title: Standard and cardiac-gated phase-contrast magnetic resonance imaging in the clinical course of patients with Chiari malformation Type I.
abstract: OBJECTIVE
  The causal treatment of Chiari malformation Type I (CM-I) consists of removing the obstruction of CSF flow at the level of the foramen magnum. Cerebrospinal fluid flow can be visualized using dynamic phase-contrast MR imaging. Because there is only a paucity of studies evaluating CSF dynamics in the region of the spinal canal on the basis of preoperative and postoperative measurements, the authors investigated the clinical usefulness of cardiacgated phase-contrast MR imaging in patients with CM-I.
  
  
  METHODS
  Ninety patients with CM-I underwent preoperative MR imaging of CSF pulsation. Syringomyelia was present in 59 patients and absent in 31 patients. Phase-contrast MR imaging of the entire CNS was used to investigate 22 patients with CM-I before surgery and after a mean postoperative period of 12 months (median 12 months, range 3-33 months). In addition to the dynamic studies, absolute flow velocities, the extension of the syrinx, and tonsillar descent were also measured.
  
  
  RESULTS
  The changes in pulsation were highly significant in the region of the (enlarged) cistern (p = 0.0005). Maximum and minimum velocities (the pulsation amplitude) increased considerably in the region where the syrinx was largest in diameter. The changes of pulsation in these patients were significant in the subarachnoid space in all spinal segments but not in the syrinx itself and in the central canal.
  
  
  CONCLUSIONS
  The demonstration of CSF flow pulsation can contribute to assessments of surgical outcomes. The results presented here, however, raise doubts about current theories on the pathogenesis of syringomyelia.
authors: Departments of Neurosurgery, German Armed Forces Hospital of Ulm, Germany.uwe-max.mauer@dgn.de
authors: Uwe Max
authors: UM
authors: Mauer
authors: Andreas
authors: A
authors: Gottschalk
authors: Carolin
authors: C
authors: Mueller
authors: Linda
authors: L
authors: Weselek
authors: Ulrich
authors: U
authors: Kunz
authors: Chris
authors: C
authors: Schulz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001139:Arnold-Chiari Malformation / Q000473:pathology* / Q000601:surgery; D002490:Central Nervous System / Q000473:pathology; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow / Q000502:physiology; D055815:Young Adult
chemical_list: D003287:Contrast Media