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

Saeed Mohsenian; Alaaddin Ibrahimy; Mohamad Motaz F Al Samman; John N Oshinski; Rafeeque A Bhadelia; Daniel L Barrow; Philip A Allen; Rouzbeh Amini; Francis Loth

doi:10.1007/s00234-023-03207-9

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

Neuroradiology. 2023 Oct;65(10):1535-1543. doi: 10.1007/s00234-023-03207-9. Epub 2023 Aug 30.

Authors

Saeed Mohsenian¹, Alaaddin Ibrahimy², Mohamad Motaz F Al Samman³, John N Oshinski⁴, Rafeeque A Bhadelia⁵, Daniel L Barrow⁶, Philip A Allen⁷, Rouzbeh Amini⁸, Francis Loth⁹

Affiliations

¹ Department of Bioengineering, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, USA. mohseniankoochaksa.s@northeastern.edu.
² Department of Biomedical Engineering, Yale University, 17 Hillhouse Ave, New Haven, CT, 06520, USA.
³ Department of Bioengineering, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, USA.
⁴ Departments of Radiology & Imaging Sciences and Biomedical Engineering, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322, USA.
⁵ Department of Radiology, Beth Israel Deaconess Medical Center & Harvard University School of Medicine, 330 Brookline Ave, Boston, MA, 02215, USA.
⁶ Department of Neurosurgery, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322, USA.
⁷ Department of Psychology, The University of Akron, 302 E Buchtel Ave, Akron, OH, 44325, USA.
⁸ Departments of Mechanical and Industrial Engineering, and Bioengineering, Northeastern University, 805 Columbus Ave, ISEC 508, Boston, MA, 02120, USA.
⁹ Departments of Mechanical and Industrial Engineering, and Bioengineering, Northeastern University, 360 Huntington Ave, SN 257, Boston, MA, 02115, USA.

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.

Keywords: Chiari malformation type I; Computational fluid dynamics techniques; Displacement encoding with stimulated echoes; Integrated longitudinal impedance.

MeSH terms

Arnold-Chiari Malformation* / diagnostic imaging
Brain / diagnostic imaging
Brain Stem
Cerebellum
Healthy Volunteers
Humans

Grants and funding

R15 NS109957/NS/NINDS NIH HHS/United States