Cerebrospinal fluid flow impedance is elevated in Type I Chiari malformation.
Cerebrospinal fluid flow impedance is elevated in Type I Chiari malformation.
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I 型 Chiari 畸形中脑脊液流动阻抗升高。
DOI：
10.1115/1.4026316
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Loth,Francis
中科院分区：
文献类型：
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作者：
Shaffer,Nicholas;Martin,BrynA;Rocque,Brandon;Madura,Casey;Wieben,Oliver;Iskandar,BermansJ;Dombrowski,Stephen;Luciano,Mark;Oshinski,JohnN;Loth,Francis
I型基亚里畸形（CMI）的诊断是困难的，因为最常用的诊断标准，小脑扁桃体疝（CTH）超过枕骨大孔3-5 mm，已被发现与患者症状严重程度几乎没有相关性。因此，有必要确定新的客观衡量标准，以帮助量化CMI严重程度。本研究探讨了纵向阻抗（LI）作为一个参数，以评估CMI的阻抗，脑脊液运动附近的颅颈交界处。LI在CMI患者（N = 15）和年龄匹配的健康对照（N = 8）中使用基于受试者特定的颈脊髓蛛网膜下腔磁共振成像（MRI）测量的计算流体动力学进行评估。此外，还测量了每例受试者的CTH。CMI组的平均LI（551 ± 66 dyn/cm 5）显著高于对照组（220 ± 17 dyn/cm 5，p < 0.001）。CMI组的平均CTH为9.0 ± 1.1 mm，而对照组为−0.4 ± 0.5 mm。LI与CTH的回归分析发现弱相关性（R2= 0.46，p < 0.001），表明CTH不是小脑疝引起的CSF运动阻抗的良好指标。这些结果表明，CMI患者的CSF流动阻抗升高，LI提供了与标准CTH测量不同的信息。进一步的研究是必要的，以确定是否LI可以在CMI患者的诊断有用。
Diagnosis of Type I Chiari malformation (CMI) is difficult because the most commonly used diagnostic criterion, cerebellar tonsillar herniation (CTH) greater than 3–5 mm past the foramen magnum, has been found to have little correlation with patient symptom severity. Thus, there is a need to identify new objective measurement(s) to help quantify CMI severity. This study investigated longitudinal impedance (LI) as a parameter to assess CMI in terms of impedance to cerebrospinal fluid motion near the craniovertebral junction. LI was assessed in CMI patients (N = 15) and age-matched healthy controls (N = 8) using computational fluid dynamics based on subject-specific magnetic resonance imaging (MRI) measurements of the cervical spinal subarachnoid space. In addition, CTH was measured for each subject. Mean LI in the CMI group (551 ± 66 dyn/cm5) was significantly higher than in controls (220 ± 17 dyn/cm5, p < 0.001). Mean CTH in the CMI group was 9.0 ± 1.1 mm compared to −0.4 ± 0.5 mm in controls. Regression analysis of LI versus CTH found a weak relationship (R2= 0.46, p < 0.001), demonstrating that CTH was not a good indicator of the impedance to CSF motion caused by cerebellar herniation. These results showed that CSF flow impedance was elevated in CMI patients and that LI provides different information than a standard CTH measurement. Further research is necessary to determine if LI can be useful in CMI patient diagnosis.