Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Radiology & Imaging Sciences and Biomedical Engineering, Emory University School of Medicine, Atlanta, Georgia, USA.
J Magn Reson Imaging. 2023 Aug;58(2):360-378. doi: 10.1002/jmri.28717. Epub 2023 Apr 3.
Cranio-spinal volume and pressure changes associated with the cardiac-cycle and respiration are altered in Chiari I malformation (CMI) due to obstruction of cerebrospinal fluid (CSF) flow at the foramen magnum. With the introduction of motion-sensitive MRI sequences, it was envisioned that these could provide noninvasive information about volume-pressure dynamics at the cranio-cervical junction in CMI hitherto available only through invasive pressure measurements. Since the early 1990s, multiple studies have assessed CSF flow and brain motion in CMI. However, differences in design and varied approaches in the presentation of results and conclusions makes it difficult to fully comprehend the role of MR imaging of CSF flow and brain motion in CMI. In this review, a cohesive summary of the current status of MRI assessment of CSF flow and brain motion in CMI is presented. Simplified versions of the results and conclusions of previous studies are presented by dividing the studies in distinct topics: 1) comparing CSF flow and brain motion between healthy subjects (HS) and CMI patients (before and after surgery), 2) comparing CSF flow and brain motion to CMI severity and symptoms, and 3) comparing CSF flow and brain motion in CMI with and without syringomyelia. Finally, we will discuss our vision of the future directions of MR imaging in CMI patients. EVIDENCE LEVEL: 2. TECHNICAL EFFICACY: 5.
颅脊容积和压力变化与心脏周期和呼吸有关，在颅底凹陷症（CMI）中由于脑脊液（CSF）在枕骨大孔处流动受阻而发生改变。随着运动敏感 MRI 序列的引入，人们设想这些序列可以提供 CMI 颅颈交界处容积-压力动力学的无创信息，而这些信息以前只能通过有创压力测量获得。自 20 世纪 90 年代初以来，多项研究评估了 CMI 中的 CSF 流动和脑运动。然而，由于设计差异以及结果和结论的呈现方式不同，使得难以全面理解 CSF 流动和脑运动的 MR 成像在 CMI 中的作用。在这篇综述中，提出了对 CMI 中 CSF 流动和脑运动的 MRI 评估的现状进行综合总结。通过将研究分为以下几个不同的主题，提出了以前研究的结果和结论的简化版本：1）比较健康受试者（HS）和 CMI 患者（手术前后）之间的 CSF 流动和脑运动，2）比较 CSF 流动和脑运动与 CMI 严重程度和症状的关系，以及 3）比较 CMI 伴或不伴脊髓空洞症的 CSF 流动和脑运动。最后，我们将讨论我们对 CMI 患者 MR 成像未来方向的看法。证据水平：2. 技术功效：5.
