Cerebrospinal Fluid Flow and Brain Motion in Chiari I Malformation: Past, Present, and Future

• Published in: Journal of magnetic resonance imaging Vol. 58; no. 2; pp. 360 - 378
• Main Authors: Bhadelia, Rafeeque A., Chang, Yu‐Ming, Oshinski, John N., Loth, Francis
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.08.2023; Wiley Subscription Services, Inc
• Subjects: Arnold-Chiari Malformation - diagnostic imaging; Brain; Brain - diagnostic imaging; brain motion; Cerebrospinal fluid; Cerebrospinal Fluid - diagnostic imaging; Chiari I malformation; CSF flow; Fluid flow; Humans; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Medical imaging; Motion; MRI; Neuroimaging; Pressure; Spinal cord; Syringomyelia - complications; Syringomyelia - surgery; brain motion; CSF flow; Chiari I malformation; MRI
• ISSN: 1053-1807; 1522-2586; 1522-2586
• DOI: 10.1002/jmri.28717

Cranio‐spinal volume and pressure changes associated with the cardiac‐cycle and respiration are altered in Chiari I malformation (CMI) due to obstruction of cerebrospinal fluid (CSF) flow at the foramen magnum. With the introduction of motion‐sensitive MRI sequences, it was envisioned that these could provide noninvasive information about volume–pressure dynamics at the cranio‐cervical junction in CMI hitherto available only through invasive pressure measurements. Since the early 1990s, multiple studies have assessed CSF flow and brain motion in CMI. However, differences in design and varied approaches in the presentation of results and conclusions makes it difficult to fully comprehend the role of MR imaging of CSF flow and brain motion in CMI. In this review, a cohesive summary of the current status of MRI assessment of CSF flow and brain motion in CMI is presented. Simplified versions of the results and conclusions of previous studies are presented by dividing the studies in distinct topics: 1) comparing CSF flow and brain motion between healthy subjects (HS) and CMI patients (before and after surgery), 2) comparing CSF flow and brain motion to CMI severity and symptoms, and 3) comparing CSF flow and brain motion in CMI with and without syringomyelia. Finally, we will discuss our vision of the future directions of MR imaging in CMI patients. Evidence Level 2. Technical Efficacy 5.