Optimum Trigger-delay for Peripheral-pulse Gating to Reduce CSF Flow Artifact in MRI of the Cervical Spine

Object. To assess its usefulness in demonstrating cisternal anatomy, the authors investigated magnetic resonance (MR) cisternography in which a heavily T2-weighted turbo spin—echo method was used to visualize normal anatomical fine structures and lesions in the basal cisterns in 20 healthy volunteers and 43 patients. The authors applied peripheral pulse gating, which had been optimized to reduce artifacts in the cisterns attributable to cerebrospinal fluid (CSF) flow. Methods. The detectability of each cranial nerve was determined in healthy volunteers. The first, second, and third nerves and the seventh—eighth nerve complex were clearly visualized in all participants; the fifth nerve was clearly seen in 80% and the sixth cranial nerve in 50%. The fourth nerve and the ninth through 12th nerves were difficult to identify individually, except in some volunteers. To reduce artifacts caused by fast CSF flow, we determined the delays as a function of the time elapsed between two consecutive peaks of pulse wave in a peripheral pulse gate (P—P interval) at which there was reversal of flow direction to minimize the CSF flow—related artifact. Using peripheral pulse gating and a time delay of 30% of the R—R interval, the authors succeeded in minimizing the CSF flow—related artifacts. Magnetic resonance cisternography appears to be very useful for demonstrating intracisternal fine anatomy and enhancing the contours of the juxtacisternal lesion. A minute amount of CSF interposed between lesions and normal structures such as nerves, vessels, or bone structures can be detected by means of this sequence. In patients with facial spasm, axial images and oblique coronal images obtained in a plane parallel to the seventh—eighth cranial nerve complex demonstrated vascular compression in all 13 patients. The MR cisternography finding of compression was confirmed in all nine patients who underwent microvascular decompression. Conclusions. Magnetic resonance cisternography appears to show great promise for evaluation of patients with neurovascular compression or tumors in and around the basal cisterns; the procedure adds only a small amount of imaging time.

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Chiari malformation Type I and syrinx in children undergoing magnetic resonance imaging

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.5.peds1121 ◽

2011 ◽

Vol 8 (2) ◽

pp. 205-213 ◽

Cited By ~ 111

Author(s):

Jennifer Strahle ◽

Karin M. Muraszko ◽

Joseph Kapurch ◽

J. Rajiv Bapuraj ◽

Hugh J. L. Garton ◽

...

Keyword(s):

Cervical Spine ◽

Mr Imaging ◽

Chiari Malformation ◽

Foramen Magnum ◽

Type I ◽

Csf Flow ◽

Tonsillar Herniation ◽

Chiari Malformation Type I ◽

Age Related ◽

Imaging Characteristics

Object Chiari malformation Type I (CM-I) with an associated spinal syrinx is a common pediatric diagnosis. A better understanding of the relative age-related prevalence and MR imaging characteristics of these associated conditions may lead to improved treatment decisions. Methods The authors performed a retrospective review of 14,116 consecutive individuals 18 years of age or younger who had undergone brain or cervical spine MR imaging at the University of Michigan between November 1997 and August 2008. In the patients with CM-I, demographic, clinical, and radiographic information was recorded. Results Five hundred nine children (3.6%) with CM-I were identified. Among these patients, 23% also had a spinal cord syrinx, and 86% of the syringes were found in the cervical spine. The MR imaging prevalence of CM-I with a syrinx was 1.2% in girls and 0.5% in boys (p < 0.0001). The severity of impaired CSF flow at the foramen magnum was associated with the amount of tonsillar herniation (p < 0.0001) and conformation of the tonsils (p < 0.0001). Patients with CM-I were treated surgically in 35% of cases; these patients exhibited more severe tonsillar herniation (p < 0.0001) and impaired CSF flow (p < 0.0001) as compared with those who did not undergo surgery. On imaging, 32% of all the patients with CM-I were considered symptomatic by the treating physician. Patients were more likely to be considered symptomatic if they were female, had a syrinx, displayed abnormal tonsillar pulsations, or had a greater amount of tonsillar herniation. Conclusions In this study the authors describe the age-related prevalence and MR imaging characteristics of CM-I and its association with a syrinx and other abnormalities in a large group of children who underwent MR imaging for any indication. Syringes are more common in older children, in girls, and in patients with a greater degree of tonsillar descent and CSF flow impairment.

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CSF Flow Artifact

Imaging in Neurology ◽

10.1016/b978-0-323-44781-2.50333-8 ◽

2016 ◽

pp. 426

Keyword(s):

Csf Flow ◽

Flow Artifact

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CSF Flow Artifact

Diagnostic Imaging: Spine ◽

10.1016/b978-0-323-37705-8.50214-5 ◽

2015 ◽

pp. 834-835

Keyword(s):

Csf Flow ◽

Flow Artifact

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Estimation of CSF Flow Resistance in the Upper Cervical Spine

The Neuroradiology Journal ◽

10.1177/197140091302600118 ◽

2013 ◽

Vol 26 (1) ◽

pp. 106-110 ◽

Cited By ~ 8

Author(s):

K-A. Mardal ◽

G. Rutkowska ◽

S. Linge ◽

V. Haughton

Keyword(s):

Cervical Spine ◽

Healthy Volunteers ◽

Subarachnoid Space ◽

Spinal Canal ◽

Flow Resistance ◽

Upper Cervical Spine ◽

Csf Flow ◽

Cervical Spinal Canal ◽

Upper Cervical ◽

Chiari I

Chiari I patients have increased CSF velocities in the foramen magnum due hypothetically to increased pressure gradients or reduced flow resistance. We calculated flow resistance in the cervical spinal canal in a group of subjects with and without the Chiari malformation. Eight subjects including healthy volunteers and Chiari I patients were studied. From 3D high resolution MR images of the cervical spine mathematical models of the subarachnoid spaces were created by means of standard programs for segmentation and discretization. Oscillatory flow through the subarachnoid space was simulated. Cross-sectional area of the subarachnoid space was computed at each level from C1 through C4 and the length of this spinal canal segment was measured. Peak caudad CSF flow velocity at each level was plotted against cross-section area. CSF volumetric flux and resistance were calculated for each subject. The correlation between velocity and resistance was calculated. In all subjects, peak velocities increased progressively from C1 to C4 by 0.6 to 0.7 cm/s per level. Spinal canal areas diminished from C1 to C5 in each subject at a rate of 0.25 to 0.29 cm2per level. Resistance averaged 4.3 pascal/ml/s in the eight subjects; 3.8 pascal/ml/s in patients with tonsilar herniation and 6.0 pascal/ml/s in volunteers. Velocity correlated inversely with resistance (R2= 0.6). CSF velocities correlated inversely with the flow resistance in the upper cervical spinal canal. Resistance tends to be lower in Chiari I patients than in healthy volunteers.

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