Cine MR in the evaluation of normal and abnormal CSF flow: intracranial and intraspinal studies

Abstract

Evaluation of intracranial and intraspinal CSF flow was accomplished by the use of cardiac gated gradient echo magnetic resonance (MR) technique. Normal patterns of pulsatile flow within the ventricles, cisterns and cervical subarachnoid space were established by this technique and these observations were compared to prior description of CSF flow. With systole there is downward (caudal) flow of CSF in the aqueduct of Sylvius, the foramen of Magendie, the basal cisterns and the dorsal and ventral subarachnoid spaces while during diastole, upward (cranial) flow of CSF in these same structures is seen. The relationships between the cardiac cycle and the CSF pulsations are demonstrated on both magnitude reconstruction and phase reconstruction MR images. Calculations of actual fluid velocity within CSF containing spaces can be obtained from the phase reconstruction images and holds promise for a more accurate analysis of CSF flow. In conditions which result in alterations of flow, cine MR dramatically shows either obstruction or excessively turbulent flow within the CSF pathways. The site of obstructed flow whether in the third ventricle, aqueduct, fourth ventricle, or subarachnoid space can be appreciated by changes in or absence of the normal hypointense signal. Cystic cord lesions such as congenital syringohydromyelia and posttraumatic spinal cord cysts may show pulsatile flow of CSF, a fact which can relate to progressive enlargement of these cysts. The distinction between myelomalacia and cyst formation in the cord is facilitated by the technique. Although the use of cine MR for the analysis of CSF flow is in its infancy, our experience indicates that this technique is useful in a wide range of pathological conditions including, but not limited to, conditions resulting in hydrocephalus or cystic cord lesions.

Dynamics of lateral ventricle and cerebrospinal fluid in normal and hydrocephalic brains

“…There is an overall strong presence of flow in the posterior-anterior direction. These observations are in good agreement with Quencer et al (18).…”

Surgical management of syringomyelia-Chiari complex

“…Cerebrospinal fluid (CSF) enters the cord through these dilated perivascular spaces to produce syringomyelia by multiple microscopic connections with the subarachnoid space, rather than the single channel from the fourth ventricle. The predominant involvement of the cervical segments of the cord may be related to the fact that maximum pulsatile pressure waves in the spinal subarachnoid space occur in the upper portion of the canal and are dissipated with increasing distances down the canal [5,21].…”

Spontaneous Resolution of Syringomyelia Without Chiari Malformation-Case Report-

“…Even among older people, Chiari I malformations could be reduced by brain atrophy, especially of the cerebellar tonsils. 7,26) Other explanations for the resolution of syringomyelia include spontaneous rupture of the arachnoid thickening or scarring at the foramen magnum and foramen of Magendie in Chiari I malformation improves the passage of CSF at the foramen magnum, 22,23,37) or resolution of the increased intracranial pressure after head trauma 41) and neuropathological examinations. 27) Spontaneous resolution of syringomyelia was reported in two patients with multiple sclerosis.…”