title: Cough-Associated Changes in CSF Flow in Chiari I Malformation Evaluated by Real-Time MRI.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: From the Department of Radiology (R.A.B., D.K.), Beth Israel Deaconess Medical Center, Boston, Massachusetts rbhadeli@bidmc.harvard.edu.
authors.forename: R A
authors.identifier: 0000-0003-1952-9732
authors.initials: RA
authors.lastname: Bhadelia
authors.affiliation: Department of Radiology (S.P.), Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: S
authors.identifier: 0000-0002-4500-1918
authors.initials: S
authors.lastname: Patz
authors.affiliation: Departments of Neurosurgery (C.H.).
authors.forename: C
authors.identifier: 0000-0001-9744-1010
authors.initials: C
authors.lastname: Heilman
authors.affiliation: From the Department of Radiology (R.A.B., D.K.), Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: D
authors.identifier: 0000-0003-4607-346X
authors.initials: D
authors.lastname: Khatami
authors.affiliation: Department of Neurosurgery (E.K.), Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: E
authors.identifier: 0000-0002-7600-3051
authors.initials: E
authors.lastname: Kasper
authors.affiliation: Phillips Healthcare (Y.Z.), Boston, Massachusetts.
authors.forename: Y
authors.identifier: 0000-0003-4639-7704
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Radiology (N.M.), Tufts Medical Center, Boston, Massachusetts.
authors.forename: N
authors.identifier: 0000-0002-3889-7293
authors.initials: N
authors.lastname: Madan
mesh_terms: D000328:Adult; D001139:Arnold-Chiari Malformation / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002555:Cerebrospinal Fluid / Q000000981:diagnostic imaging*; D003371:Cough / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging*; D005260:Female; D005539:Foramen Magnum / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged