Pujol J, Roig C, Capdevila A, Pou A, Martí-Vilalta J L, Kulisevsky J, Escartín A, Zannoli G
Magnetic Resonance Center of Pedralbes, Barcelona, Spain.
Neurology. 1995 Sep;45(9):1746-53. doi: 10.1212/wnl.45.9.1746.
We studied the effects on CSF dynamics at the foramen magnum and the clinical significance of the abnormal tonsillar motion in 14 patients with Chiari type I malformation and 14 control subjects using cine phase-contrast MRI. Dynamic MRI consisted of axial and sagittal cine phase-contrast sequences. CSF and tonsillar motion were qualitatively and quantitatively evaluated, and the subarachnoid space at the foramen magnum measured. In Chiari patients, cine phase-contrast MRI detected the abnormal pulsatile motion of the cerebellar tonsils, which produced a selective obstruction of CSF flow from the cranial cavity to the spine. The amplitude of the tonsillar pulsation and the severity of the arachnoid space reduction were associated with the symptom of cough-strain headache, but not with the presence of syringomyelia. The finding of abnormal valve dynamics of the cerebellar hernia revealed by cine phase-contrast MRI conforms to the pathophysiologic mechanisms suggested in pressure register studies and opens a new possibility in the presurgical assessment of Chiari patients with exertional symptoms.
我们使用电影相位对比磁共振成像（cine phase - contrast MRI）研究了14例I型Chiari畸形患者和14例对照者枕大孔处脑脊液动力学的影响以及扁桃体异常运动的临床意义。动态MRI由轴向和矢状位电影相位对比序列组成。对脑脊液和扁桃体运动进行了定性和定量评估，并测量了枕大孔处的蛛网膜下腔。在Chiari患者中，电影相位对比MRI检测到小脑扁桃体的异常搏动性运动，这导致了脑脊液从颅腔向脊柱流动的选择性梗阻。扁桃体搏动的幅度和蛛网膜下腔缩小的严重程度与咳嗽 - 用力性头痛症状相关，但与脊髓空洞症的存在无关。电影相位对比MRI揭示的小脑疝瓣膜动力学异常的发现符合压力记录研究中提出的病理生理机制，并为有运动症状的Chiari患者术前评估开辟了新的可能性。
