Chiari Malformasyonlu Hastaların BOS Akım Parametrelerinin Normal Sağlıklı Grup ile Kıyaslaması

Öz

Chiari malformasyonu (CM) serebellar tonsillerin foramen magnumun altına 5 mm'den fazla indiği bir hastalıktır. Semptomatik olmayan Chiari hastalarının nasıl yönetileceği konusunda fikir birliği yoktur. Çalışmamızda Chiari malformasyonu olan hastalarda BOS akım parametrelerinin normal sağlıklı grup ile kıyaslayarak farklılıkları ortaya koymayı hedefledik. Ocak 2016 ile Aralık 2019 arasında faz kontrast BOS akım MRG incelemesi yapılan 85 Chiari malformasyonlu hastayı ardışık olarak değerlendirdik. 18 ile 60 yaş arasındaki bireyleri dahil ettik. Ayrıca 29 adet sağlıklı gönüllü dahil edilerek faz-kontrast BOS akım MR görüntülemesi yapıldı. İleri hacim (FV), ters hacim (RV), akuaduktal strok hacmi (ASV), ortalama alan ve tepe hızı içeren BOS akış parametrelerini değerlendirildi. Ayrıca CM hastaların volümetrik T2 CISS görüntülemelerinden herniye tonsil ve foramen magnum çapları da kaydedildi. Akuaduktal strok volümünün CM hastalarında anlamlı olarak arttığı gözlendi (p = 0,049). Ortalama AS alanı CM hastalarında normal gruba oranla istatistiksel olarak anlamlı geniş bulunmuştur (p <0,001). Herniye tonsil ile foramen magnum çaplarının BOS akım parametreleri ile karşılaştırıldığında; herniye tonsil çapı arttıkça ASV azalmakta (p = 0.002, r = -0.333), foramen magnum çapı arttıkça da ASV azalmakta idi (p = 0.020, r = -0.251). CM hastalarında faz kontrast MR tekniği ile BOS akım parametrelerinin değerlendirmede akuaduktus Silvi düzeyi kolay ve pratik olması ve daha doğru sonuçlar vermesi nedeni ile kullanılabilecek anatomik bölgedir. CM hastalarında artmış ASV ve ortalama AS alan değerleri izlenmekte birlikte olağan dışı BOS akım değerlerini bize bildirmektedir.

Anahtar Kelimeler

• BOS akım
• mr
• chiari malformasyonu
• akuaduktal vurum hacmi
• faz kontrast MR

Comparison of CSF Flow Parameters of Patients with Chiari Malformation with Healthy Individuals

Öz

Chiari malformation (CM) is a disease in which cerebellar tonsils descend more than 5 mm below the foramen magnum. There is no consensus on how to manage non-symptomatic patients with CM. In our study, we tried to reveal the differences in CSF flow parameters in patients with Chiari malformation by comparing them with the normal healthy group.We evaluated 85 patients with Chiari malformation, who underwent phase contrast CSF flow MRI between January 2016 and December 2019, consecutively. We included individuals aged between 18 and 60 years. In addition, 29 healthy volunteers were included and phase-contrast CSF flow MR imaging was performed. CSF flow parameters including forward volume (FV), reverse volume (RV), aqueductal stroke volume (ASV), mean area, and peak velocity were evaluated. In addition, the diameters of the herniated tonsil and foramen magnum were recorded from volumetric T2 CISS images of CM patients. It was observed that the aqueductal stroke volume increased significantly in CM patients (p = 0.049). The mean area of AS was found to be statistically significantly larger in CM patients compared to the normal group (p <0.001). When the diameters of the herniated tonsil and foramen magnum were compared with the CSF flow parameters; ASV decreased as the diameter of the herniated tonsil increased (p = 0.002, r = -0.333), and as the diameter of the foramen magnum increased, ASV decreased (p = 0.020, r = -0.251). Aqueductus Sylvii level is an anatomical location that can be used in CM patients for the evaluation of CSF flow parameters with phase contrast MR technique, since it is easy and practical and gives more accurate results. Increased ASV and average AS field values are observed in CM patients, and these are unusual CSF flow values.

Anahtar Kelimeler

• MR
• aquaductal stroke volume
• phase contrast MR
• CSF flow

Kaynakça

1. 1. Barkovich AJ, Wippold FJ, Sherman JL, Citrin CM. Significance of cerebellar tonsillar position on MR. AJNR Am J Neuroradiology 1986;7:795-799.
2. 2. Smith BW, Strahle J, Bapuraj JR, Muraszko KM, Garton HJ, Maher CO. Distribution of cerebellar tonsil position: implications for understanding Chiari malformation. J Neurosurg 2013;119:812-819.
3. 3. Koc K, Anik Y, Anik I, Cabuk B, Ceylan S. Chiari malformation with syringomyelia: correlation phase-contrast cine MR imaging and outcome. Turk Neurosurg 2007;17:183-192.
4. 4. Wang CS, Wang X, Fu CH, Wei LQ, Zhou DQ, Lin JK. Analysis of cerebrospinal fluid flow dynamics and morphology in Chiari I malformation with cine phase-contrast magnetic resonance imaging. Acta Neurochir 2014;156:707-713.
5. 5. Lloyd RA, Fletcher DF, Clarke EC, Bilston LE. Chiari malformation may increase perivascular cerebrospinal fluid flow into the spinal cord: A subject-specific computational modelling study. J Biomech 201;65:185-193.
6. 6. Levine DN. The pathogenesis of syringomyelia associated with lesions at the foramen magnum: a critical review of existing theories and proposal of new hypothesis. J Neurol Sci 2004;220:3-21.
7. 7. Panigrahi M, Reddy BP, Reddy AK, Reddy JJ. CSF flow study in Chiari I malformation. Childs Nerv Syst. 2004 May;20(5):336-40. doi: 10.1007/s00381-003-0881-3. Epub 2004 Apr 9.
8. 8. Krueger KD, Haughton VM, Hetzel S. Peak CSF velocities in patients with symptomatic and asymptomatic Chiari I malformation. AJNR Am J Neuroradiol. 2010 Nov;31(10):1837-41.

9. 9. McGirt MJ, Nimjee SM, Floyd J, Bulsara KR, George TM. Correlation of cerebrospinal fluid flow dynamics and headache in Chiari I malformation. Neurosurgery. 2005 Apr;56(4):716-21;
10. 10. Schaffer N, Martin B, Loth F. Cerebrospinal fluid hydrodynamics in type I Chiari malformation. Neurol Res 2011;33:247-260.
11. 11. Shah S, Haughton V, Munoz del Rio A. CSF flow through the upper cervical canal in Chiari I malformation. AJNR Am J Neuroradiology 2011;32:1149-1153.
12. 12. Wentland AL, Wieben O, Korosec FR, et al. Accuracy and reproduccility of phase-contrast MR imaging measurements for CSF flow. Am J Neuroradiol 2010;31:1331-1336.