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

Bhadelia, Rafeeque A.; Madan, Neel; Zhao, Yongbo; Wagshul, Mark E.; Heilman, Carl B.; Butler, J; Patz, Samuel

doi:10.3174/ajnr.a3509

Cited by 29 publications

(42 citation statements)

References 24 publications

(41 reference statements)

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“…Using multiplanar image reformatting, we positioned the pencil beam to cover the entire thecal sac. 20 The PBI scan was acquired for approximately 90 seconds, during which the participant was asked to do the following: 1) breathe quietly for the first 15-20 seconds (by counting from 1 to 20); 2) then cough as forcefully as possible consecutively 6 times; and 3) breathe quietly again after the end of coughing. Each ϳ90-second scan session was repeated 3 times.…”

Section: Mr Imagingmentioning

confidence: 99%

“…However, this is difficult, even with a very fast version of the cine phase contrast sequence, because it produces images that are weighted averages of the phasic behavior over many cardiac cycles and is therefore unable to show transient changes in CSF flow that result from a physiologic challenge and in which the duration of the transient changes is just a few cardiac cycles. 20 Therefore, we have chosen to assess CSF flow with the real-time MR imaging technique, pencil beam imaging (PBI). Previously performed simultaneous invasive cranial and spinal pressure monitoring showed that in symptomatic patients with CMI, immediately after coughing or Valsalva maneuver, dissociation develops between intracranial and intraspinal pressures.…”

Section: Abbreviationsmentioning

confidence: 99%

“…20,24,25 For this investigation, a 25-mm-diameter and 64-mm-length cylinder was excited by using a 2D spatially localized radiofrequency pulse with 8-turn spiral excitations, followed by a bipolar velocity-encoding gradient and a readout gradient applied along the axis of the cylinder. 20 A velocity-encoding of 5 cm/s along the superior-to-inferior direction was used. Other imaging parameters were the following: TR, 25-28 ms; TE, 3.8 ms; and flip angle, 10°.…”

Section: Csf Flow Imaging Techniquementioning

confidence: 99%

“…During this pressure dissociation, a higher intracranial pressure compared with intraspinal pressure pushes the already herniated tonsils downward and further narrows the foramen magnum and thereby transiently reduces the CSF flow across it. 18,[20][21][22][23] The purpose of this exploratory study was to demonstrate this phenomenon noninvasively by assessing CSF flow response to coughing in patients with CMI by using PBI and to compare the response with that in healthy participants.…”

Section: Abbreviationsmentioning

confidence: 99%

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

Bhadelia

Patz

Heilman³

et al. 2015

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:Invasive pressure studies have suggested that CSF flow across the foramen magnum may transiently decrease after coughing in patients with symptomatic Chiari I malformation. The purpose of this exploratory study was to demonstrate this phenomenon noninvasively by assessing CSF flow response to coughing in symptomatic patients with Chiari I malformation by using MR pencil beam imaging and to compare the response with that in healthy participants.

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Section: Mr Imagingmentioning

confidence: 99%

Section: Abbreviationsmentioning

confidence: 99%

Section: Csf Flow Imaging Techniquementioning

confidence: 99%

Section: Abbreviationsmentioning

confidence: 99%

See 2 more Smart Citations

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

Bhadelia

Patz

Heilman³

et al. 2015

American Journal of Neuroradiology

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“…21 While traditional MRI is unable to capture Valsalva-related changes in CSF flow, cine flow can measure the more dynamic fluctuations relevant to patients with CSF obstruction. 4 Although we were only able to obtain preoperative cine flow images for 8 (44.4%) of 18 patients in this study, multiple studies have demonstrated that cine flow MRI has additional value for evaluating which patients are most likely to benefit from surgical intervention. Patients with Chiari malformation demonstrate abnormal CSF flow dynamics on cine compared with healthy controls, 12 and cine parameters can be used to identify those with the disease.…”

mentioning

confidence: 99%

Multimodal evaluation of CSF dynamics following extradural decompression for Chiari malformation Type I

