Cerebrospinal Fluid Flow Analysis in Prepontine Cistern, Foramen Magnum and 5th  Cervical Spine Levels: Temporal and Spatial Patterns at MR Imaging in Volunteers and in Patients with Chiari I Malformation: Cerebrospinal Fluid Flow Analysis in Prepontine Cistern, Foramen Magnum and 5th  Cervical Spine Levels: Temporal and Spatial Patterns at MR Imaging in Volunteers and in Patients with Chiari I Malformation

Chewarat Wirojtananugoon; Parichart Somtua; Witaya Sangkarat; Attaporn Boongerd; Udomchai Techavipoo

Authors

Chewarat Wirojtananugoon M.D. Decartment of Radiology. Faculty of Medicine, Rarmathitodi Hospital
Parichart Somtua M.D. Decartment of Radiology. Faculty of Medicine, Rarmathitodi Hospital
Witaya Sangkarat M.D., Ph.D. Decartment of Radiology. Faculty of Medicine, Rarmathitodi Hospital
Attaporn Boongerd M.D. Department of Surgery. Faculty of Medicine. Ramathibodi Hospital
Udomchai Techavipoo, Ph.D. National Electronics and Computer Technology Center

Abstract

Background and Purpose: The neurological signs and symptoms in Chiari I malformation patients are

related to cerebrospinal fluid (CSF) flow obstruction at the foramen magrum. Previous studies show

signilicantly higher peak CSF velocity at the foramen magnum level in these patients than in the normal

population. However, recent studies report no significant difference of peak CSF velocity at the foramen

magnum between symotomatic and asymptomatic Chiari I groups and suggested further studies of CSF

flow outside the foramen magnum for better patient classication. The purpose of this study was to

evaluate and compare CSF flow patterns in Chiari I patients and in healthy controls at the prepontine

cistern, foramen magnum, and 5th cervical spine (C5) levels.

Methods: Five patients and ten healthy control volunteers were studled with a phase-contrast MRI at

these levels through 20 phases of a cardiac cycle. The CSF flow patterns were analyzed for inhogeity

using the flow velocity diffence between the areas anterior and posterior to the spinal cord, the synchronous

bidirectional flow, and the preferential flow direction.

Results: The peak systolic velocity means in the patients were higher than those in the controls for all

three levels: However, statistical signicance occurred only at the foramen magnum level. For all three

levels, the flow spatial and temporal variations (flow nodes and jets and consecutive images with synchronous

bidirectional flows) were more evident in the patients than in the controls.

Conclusion: No significant diffence of the CSF flow occurs at the prepontine cistem and C5 levels

between the patients and controls. Therefore, the CSF flow studies outside the foramen magnum may not

be effective for patient evaluation

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Cerebrospinal Fluid Flow Analysis in Prepontine Cistern, Foramen Magnum and 5th Cervical Spine Levels: Temporal and Spatial Patterns at MR Imaging in Volunteers and in Patients with Chiari I Malformation