Magnetic resonance imaging measures of posterior cranial fossa morphology and cerebrospinal fluid physiology in Chiari malformation type I.
Magnetic resonance imaging measures of posterior cranial fossa morphology and cerebrospinal fluid physiology in Chiari malformation type I.
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DOI：
10.1227/neu.0000000000000507
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发表时间：
2014-11
期刊：
影响因子：
4.8
通讯作者：
Sekula R
中科院分区：
文献类型：
--
作者：
Alperin N;Loftus JR;Oliu CJ;Bagci AM;Lee SH;Ertl-Wagner B;Green B;Sekula R
有充分的文献证明，与扁桃体造成畸形，CHIARI畸形I型（CMI）与较小的后颅窝（PCF）以及颅骨群（CCJ）中的CSF流动和组织运动改变有关。
这项研究评估了PCF体积和CSF与组织动力学与基于成像的组合形态学 - 生理特征的关系，以确定最能区分CMI的参数的子集。
PCF的长度和体积测量值（包括体积，拥挤性和第4通气体积，CSF的四个测量和CCJ中的四项测量）以及5次全球颅内测量值，包括颅内依从性和压力，包括MRI在36个症状CMI受试者中测量（28F，37±11岁）和37名对照受试者（24F，36±12年）。和“非典型”亚组。
在CMI和对照组之间，在形态学和生理措施中有10个显着差异。拥挤，归一化PCF体积，第四通气体积，最大绳索位移（P <.001）和MR测量ICP （p = .007）。与非典型CMI队列相比，在CMI和对照组之间，CMI和MRRICP之间的强大歧视器子集确定了绳索位移，PCF拥挤性和归一化PCF。
所确定的10个完成形态和生理措施比单独的扁桃体催眠提供了CMI的更完整和症状相关的特征。
It has been well documented that along with tonsillar herniation, Chiari Malformation Type I (CMI) is associated with smaller posterior cranial fossa (PCF) and altered CSF flow and tissue motion in the cranio-cervical junction (CCJ). This study assesses the relationship between PCF volumetry and CSF and tissue dynamics toward a combined imaging-based morphologic-physiologic characterization of CMI. Multivariate analysis is employed to identify the subset of parameters that best discriminates CMI from healthy. Eleven length and volumetric measures of PCF, including volume, crowdedness, and 4th ventricle volume, four measures of CSF and cord motion in the CCJ, and five global intracranial measures, including intracranial compliance and pressure, were measured by MRI in 36 symptomatic CMI subjects (28F, 37±11 years) and 37 control subjects (24F, 36±12 years). The CMI group was further divided based on symptomatology into “typical” and “atypical” subgroups. Ten of the 20 morphologic and physiologic measures were significantly different between the CMI and the control cohorts. These parameters also had less variability and stronger significance in the typical CMI compared with the atypical. The measures with the most significance were clival and supraocciput lengths, PCF crowdedness, normalized PCF volume, 4th ventricle volume, maximal cord displacement (p<.001), and MR measure of ICP (p=.007). Multivariate testing identified cord displacement, PCF crowdedness, and normalized PCF as the strongest discriminator subset between CMI and controls. MRICP was higher in the typical CMI cohort compared with the atypical. The identified 10 complementing morphologic and physiologic measures provide a more complete and symptomatology relevant characterization of CMI than tonsillar herniation alone.