Cough-Associated Changes in CSF Flow in Chiari I Malformation Evaluated by Real-Time MRI

Bhadelia, Rafeeque A.; Patz, Samuel; Heilman, Carl B.; Khatami, David; Kasper, Ekkehard M.; Zhao, Yongbo; Madan, Neel

doi:10.3174/ajnr.a4629

Cited by 20 publications

(21 citation statements)

References 26 publications

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“…22,[33][34][35] These studies also demonstrated that there was minimal if any pressure dissociation in these patients with CMI at rest before coughing or Valsalva. 33 While we did not calculate pressure gradients from our velocity data, our results confirmed both of these observations made by previous invasive pressure studies. 34,35,41 First, a decrease in CSF flow after coughing in patients with CMI indicates that CSF circulation from the head to spine is impaired, a condition that would result in pressure dissociation.…”

Section: Discussionmentioning

confidence: 55%

“…21,23,24,[32][33][34][35] The development of pressure dissociation is explained by a transient increase in spinal pressure (from increased intrathoracic pressure and consequent distension of the epidural veins) during coughing, moving CSF to the head, which returns to the spinal canal immediately postcoughing in a healthy subject but not in a patient with CMI, provided there is sufficient foramen magnum obstruction due to neural crowding. 22,[33][34][35] These studies also demonstrated that there was minimal if any pressure dissociation in these patients with CMI at rest before coughing or Valsalva. 33 While we did not calculate pressure gradients from our velocity data, our results confirmed both of these observations made by previous invasive pressure studies.…”

Section: Discussionmentioning

confidence: 99%

“…(Fig 1). 32,33 The PBI scan provides a phase-encoded velocity measurement with a temporal resolution of ϳ50 ms and spatial resolution along the cylinder axis. 38 To avoid phase wrap, we used a velocity encoding of 5 cm/s along the superior-to-inferior direction.…”

Section: Mr Imagingmentioning

confidence: 99%

“…Because physiologic challenges such as coughing or the Valsalva maneuver are known to transiently induce or exaggerate pressure dissociations at the craniocervical junction affecting CSF flow for only a few seconds, these weighted averages of CSF flow over many cardiac cycles measured by cine phase-contrast may not capture transient changes in CSF flow. [21][22][23][32][33][34][35] In a recent study, Bhadelia et al 32 proposed a real-time CSF flow imaging technique to assess the transient changes in CSF flow as a consequence of physiologic maneuvers. This technique was further used to compare CSF flow response to coughing in patients with CMI and healthy subjects.…”

mentioning

confidence: 99%

“…This technique was further used to compare CSF flow response to coughing in patients with CMI and healthy subjects. 33 In this exploratory study, we used real-time MR imaging to correlate disease severity among symptomatic patients with CMI with cough-associated changes in CSF flow.…”

mentioning

confidence: 99%

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Relationship between Cough-Associated Changes in CSF Flow and Disease Severity in Chiari I Malformation: An Exploratory Study Using Real-Time MRI

Bezuidenhout¹,

Khatami²,

Heilman³

et al. 2018

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Mr Imagingmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Relationship between Cough-Associated Changes in CSF Flow and Disease Severity in Chiari I Malformation: An Exploratory Study Using Real-Time MRI

Bezuidenhout¹,

Khatami²,

Heilman³

et al. 2018

AJNR Am J Neuroradiol

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Cerebrospinal Fluid Flow and Brain Motion in Chiari I Malformation: Past, Present, and Future

Bhadelia

Chang

Oshinski

et al. 2023

Magnetic Resonance Imaging

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Cranio-spinal volume and pressure changes associated with the cardiac-cycle and respiration are altered in Chiari I malformation (CMI) due to obstruction of cerebrospinal fluid (CSF) flow at the foramen magnum. With the introduction of motion-sensitive MRI sequences, it was envisioned that these could provide noninvasive information about volumepressure dynamics at the cranio-cervical junction in CMI hitherto available only through invasive pressure measurements. Since the early 1990s, multiple studies have assessed CSF flow and brain motion in CMI. However, differences in design and varied approaches in the presentation of results and conclusions makes it difficult to fully comprehend the role of MR imaging of CSF flow and brain motion in CMI. In this review, a cohesive summary of the current status of MRI assessment of CSF flow and brain motion in CMI is presented. Simplified versions of the results and conclusions of previous studies are presented by dividing the studies in distinct topics: 1) comparing CSF flow and brain motion between healthy subjects (HS) and CMI patients (before and after surgery), 2) comparing CSF flow and brain motion to CMI severity and symptoms, and 3) comparing CSF flow and brain motion in CMI with and without syringomyelia. Finally, we will discuss our vision of the future directions of MR imaging in CMI patients. Evidence Level: 2. Technical Efficacy: 5.

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Real‐time imaging of respiratory effects on cerebrospinal fluid flow in small diameter passageways

Töger

Andersen

Haglund

et al. 2022

Magnetic Resonance in Med

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Purpose: Respiration-related CSF flow through the cerebral aqueduct may be useful for elucidating physiology and pathophysiology of the glymphatic system, which has been proposed as a mechanism of brain waste clearance. Therefore, we aimed to (1) develop a real-time (CSF) flow imaging method with high spatial and sufficient temporal resolution to capture respiratory effects, (2) validate the method in a phantom setup and numerical simulations, and (3) apply the method in vivo and quantify its repeatability and correlation with different respiratory conditions.Methods: A golden-angle radial flow sequence (reconstructed temporal resolution 168 ms, spatial resolution 0.6 mm) was implemented on a 7T MRI scanner and reconstructed using compressed sensing. A phantom setup mimicked simultaneous cardiac and respiratory flow oscillations. The effect of temporal resolution and vessel diameter was investigated numerically. Healthy volunteers (n = 10) were scanned at four different respiratory conditions, including repeat scans. Results: Phantom data show that the developed sequence accurately quantifies respiratory oscillations (ratio real-time/reference Q R = 0.96 ± 0.02), but underestimates the rapid cardiac oscillations (ratio Q C = 0.46 ± 0.14). Simulations suggest that Q C can be improved by increasing temporal resolution. In vivo repeatability was moderate to very strong for cranial and caudal flow (intraclass correlation coefficient range: 0.55-0.99) and weak to strong for net flow (intraclass correlation coefficient range: 0.48-0.90). Net flow was influenced by respiratory condition (p < 0.01). Conclusions:The presented real-time flow MRI method can quantify respiratory-related variations of CSF flow in the cerebral aqueduct, but it underestimates rapid cardiac oscillations. In vivo, the method showed good repeatability and a relationship between flow and respiration.

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Cough-Associated Changes in CSF Flow in Chiari I Malformation Evaluated by Real-Time MRI

Cited by 20 publications

References 26 publications

Relationship between Cough-Associated Changes in CSF Flow and Disease Severity in Chiari I Malformation: An Exploratory Study Using Real-Time MRI

Relationship between Cough-Associated Changes in CSF Flow and Disease Severity in Chiari I Malformation: An Exploratory Study Using Real-Time MRI

Cerebrospinal Fluid Flow and Brain Motion in Chiari I Malformation: Past, Present, and Future

Real‐time imaging of respiratory effects on cerebrospinal fluid flow in small diameter passageways

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