Peak CSF Velocities in Patients with Symptomatic and Asymptomatic Chiari I Malformation

Abstract

BACKGROUND AND PURPOSE PCMR is used to evaluate the Chiari I malformation. We compared quantitative PCMR in symptomatic and asymptomatic patients with Chiari I. MATERIALS AND METHODS PCMR image data in an axial section near the foramen magnum in a consecutive series of patients with Chiari I malformations were evaluated. Patients were classified as symptomatic for a Chiari I if they had apnea spells and/or exertional headaches and as asymptomatic if they had symptoms not considered specific for a Chiari I malformation. The PCMR CSF flow study was obtained with the same protocol for all patients and with the neck in neutral, flexed, and extended positions. Images were inspected for CSF flow jets and synchronous bidirectional flow. Peak CSF flow velocities were calculated with commercial software. Differences between the 2 groups were tested with mixed-effects ANOVA and Wilcoxon rank sum or Fisher exact probability tests with significance set at the .05 level. RESULTS Twenty-six patients with Chiari I were classified as symptomatic, and 24, as asymptomatic. Abnormal flow jets tended to occur more often in the symptomatic than in the asymptomatic patients (P = .054). Peak CSF velocities ranged from 2 to 20 cm/s in the symptomatic and the asymptomatic groups and did not differ significantly between the 2 groups or with neck position. CONCLUSIONS Peak CSF flow velocities near the foramen magnum did not differentiate symptomatic and asymptomatic patients with Chiari I.

Magnetic resonance 4D flow characteristics of cerebrospinal fluid at the craniocervical junction and the cervical spinal canal

“…As such, it may help to more precisely identify those patients who are likely to benefit from craniocervical decompression. Very recently, the ability to differentiate between these patient populations on the basis of simple 2D PC flow analysis has been questioned [26].…”

Physiology-Based MR Imaging Assessment of CSF Flow at the Foramen Magnum with a Valsalva Maneuver

“…1,2,4,6,21 Because CSF flow estimation by MR imaging is currently done in resting conditions, limited clinical usefulness has been found for quantitative CSF flow imaging in patient populations. 12,22 This is likely because of a high variability in CSF flow pulsation amplitudes among patients because of differences in cerebral arterial and venous flow amplitudes, intracranial compliance, and the anatomy of CSF pathways. 7,23,24 The major benefit of our approach is that by comparing cardiac cycle-related CSF flow for a participant at rest with that during and after a Valsalva maneuver, compensatory CSF flow changes can be assessed on an individualized basis, eliminating the need to compare CSF flow across participants.…”

“…As a result, most cine-PC studies of CSF flow have only been used during quiet breathing, both in healthy participants and in patients with suspected CSF circulation abnormalities. [7][8][9][10][11][12][13][14] The 1 exception is a 2006 abstract by Wentland et al 15 reporting CSF flow during rest and Valsalva by using an undersampled projection reconstruction method with data acquisi-tion times of as little as 16 heartbeats. For healthy participants, however, only minimal differences in flow were seen.…”

Posturographic examination of body balance in patients with Chiari type I malformation and correlation with the presence of syringomyelia and degree of cerebellar ectopia

“…The severity of the clinical signs is proportional to the impact on the flow of cerebrospinal fluid at the craniocervical junction, [10] and abnormal cerebrospinal fluid flow patterns are detected significantly more often in patients with symptomatic CM-I than in those with asymptomatic tonsillar ectopia. [11] Signs and symptoms of CM vary widely.…”