4D MRI Flow Quantification of Cerebrospinal Fluid Motion in the Cervical Spine in Healthy Subjects and Chiari Malformation Patients: How Do the Results Compare With 3D Computational Fluid Dynamics?

In this study, we employed time-resolved three directional velocity encoded phase contrast MRI (4DMRI) to quantify cerebrospinal fluid (CSF) movement within the complete cervical spinal subarachnoid space (SSS). The 4DMRI measurements were compared to a 3D computational fluid dynamics simulation (3DCFD) of the same space in healthy subjects and patients with Chiari I malformation. The results were assessed in terms of peak CSF flow velocities in the foot and head direction and flow patterns at nine axial locations along the cervical spine. It was found that the peak flow velocities measured by 4DMRI were consistently greater than those quantified by 3DCFD. In healthy subjects the 4DMRI flow velocities and patterns compared better to the 3DCFD than in Chiari I patients. Peak velocities had the greatest differences in the upper cervical spine of Chiari patients, where the 4DMRI quantified greater fluid jets at the craniocervical junction than the 3DCFD. Overall, these results represent the first quantitative comparison of 4DMRI to 3DCFD of CSF motion.