Pulsatile Cerebrospinal Fluid Flow Measurement Using Phase-Contrast Magnetic Resonance Imaging in Patients With Cervical Myelopathy

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Abstract
A technical report is presented. To investigate the relation between the severity of myelopathy and the degree of cerebrospinal fluid flow disturbance by using magnetic resonance imaging to measure the velocity of the cerebrospinal fluid flow in patients with cervical spondylotic myelopathy. Analyses of pulsatile cerebrospinal fluid flow measured by phase-contrast magnetic resonance imaging in healthy subjects and patients with Arnold–Chiari syndrome have been reported. Few studies have evaluated the change of pulsatile cerebrospinal fluid flow velocity and the waveform of the plotted velocity in patients with cervical spondylotic myelopathy. Study 1: Pulsatile cerebrospinal fluid flow was measured at C7, positioned with cervical spine flexion and extension, to investigate the influence of cervical alignment on the pulsatile cerebrospinal fluid flow in five patients with cervical spondylotic myelopathy. Study 2: In 31 patients with cervical spondylotic myelopathy, pulsatile cerebrospinal fluid flow was measured at C3 and C7, with the neck set centrally. The relevance of cerebrospinal fluid flow disturbance and the severity of myelopathy evaluated by the Japanese Orthopedic Association scoring system also were studied. Study 1: The waveform of plotted pulsatile cerebrospinal fluid flow velocity showed no change resulting from the position of the cervical spine. Study 2: A high correlation between the Japanese Orthopedic Association score and the cerebrospinal fluid pulsatile flow amplitude at C7 was demonstrated (r = 0.75;P < 0.0001). The average Japanese Orthopedic Association score of 14 patients whose cerebrospinal fluid flow velocity waveforms were absent was significantly lower (P < 0.0001) than that of 17 patients whose waveforms were present. The disturbance of pulsatile cerebrospinal fluid flow demonstrated high correlation with the severity of myelopathy. Measurement of cerebrospinal fluid flow disturbance can quantify the degree of dural sac and spinal cord compression.