Magnetic resonance 4D flow analysis of cerebrospinal fluid dynamics in Chiari I malformation with and without syringomyelia

European Radiology volume 22, pages1860–1870(2012)Cite this article

Abstract

Objective

To analyse cerebrospinal fluid (CSF) hydrodynamics in patients with Chiari type I malformation (CM) with and without syringomyelia using 4D magnetic resonance (MR) phase contrast (PC) flow imaging.

Methods

4D-PC CSF flow data were acquired in 20 patients with CM (12 patients with presyrinx/syrinx). Characteristic 4D-CSF flow patterns were identified. Quantitative CSF flow parameters were assessed at the craniocervical junction and the cervical spinal canal and compared with healthy volunteers and between patients with and without syringomyelia.

Results

Compared with healthy volunteers, 17 CM patients showed flow abnormalities at the craniocervical junction in the form of heterogeneous flow (n = 3), anterolateral flow jets (n = 14) and flow vortex formation (n = 5), most prevalent in patients with syringomyelia. Peak flow velocities at the craniocervical junction were significantly increased in patients (−15.5 ± 11.3 vs. −4.7 ± 0.7  cm/s in healthy volunteers, P < 0.001). At the level of C1, maximum systolic flow was found to be significantly later in the cardiac cycle in patients (30.8 ± 10.3 vs. 22.7 ± 4.1%, P < 0.05).

Conclusions

4D-PC flow imaging allowed comprehensive analysis of CSF flow in patients with Chiari I malformation. Alterations of CSF hydrodynamics were most pronounced in patients with syringomyelia.

Key Points

• Analysis of CSF flow is important in patients with Chiari I malformation

• 4D-PC MRI allows analysis of CSF in patients with Chiari I.

• Chiari I patients show characteristic qualitative and quantitative alterations of CSF flow.

• Alterations of CSF hydrodynamics are most pronounced in patients with associated syringomyelia.

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Acknowledgements

B. Martin currently receives funding from the Swiss National Science Foundation. G. Crelier is an employee of Gyrotools Ltd., Zürich, Switzerland.

Author information

Affiliations

  1. Department of Clinical Radiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, building A1, 48149, Muenster, Germany

    Alexander C. Bunck, Jan Robert Kroeger, Alena Juettner, Walter Heindel, David Maintz, Wolfram Schwindt & Thomas Niederstadt

  2. Department of Neurosurgery, University Hospital of Muenster, Muenster, Germany

    Angela Brentrup

  3. Department of General Pediatrics, University Hospital of Muenster, Muenster, Germany

    Barbara Fiedler

  4. Institute for Biomedical Engineering, ETH and University of Zurich, Zurich, Switzerland

    Gerard R. Crelier

  5. Laboratory of Hemodynamics and Cardiovascular Technology, School of Engineering, Interfaculty Institute of Bioengineering, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland

    Bryn A. Martin

  6. Department of Radiology, University Hospital of Cologne, Cologne, Germany

    David Maintz

  7. Department of Radiology, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany

    Alexander C. Bunck

Authors
  1. Alexander C. Bunck
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  2. Jan Robert Kroeger
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  3. Alena Juettner
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  4. Angela Brentrup
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  7. Bryn A. Martin
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  8. Walter Heindel
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  9. David Maintz
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  10. Wolfram Schwindt
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  11. Thomas Niederstadt
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Correspondence to Alexander C. Bunck.

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W. Schwindt and T. Niederstadt contributed equally as senior authors.

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Bunck, A.C., Kroeger, J.R., Juettner, A. et al. Magnetic resonance 4D flow analysis of cerebrospinal fluid dynamics in Chiari I malformation with and without syringomyelia. Eur Radiol 22, 1860–1870 (2012). https://doi.org/10.1007/s00330-012-2457-7

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Keywords

  • Chiari malformation
  • Syringomyelia
  • Cerebrospinal fluid
  • 4D flow imaging
  • MRI