TY - JOUR T1 - Cough-Associated Changes in CSF Flow in Chiari I Malformation Evaluated by Real-Time MRI JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. SP - 825 LP - 830 DO - 10.3174/ajnr.A4629 VL - 37 IS - 5 AU - R.A. Bhadelia AU - S. Patz AU - C. Heilman AU - D. Khatami AU - E. Kasper AU - Y. Zhao AU - N. Madan Y1 - 2016/05/01 UR - http://www.ajnr.org/content/37/5/825.abstract N2 - BACKGROUND AND PURPOSE: Invasive pressure studies have suggested that CSF flow across the foramen magnum may transiently decrease after coughing in patients with symptomatic Chiari I malformation. The purpose of this exploratory study was to demonstrate this phenomenon noninvasively by assessing CSF flow response to coughing in symptomatic patients with Chiari I malformation by using MR pencil beam imaging and to compare the response with that in healthy participants.MATERIALS AND METHODS: Eight symptomatic patients with Chiari I malformation and 6 healthy participants were studied by using MR pencil beam imaging with a temporal resolution of ∼50 ms. Patients and healthy participants were scanned for 90 seconds (without cardiac gating) to continuously record cardiac cycle–related CSF flow waveforms in real-time during resting, coughing, and postcoughing periods. CSF flow waveform amplitude, CSF stroke volume, and CSF flow rate (CSF Flow Rate = CSF Stroke Volume × Heart Rate) in the resting and immediate postcoughing periods were determined and compared between patients and healthy participants.RESULTS: There was no significant difference in CSF flow waveform amplitude, CSF stroke volume, and the CSF flow rate between patients with Chiari I malformation and healthy participants during rest. However, immediately after coughing, a significant decrease in CSF flow waveform amplitude (P < .001), CSF stroke volume (P = .001), and CSF flow rate (P = .001) was observed in patients with Chiari I malformation but not in the healthy participants.CONCLUSIONS: Real-time MR imaging noninvasively showed a transient decrease in CSF flow across the foramen magnum after coughing in symptomatic patients with Chiari I malformation, a phenomenon not seen in healthy participants. Our results provide preliminary evidence that the physiology-based imaging method used here has the potential to be an objective clinical test to differentiate symptomatic from asymptomatic patients with Chiari I malformation.ACSFCSF flow waveform amplitudeCMIChiari I malformationFRCSFCSF flow ratePBIpencil beam imagingSVCSFCSF stroke volume ER -