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Magnetic resonance 4D flow characteristics of cerebrospinal fluid at the craniocervical junction and the cervical spinal canal

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Abstract

Objectives

To evaluate the applicability of 4D phase contrast (4D PC) MR imaging in the assessment of cerebrospinal fluid dynamics in healthy volunteers and patients with lesions at the craniocervical junction or the cervical spinal canal.

Methods

Ten healthy volunteers and four patients with lesions including Chiari I malformation and cervical canal stenoses were examined by a cardiac-gated 4D PC imaging sequence on 1.5T MRI. Phase contrast images were postprocessed allowing for flow quantification and flow pathline visualisation. Velocity data were compared with conventional axial 2D phase contrast images.

Results

The 4D PC sequence allowed for flow quantification and visualisation in all individuals. Bland-Altman analysis showed good agreement of 2D and 4D PC velocity data. In healthy volunteers, CSF flow was homogeneously distributed in the anterior and anterolateral subarachnoid space with the flow directed caudally during systole and cranially during diastole. Flow velocities were closely related to the width of the subarachnoid space. Patients showed grossly altered CSF flow patterns with formation of flow jets with increased flow velocities.

Conclusions

4D PC MR imaging allows for a detailed assessment of CSF flow dynamics helping to distinguish physiological from complex pathological flow patterns at the craniocervical junction and the cervical spine.

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Authors and Affiliations

  1. Department of Clinical Radiology, University Hospital of Muenster, Muenster, Germany

    Alexander C. Bunck, Jan-Robert Kröger, Alena Jüttner, Wolfram Schwindt, Walter Heindel, Thomas Niederstadt & David Maintz

  2. Department of Neurosurgery, University Hospital of Muenster, Muenster, Germany

    Angela Brentrup

  3. Department of General Pediatrics, Subdivision Pediatric Neurology, University Hospital of Muenster, Muenster, Germany

    Barbara Fiedler

  4. Institute of Biostatistics, Leibniz University Hannover, Hannover, Germany

    Frank Schaarschmidt

  5. Institute for Biomedical Engineering, ETH and University of Zurich, Zurich, Switzerland

    Gerard R. Crelier

  6. Department of Clinical Radiology, University Hospital Muenster, Albert-Schweitzer-Strasse 33, 48149, Muenster, Germany

    Alexander C. Bunck

Authors
  1. Alexander C. Bunck
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  2. Jan-Robert Kröger
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  3. Alena Jüttner
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  4. Angela Brentrup
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  5. Barbara Fiedler
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  6. Frank Schaarschmidt
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  7. Gerard R. Crelier
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  8. Wolfram Schwindt
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  9. Walter Heindel
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  10. Thomas Niederstadt
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  11. David Maintz
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Corresponding author

Correspondence to Alexander C. Bunck.

Electronic supplementary material

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Movie 1

In healthy volunteers the main CSF flow component was evenly distributed across the anterior and anterolateral subarachnoid space extending from the craniocervical junction throughout the entire cervical spinal canal. (MPG 10050 kb)

Movie 2

Patient 1 with pronounced Chiari I malformation and presyrinx at the level of C2 showing two flow vortices located bilaterally in the anterolateral subarachnoid space extending from the foramen magnum to the level of C2/C3. (MPG 8426 kb)

SSFP Cine imaging showing increased motion of cerebellar tonsils and brain stem in patient 1. (AVI 636 kb)

On SSFP cine images in patient 2 only a little excursion of the cerebellar tonsils was observed (1 mm), anterior subarachnoid space at the level of C1 narrowed by 0.3 mm. (AVI 496 kb)

Movie 5

4D flow imaging showing severe flow acceleration in patient 2 with two flow jets located bilaterally in the anterolateral subarachnoid space extending from the foramen magnum to the level of C2/C3 with accentuation on the right side (MPG 6200 kb)

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Bunck, A.C., Kröger, JR., Jüttner, A. et al. Magnetic resonance 4D flow characteristics of cerebrospinal fluid at the craniocervical junction and the cervical spinal canal. Eur Radiol 21, 1788–1796 (2011). https://doi.org/10.1007/s00330-011-2105-7

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  • DOI: https://doi.org/10.1007/s00330-011-2105-7

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