Quon¹,

Grant²,

DiLuna³

2015

SPI

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OBJECT Extradural decompression is a minimally invasive technique for treating Chiari malformation Type I (CM-I) that avoids the complications of dural opening. While there is no agreement on which surgical method is optimal, mounting evidence demonstrates that extradural decompression effectively treats clinical symptoms, with a minimal reoperation rate. Neurological symptoms such as headache may be related to obstructed flow of CSF, and one aspect of successful extradural decompression is improved CSF dynamics. In this series, the authors report on their use of phase-contrast cine flow MRI to assess CSF flow as well as satisfactory decompression. METHODS The authors describe their first surgical series of 18 patients with CM-I undergoing extradural decompression and correlate clinical improvement with radiological changes. Patients were categorized as having complete, partial, or no resolution of their symptoms. Posterior fossa area, cisterna magna area, and tonsillar herniation were assessed on T2-weighted MRI, whereas improvement of CSF flow was evaluated with phase-contrast cine flow MRI. All patients received standard pre- and postoperative MRI studies; 8 (44.4%) patients had pre- and postoperative phase-contrast cine, while the rest underwent cine studies only postoperatively. RESULTS All 18 patients presented with symptomatic CM-I, with imaging studies demonstrating tonsillar herniation ≥ 5 mm, and 2 patients had associated syringomelia. All patients underwent suboccipital decompression and C-1 laminectomy with splitting of the dura. Patients with complete resolution of their symptoms had a greater relative increase in cisterna magna area compared with those with only partial improvement (p = 0.022). In addition, in those with complete improvement the preoperative cisterna magna area was smaller than in those who had either partial (0.020) or no (0.025) improvement. Ten (91%) of the 11 patients with improved flow also had improvement in their symptoms. There was 1 postoperative complication of dysphagia and dysphonia. None of the patients have required a second operation. CONCLUSIONS Extradural decompression has the potential to be the first-line treatment for CM-I but has been lacking an objective measure by which to assess surgical success as well as the need for reoperation. An increase in the CSF spaces and improved CSF dynamics may be associated with resolution of clinical symptoms. Including cine imaging as part of routine pre- and postoperative evaluation can help identify which patients are most likely to benefit from surgery.

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The “Valva Cerebri”: Morphometry, Topographic Anatomy and Histology of the Rhomboid Membrane at the Craniocervical Junction

et al. 2019

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The arachnoid membranes' anatomy is a controversial topic in the literature, and the rhomboid membrane at the craniovertebral junction is an element of this system that has been described poorly. Hence, the objective of our study was to examine this membrane's anatomy and histology. A total of 45 fresh formalin‐fixed human cadaveric heads were examined, and anatomic dissections and histologic examinations using standard staining methods were performed. The membrane was found to be a constant structure. It has a rhomboid shape and is located on the medulla oblongata and upper cervical spine's ventral surface within the subarachnoid space. Its average craniocaudal length is 49 mm and the short axis is 26 mm. The cranial apex is attached to the vertebral arteries' junction, and the caudal apex reaches the level of C4. The lateral apices are attached to the dura mater at the level of the denticulate ligament's second insertion. The C1 spinal nerves perforate the membrane, while the C2 roots are located dorsal to it. The membrane is attached strongly to the underlying pia mater. Histologically, it has a typical arachnoid structure, in which its adhesions to the vertebral arteries as well as to the pia mater could be verified histologically. This is the first detailed examination of the rhomboid membrane. Our results suggest that the membrane serves a valve‐like function between the spinal and cranial subarachnoid spaces. Based on our findings, further hydrodynamic studies should clarify the membrane's physiological role. Clin. Anat. 32:56–65, 2019. © 2019 Wiley Periodicals, Inc.

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

Abstract: BACKGROUND AND PURPOSE: MR imaging is currently not used to evaluate CSF flow changes due to short-lasting physiological maneuvers. The purpose of this study was to evaluate the ability of MR imaging to assess the CSF flow response to a Valsalva maneuver in healthy participants.

Cited by 29 publications

References 24 publications

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

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

Multimodal evaluation of CSF dynamics following extradural decompression for Chiari malformation Type I

The “Valva Cerebri”: Morphometry, Topographic Anatomy and Histology of the Rhomboid Membrane at the Craniocervical Junction

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