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Relationship between Cough-Associated Changes in CSF Flow and Disease Severity in Chiari I Malformation: An
A F Bezuidenhout1, D Khatami2, C B Heilman3
1From the Departments of Radiology (A.F.B., D.K., R.A.B.) abezuide@bidmc.harvard.edu.
AJNR. American Journal of Neuroradiology
|May 12, 2018
Summary
Assessing cerebrospinal fluid (CSF) flow changes after coughing may offer an objective measure for Chiari I malformation severity. This noninvasive test could aid in clinical assessment of the condition.
Area of Science:
- Neurology
- Medical Imaging
- Fluid Dynamics
Background:
- Chiari I malformation lacks objective tests for disease severity.
- Current assessment relies on subjective symptom interpretation.
Purpose of the Study:
- To correlate disease severity in symptomatic Chiari I malformation patients with cough-associated changes in cerebrospinal fluid (CSF) flow.
- To explore the potential of real-time MR imaging for objective disease assessment.
Main Methods:
- Prospective study of 13 symptomatic Chiari I malformation patients (tonsillar herniation ≥5 mm).
- Real-time, flow-sensitized MR imaging measured CSF stroke volume during rest and post-coughing.
- Patients were categorized by neurosurgeons into nonspecific and specific Chiari I malformation groups.
Main Results:
- A significant negative correlation was found between the percentage change in CSF stroke volume (resting to post-coughing) and Chiari I malformation disease severity (R = 0.59; P = .03).
- The percentage change in CSF stroke volume differed significantly between patient groups (P = .04).
- No other CSF flow or anatomical measurements showed significant differences between groups.
Conclusions:
- Coughing challenge assessment of CSF flow shows potential as an objective, noninvasive test for Chiari I malformation severity.
- This method may improve clinical evaluation and disease management.
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