Abstract

CSF flow has been shown to exhibit complex patterns in MR images in both healthy subjects and in patients with Chiari I. Abnormal CSF flow oscillations, according to prevailing opinion, cause syringomyelia and other clinical manifestations that affect some patients with the Chiari I malformation. For this article, we reviewed the literature on PC MR of CSF flow, collected the published CFD studies relevant to CSF flow, and performed flow simulations. PC MR creates cine and still images of CSF flow and measurements of flow velocities. CFD, a technique used to compute flow and pressure in liquid systems, simulates the CSF flow patterns that occur in a specific geometry or anatomy of the SAS and a specific volume of flow. Published PC MR studies show greater peak CSF velocities and more complex flow patterns in patients with Chiari I than in healthy subjects, with synchronous bidirectional flow one of the characteristic markers of pathologic flow. In mathematic models of the SAS created from high-resolution MR images, CFD displays complex CSF flow patterns similar to those shown in PC MR in patients. CFD shows that the pressure and flow patterns vary from level to level in the upper spinal canal and differ between patients with Chiari and healthy volunteers. In models in which elasticity and motion are incorporated, CFD displays CSF pressure waves in the SAS. PC MR and CFD studies to date demonstrate significant alterations of CSF flow and pressure patterns in patients with Chiari I. CSF flow has nonlaminar complex spatial and temporal variations and associated pressure waves and pressure gradients. Additional simulations of CSF flow supplemented by PC MR will lead to better measures for distinguishing pathologic flow abnormalities that cause syringomyelia, headaches, and other clinical manifestations in Chiari I malformations.

Highlights

  • ABBREVIATIONS: CFD ϭ computational fluid dynamics; PC MR ϭ phase-contrast cardiac-gated MR studies; SAS ϭ subarachnoid space

  • Oscillatory CSF flow has been characterized with PC MR and CFD

  • CFD, by simulating CSF flow in patient-specific and in idealized models of the SAS, provides flow descriptions with greater temporal and spatial resolution than those obtained with PC MR and provides other parameters of flow, such as pressures, pressure gradients, pressure waves, and stresses

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Summary

Introduction

ABBREVIATIONS: CFD ϭ computational fluid dynamics; PC MR ϭ phase-contrast cardiac-gated MR studies; SAS ϭ subarachnoid space. PC MR displays CSF flow patterns, shows spinal cord and tonsil motion, and measures changes in CSF flow velocities during the cardiac cycle. Effect on CSF Flow of Varying Anatomy and Boundary Conditions in Rigid Models of the SAS Patients with Chiari I have different SAS dimensions and a different tonsil position than healthy individuals.

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