Magnetic resonance imaging—based measurements of cerebrospinal fluid and blood flow as indicators of intracranial compliance in patients with Chiari malformation

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Object

The diagnosis of Chiari malformation (CM) is based on the degree of tonsilar herniation, although this finding does not necessarily correlate with the presence or absence of symptoms. Intracranial compliance (ICC) and local craniocervical hydrodynamic parameters derived using magnetic resonance (MR) imaging flow measurements were assessed in symptomatic patients and control volunteers to evaluate the role of these factors in the associated pathophysiology.

Methods

Seventeen healthy volunteers and 34 symptomatic patients with CM were studied using a 1.5-tesla MR imager. Cine phase-contrast images of blood and cerebrospinal fluid (CSF) flow to and from the cranium were used to quantify local hydrodynamic parameters (for example, cord displacement and systolic CSF velocity and flow rates) and ICC. The ICC was derived using a previously described method that measures the small, natural changes in intracranial volume and pressure with each cardiac cycle.

Differences in the average cord displacement and systolic CSF velocity and flow, comparing healthy volunteers and patients with CM were not statistically significant. Note, however, that a statistically significant lower ICC (20%) was observed in patients compared with controls.

Conclusions

Previous investigators have focused on CSF flow velocities and cord displacement to explain the pathogenesis of CM. Analysis of results have indicated that ICC is more sensitive than local hydrodynamic parameters to changes in the craniospinal biomechanical properties in symptomatic patients. The authors concluded that decreased ICC better explains CM pathophysiology than local hydrodynamic parameters such as cervical CSF velocities and cord displacement. Low ICC also better explains the onset of symptoms in adulthood given the decline in ICC with aging.

Article Information

Address reprint requests to: Noam Alperin, Ph.D., Physiological Imaging and Modeling Lab, Department of Radiology (M/C 711), University of Illinois at Chicago, 830 South Wood Street, Chicago, Illinois 60612. email: alperin@uic.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Illustration depicting a compartmental model of the craniospinal system used in the derivation of the ΔICV and ICC. The model shows arterial inflow, venous outflow, and oscillating CSF flow between the cranium and spinal canal. Given that blood, CSF, and brain tissue are not compressible, the volume change can be derived from the instantaneous difference between volumetric inflow and outflow rates.

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    Left: A velocity-encoded phase-contrast MR image revealing the blood flow to and from the cranium. Black pixels indicate flow in the caudocranial direction (arterial flow), and white pixels flow in the craniocaudal direction (venous flow). Right: A midsagittal MR image of the blood vessel demonstrating the location of the imaging plane used for the arterial and venous flow measurements.

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    Graphs depicting representative MR imaging—derived waveforms of total arterial inflow and total venous outflow in a healthy volunteer (left) and a patient with CM (right). Note that the venous flow is much more pulsatile in the patient compared with that in the healthy volunteer. total_art = total arterial inflow; total_ven = total venous outflow.

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    Left: Phase-contrast MR image obtained during the systolic phase, exhibiting the CSF flow velocities through the CSF space in the cervical spine. Right: Anatomical midsagittal T1-weighted MR image demonstrating the location of the imaging plane.

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    Graphs depicting the oscillatory CSF VFR waveform in a control volunteer (left) and a patient with CM (right). Positive values indicate flow from the cranium to the spinal canal. In the patient with CM, the maximal VFR is lower than that in the healthy control.

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    Graphs illustrating representative net transcranial blood flow (arterial inflow — venous outflow [A-V]) and the CSF flow waveforms in a healthy volunteer (left) and a patient with CM (right). Note that the CSF waveform follows the A-V waveform more closely in the patient with CM compared with those in the control volunteer, indicating a less compliant intracranial compartment.

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