).…”

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confidence: 98%

Spinal Fluid Biomechanics and Imaging: An Update for Neuroradiologists

Haughton

Mardal

2014

AJNR Am J Neuroradiol

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SUMMARY:Flow imaging with cardiac-gated phase-contrast MR has applications in the management of neurologic disorders. Together with computational fluid dynamics, phase-contrast MR has advanced our understanding of spinal CSF flow. Phase-contrast MR is used to evaluate patients with Chiari I malformation who are candidates for surgical treatment. In theory, abnormal CSF flow resulting from the abnormal tonsil position causes syringomyelia and other neurologic signs and symptoms in patients with Chiari I. CSF flow imaging also has research applications in syringomyelia and spinal stenosis. To optimize MR acquisition and interpretation, neuroradiologists must have familiarity with healthy and pathologic patterns of CSF flow. The purpose of this review is to update concepts of CSF flow that are important for the practice of flow imaging in the spine. ABBREVIATION: PCMR ϭ phase-contrast MR

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Magnetic resonance 4D flow analysis of cerebrospinal fluid dynamics in Chiari I malformation with and without syringomyelia

Abstract: 4D-PC flow imaging allowed comprehensive analysis of CSF flow in patients with Chiari I malformation. Alterations of CSF hydrodynamics were most pronounced in patients with syringomyelia.

Cited by 75 publications

References 32 publications

Cerebellar and hindbrain motion in Chiari malformation with and without syringomyelia

Cerebellar and hindbrain motion in Chiari malformation with and without syringomyelia

Cerebrospinal Fluid Flow Impedance is Elevated in Type I Chiari Malformation

Spinal Fluid Biomechanics and Imaging: An Update for Neuroradiologists

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