title: Magnetic resonance 4D flow analysis of cerebrospinal fluid dynamics in Chiari I malformation with and without syringomyelia.
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.
authors.affiliation: Department of Clinical Radiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, building A1, 48149 Muenster, Germany. alexander.bunck@uk-koeln.de
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Bunck
authors.forename: Jan Robert
authors.initials: JR
authors.lastname: Kroeger
authors.forename: Alena
authors.initials: A
authors.lastname: Juettner
authors.forename: Angela
authors.initials: A
authors.lastname: Brentrup
authors.forename: Barbara
authors.initials: B
authors.lastname: Fiedler
authors.forename: Gerard R
authors.initials: GR
authors.lastname: Crelier
authors.forename: Bryn A
authors.initials: BA
authors.lastname: Martin
authors.forename: Walter
authors.initials: W
authors.lastname: Heindel
authors.forename: David
authors.initials: D
authors.lastname: Maintz
authors.forename: Wolfram
authors.initials: W
authors.lastname: Schwindt
authors.forename: Thomas
authors.initials: T
authors.lastname: Niederstadt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001139:Arnold-Chiari Malformation / Q000473:pathology* / Q000503:physiopathology*; D002555:Cerebrospinal Fluid / Q000166:cytology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012212:Rheology / Q000379:methods*; D012680:Sensitivity and Specificity; D013595:Syringomyelia / Q000473:pathology* / Q000503:physiopathology*; D055815:Young Adult