Association between resistance to cerebrospinal fluid flow and cardiac-induced brain tissue motion for Chiari malformation type I

• Authors: Saeed Mohsenian, Northeastern University; Alaaddin Ibrahimy, Yale University; Mohamad Motaz F. Al Samman, Northeastern University; John Oshinski, Emory University; Rafeeque A. Bhadelia, Beth Israel Deaconess Medical Center; Daniel Barrow, Emory University; Philip A. Allen, University of Akron; Rouzbeh Amini, Northeastern University; Francis Loth, Northeastern University
• Journal Title: NEURORADIOLOGY
• Volume: Volume 65, Number 10
• Publisher: SPRINGER | 2023-08-30, Pages 1535-1543
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1007/s00234-023-03207-9
• Subjects: Health Sciences, Radiology; Biology, Neuroscience
• Keywords: Science & Technology; Life Sciences & Biomedicine; Clinical Neurology; Neuroimaging; Radiology, Nuclear Medicine & Medical Imaging; Neurosciences & Neurology; Chiari malformation type I; Integrated longitudinal impedance; Computational fluid dynamics techniques; Displacement encoding with stimulated echoes; CEREBELLAR; TRACKING; DENSE

Abstract

Purpose: Chiari malformation type I (CMI) patients have been independently shown to have both increased resistance to cerebrospinal fluid (CSF) flow in the cervical spinal canal and greater cardiac-induced neural tissue motion compared to healthy controls. The goal of this paper is to determine if a relationship exists between CSF flow resistance and brain tissue motion in CMI subjects. Methods: Computational fluid dynamics (CFD) techniques were employed to compute integrated longitudinal impedance (ILI) as a measure of unsteady resistance to CSF flow in the cervical spinal canal in thirty-two CMI subjects and eighteen healthy controls. Neural tissue motion during the cardiac cycle was assessed using displacement encoding with stimulated echoes (DENSE) magnetic resonance imaging (MRI) technique. Results: The results demonstrate a positive correlation between resistance to CSF flow and the maximum displacement of the cerebellum for CMI subjects (r = 0.75, p = 6.77 × 10−10) but not for healthy controls. No correlation was found between CSF flow resistance and maximum displacement in the brainstem for CMI or healthy subjects. The magnitude of resistance to CSF flow and maximum cardiac-induced brain tissue motion were not statistically different for CMI subjects with and without the presence of five CMI symptoms: imbalance, vertigo, swallowing difficulties, nausea or vomiting, and hoarseness. Conclusion: This study establishes a relationship between CSF flow resistance in the cervical spinal canal and cardiac-induced brain tissue motion in the cerebellum for CMI subjects. Further research is necessary to understand the importance of resistance and brain tissue motion in the symptomatology of CMI.