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AJNR Am J Neuroradiol. 2016 May;37(5):825-30. doi: 10.3174/ajnr.A4629. Epub 2015 Dec 24.

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

Author information

  • 1From the Department of Radiology (R.A.B., D.K.), Beth Israel Deaconess Medical Center, Boston, Massachusetts rbhadeli@bidmc.harvard.edu.
  • 2Department of Radiology (S.P.), Brigham and Women's Hospital, Boston, Massachusetts.
  • 3Departments of Neurosurgery (C.H.).
  • 4From the Department of Radiology (R.A.B., D.K.), Beth Israel Deaconess Medical Center, Boston, Massachusetts.
  • 5Department of Neurosurgery (E.K.), Beth Israel Deaconess Medical Center, Boston, Massachusetts.
  • 6Phillips Healthcare (Y.Z.), Boston, Massachusetts.
  • 7Radiology (N.M.), Tufts Medical Center, Boston, Massachusetts.

Abstract

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.

MATERIALS AND METHODS:

Eight symptomatic patients with Chiari I malformation and 6 healthy participants were studied by using MR pencil beam imaging with a temporal resolution of ∼50 ms. Patients and healthy participants were scanned for 90 seconds (without cardiac gating) to continuously record cardiac cycle-related CSF flow waveforms in real-time during resting, coughing, and postcoughing periods. CSF flow waveform amplitude, CSF stroke volume, and CSF flow rate (CSF Flow Rate = CSF Stroke Volume × Heart Rate) in the resting and immediate postcoughing periods were determined and compared between patients and healthy participants.

RESULTS:

There was no significant difference in CSF flow waveform amplitude, CSF stroke volume, and the CSF flow rate between patients with Chiari I malformation and healthy participants during rest. However, immediately after coughing, a significant decrease in CSF flow waveform amplitude (P < .001), CSF stroke volume (P = .001), and CSF flow rate (P = .001) was observed in patients with Chiari I malformation but not in the healthy participants.

CONCLUSIONS:

Real-time MR imaging noninvasively showed a transient decrease in CSF flow across the foramen magnum after coughing in symptomatic patients with Chiari I malformation, a phenomenon not seen in healthy participants. Our results provide preliminary evidence that the physiology-based imaging method used here has the potential to be an objective clinical test to differentiate symptomatic from asymptomatic patients with Chiari I malformation.

PMID:
26705321
DOI:
10.3174/ajnr.A4629
[PubMed - in process]
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