哮喘联盟

   摘要
   背景和目的:侵入性压力研究已经表明：有症状的Chiari I畸形患者咳嗽后，经枕骨大孔的脑脊液循环可能会暂时性减少。这项探索性研究的目的是：通过使用非侵袭性的方式（MR笔形束成像）来评价有症状的Chiari I 畸形患者咳嗽时的脑脊液循环反应并与健康受试者的反应进行比较来证明这个现象。
   材料与方法:通过使用50ms瞬时分辨率的MR笔形束成像对8例有症状的Chiari I 畸形患者和6名健康受试者进行研究。患者和健康受试者经90秒扫描(无心脏门控)，以在静息期、咳嗽期和咳嗽后期持续性实时记录心脏循环相关的脑脊液循环波形。测定静息期和咳嗽后初期的脑脊液循环波形振幅、脑脊液每搏输出量和脑脊液流速(脑脊液流速=脑脊液每搏输出量×心率)，并将患者与健康受试者的数据相比较。
   结果:在静息期，Chiari I畸形患者与健康受试者之间的脑脊液循环波形振幅、脑脊液每搏输出量和脑脊液流速没有显著性差异。然而，咳嗽后初期，在Chiari I畸形患者中观察到脑脊液循环波形振幅(P < .001)、脑脊液每搏输出量(P = .001)和脑脊液流速(P = .001) 显著下降，而在健康受试者中没有观察到该现象。
   结论:实时MR成像非侵袭性地显示：Chiari I畸形患者咳嗽后，经枕骨大孔的脑脊液循环短暂下降，而这一现象在健康受试者中未被观察到。我们的结果初步证明：这里采用的基于生理成像的方法可能成为一种客观的临床测试方法，用来区分有症状的和无症状的Chiari I畸形患者。
 

（苏欣 审校）
AJNR Am J Neuroradiol. 2015 Dec 24. [Epub ahead of print]


 

Cough-Associated Changes in CSF Flow in Chiari I Malformation Evaluated by Real-Time MRI.
 

Bhadelia RA1, Patz S2, Heilman C2, Khatami D2, Kasper E2, Zhao Y2, Madan N2.
 

Abstract
BACKGROUND AND PURPOSE:Invasive pressure studies have suggested that CSF flow across the foramen magnum may transiently decrease after coughing in patients with symptomatic Chiari I malformation. The purpose of this exploratory study was to demonstrate this phenomenon noninvasively by assessing CSF flow response to coughing in symptomatic patients with Chiari I malformation by using MR pencil beam imaging and to compare the response with that in healthy participants.
MATERIALS AND METHODS:Eight symptomatic patients with Chiari I malformation and 6 healthy participants were studied by using MR pencil beam imaging with a temporal resolution of ∼50 ms. Patients and healthy participants were scanned for 90 seconds (without cardiac gating) to continuously record cardiac cycle-related CSF flow waveforms in real-time during resting, coughing, and postcoughing periods. CSF flow waveform amplitude, CSF stroke volume, and CSF flow rate (CSF Flow Rate = CSF Stroke Volume × Heart Rate) in the resting and immediate postcoughing periods were determined and compared between patients and healthy participants.
RESULTS:There was no significant difference in CSF flow waveform amplitude, CSF stroke volume, and the CSF flow rate between patients with Chiari I malformation and healthy participants during rest. However, immediately after coughing, a significant decrease in CSF flow waveform amplitude (P < .001), CSF stroke volume (P = .001), and CSF flow rate (P = .001) was observed in patients with Chiari I malformation but not in the healthy participants.
CONCLUSIONS:Real-time MR imaging noninvasively showed a transient decrease in CSF flow across the foramen magnum after coughing in symptomatic patients with Chiari I malformation, a phenomenon not seen in healthy participants. Our results provide preliminary evidence that the physiology-based imaging method used here has the potential to be an objective clinical test to differentiate symptomatic from asymptomatic patients with Chiari I malformation.
 

AJNR Am J Neuroradiol. 2015 Dec 24. [Epub ahead of print]