Journal of Clinical and Translational Science · Published 2026-04-01 · DOI 10.1017/cts.2026.10430
Objectives/Goals: Alterations in the patterns of cerebrospinal fluid (CSF) have been proposed to play a role in the development of symptoms related to Chiari I malformation (CMI). We aim to use 4D MRI to evaluate CSF fluid dynamics in CMI, including CSF pressures and local flow vectors, and their association with pre- and post-operative symptoms. Methods/Study Population: Study Population: Pediatric and adult patients diagnosed with Chiari I malformation (caudal descent of cerebellar tonsils ≥ 5 mm below the foramen magnum) at Washington University in St. Louis. Methods: Patients underwent CSF 4D flow MRI studies on 3.0T MRI at Washington University in St. Louis. The acquired imaging data will be preprocessed to unwrap velocity aliasing, denoise, and account for MRI-associated eddy artifact. Flow visualization and quantification will be performed in order to calculate patient-specific flow patterns, such as flow vortices and bidirectional flow, and vectors, such as peak velocity, at CSF spaces of the brain and spine. Clinical data, including demographics, symptom history (e.g., headache), physical exam findings, and presence of syrinx have already been collected. Results/Anticipated Results: We anticipate that patients with greater preoperative CSF flow heterogeneities and abnormalities of flow vectors will be associated with a higher likelihood of symptoms, and that patients with greater postoperative normalization of these variables will be more likely to experience symptom relief. Discussion/Significance of Impact: The role of CSF hydrodynamics in CMI remains incompletely understood. We aim to examine whether alterations in CSF flow may explain why some patients are asymptomatic, while others suffer debilitating headaches and cranial nerve palsies. The results would expand scientific knowledge and may aid in identifying patients likely to benefit from surgery.
Abstract from DOAJ. Public domain (CC0 1.0).
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