Tarek Zoubi, Presenter: Nothing to Disclose

Jan Robert Kroger, Abstract Co-Author: Nothing to Disclose

Thomas Niederstadt MD, Abstract Co-Author: Nothing to Disclose

Wolfram Schwindt MD, Abstract Co-Author: Nothing to Disclose

Angela Brentrup MD, Abstract Co-Author: Nothing to Disclose

David Christian Maintz MD, Abstract Co-Author: Nothing to Disclose

Barbara Fiedler MD, Abstract Co-Author: Nothing to Disclose

Gerard Crelier, Abstract Co-Author: Employee, GyroTools Ltd Shareholder, GyroTools Ltd

Walter Leonhard Heindel MD, Abstract Co-Author: Nothing to Disclose

Alexander Christian Bunck, Abstract Co-Author: Nothing to Disclose

Our purpose was to analyze the cerebrospinal fluid (CSF) flow dynamics in patients with idiopathic syringomyelia using magnetic resonance (MR) 4D flow imaging.

11 patients with idiopathic syringomyelia were examined using cardiac gated 4D-phase-contrast imaging at the craniocervical junction and the cervical spinal canal on a 1.5T MRI system followed by quantitative and qualitative flow analysis. Results were compared with a group of 10 healthy volunteers. On qualitative analysis altered flow-patterns were identified. On quantitative analysis peak flow velocities and timing of the CSF pulse wave were assessed.

Compared with healthy volunteers patients with idiopathic syringomyelia showed significantly increased systolic CSF flow velocities at the level of the craniocervical junction (Foramen magnum: -3,1±1 cm/s vs. -6,5±3,0 cm/s, p=0,001; C1: -3,7±0,8 cm/s vs. -6,3±1,6 cm/s, p<0,001). Maximal systolic CSF flow velocities at the levels of C1 and C7 occured significantly later in patients (C1: 31±14% of cardiac cylce vs. 23±4%, p<0.05; C7: 50±28% vs. 27±6%, p<0.005). A comparison of the timing of maximal systolic flow at the levels of C1 and C7 revealed a tendency for a slower CSF pulse wave in patients without reaching statistical significance. On qualitative analysis 5 patients showed no conspicuous findings, while altered flow patterns were found in 6 patients with bilateral flow jets in 5 patients and an anterior flow jet in 1 patient.

MR 4D flow imaging allowed for a comprehensive qualitative and quantitative analysis of the altered CSF flow dynamics in patients with idiopathic syringomyelia. CSF peak flow velocity were significantly increased in patients. Moreover, peak systolic velocities occured significantly later in cardiac cycle implying a significant phase offset between the arterial and CSF pulse wave in patients with idiopathic syringomyelia.

Our study shows how 4D MR flow imaging in patients with idiopathic syringomyelia helps to improve our understanding of the mechanisms leading to syrinx formation.

Zoubi, T, Kroger, J, Niederstadt, T, Schwindt, W, Brentrup, A, Maintz, D, Fiedler, B, Crelier, G, Heindel, W, Bunck, A, MRI 4D Flow Characteristics of Cerebrospinal Fluid at Craniocervical Junction and Cervical Spinal Canal in Patients with Idiopathic Syringomyelia.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12028920.html