Magnetic resonance imaging-based measurements of cerebrospinal fluid and blood flow as indicators of intracranial compliance in patients with Chiari malformation
Magnetic resonance imaging-based measurements of cerebrospinal fluid and blood flow as indicators of intracranial compliance in patients with Chiari malformation
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DOI：
10.3171/jns.2005.103.1.0046
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发表时间：
2005-07-01
影响因子：
4.1
通讯作者：
Lichtor, T
中科院分区：
文献类型：
--
作者：
Alperin, N;Sivaramakrishnan, A;Lichtor, T
Object.基亚里畸形（CM）的诊断是基于扁桃体疝的程度，尽管这一发现并不一定与症状的存在或不存在相关。在有症状的患者和对照志愿者中评估颅内顺应性（ICC）和使用磁共振（MR）成像血流测量得出的局部颅颈流体动力学参数，以评估这些因素在相关病理生理学中的作用。17名健康志愿者和34例有症状的CM患者进行了研究，使用1.5特斯拉的MR成像仪。使用血液和脑脊液（CSF）流入和流出颅骨的电影相位对比图像来量化局部流体动力学参数（例如，脊髓位移和收缩期CSF速度和流速）和ICC。ICC是使用先前描述的方法得出的，该方法测量每个心动周期颅内体积和压力的微小自然变化，比较健康志愿者和CM患者的平均脊髓位移和收缩期CSF速度和流量的差异无统计学意义。然而，请注意，与对照组相比，患者的ICC（20%）在统计学上显著降低。以前的研究者主要关注脑脊液流速和脊髓移位来解释CM的发病机制。结果分析表明，ICC是更敏感的比当地的流体动力学参数的变化在有症状的患者的颅脊髓生物力学特性。作者得出结论，ICC降低比局部流体动力学参数（如颈部CSF速度和脊髓移位）更能解释CM病理生理学。低ICC也更好地解释了成年后症状的发作，因为ICC随着年龄的增长而下降。
Object. The diagnosis of Chiari malformation (CM) is based on the degree of tonsilar herniation, although this finding does not necessarily correlate with the presence or absence of symptoms. Intracranial compliance (ICC) and local craniocervical hydrodynamic parameters derived using magnetic resonance (MR) imaging flow measurements were assessed in symptomatic patients and control volunteers to evaluate the role of these factors in the associated pathophysiology.Methods. Seventeen healthy volunteers and 34 symptomatic patients with CM were studied using a 1.5-tesla MR imager. Cine phase-contrast images of blood and cerebrospinal fluid (CSF) flow to and from the cranium were used to quantify local hydrodynamic parameters (for example, cord displacement and systolic CSF velocity and flow rates) and ICC. The ICC was derived using a previously described method that measures the small, natural changes in intracranial volume and pressure with each cardiac cycle.Differences in the average cord displacement and systolic CSF velocity and flow, comparing healthy volunteers and patients with CM were not statistically significant. Note, however, that a statistically significant lower ICC (20%) was observed in patients compared with controls.Conclusions. Previous investigators have focused on CSF flow velocities and cord displacement to explain the pathogenesis of CM. Analysis of results have indicated that ICC is more sensitive than local hydrodynamic parameters to changes in the craniospinal biomechanical properties in symptomatic patients. The authors concluded that decreased ICC better explains CM pathophysiology than local hydrodynamic parameters such as cervical CSF velocities and cord displacement. Low ICC also better explains the onset of symptoms in adulthood given the decline in ICC with aging.