Korean J Radiol.  2000 Mar;1(1):11-18. 10.3348/kjr.2000.1.1.11.

Application of Spatial Modulation of Magnetization to Cervical Spinal Stenosis for Evaluation of the Hydrodynamic Changes Occurring in Cerebrospinal Fluid

• Lee KH
• Chung TS
• Jeon TJ
• Kim YH
• Chien D
• Laub G

• KMID: 1777290
• DOI: http://doi.org/10.3348/kjr.2000.1.1.11

Abstract

OBJECTIVE
To evaluate the hydrodynamic changes occurring in cerebrospinal fluid (CSF) flow in cervical spinal stenosis using the spatial modulation of magnetization (SPAMM) technique. MATERIALS AND METHODS: Using the SPAMM technique, 44 patients with cervical spinal stenosis and ten healthy volunteers were investigated. The degree of cervical spinal stenosis was rated as low-, intermediate-, or high-grade. Low-grade stenosis was defined as involving no effacement of the subarachnoid space, intermediate-grade as involving effacement of this space, and high-grade as involving effacement of this space, together with compressive myelopathy. The patterns of SPAMM stripes and CSF velocity were evaluated and compared between each type of spinal stenosis and normal spine. RESULTS: Low-grade stenosis (n = 23) revealed displacement or discontinuity of stripes, while intermediate- (n = 10) and high-grade (n = 11) showed a continuous straight band at the stenotic segment. Among low-grade cases, 12 showed wave separation during the systolic phase. Peak systolic CSF velocity at C4 -5 level in these cases was lower than in volunteers (p <.05), but jet-like CSF propulsion was maintained. Among intermediate-grade cases, peak systolic velocity at C1-2 level was lower than in the volunteer group, but the difference was not significant (p >.05). In high-grade stenosis, both diastolic and systolic velocities were significantly lower (p <.05). CONCLUSION: Various hydrodynamic changes occurring in CSF flow in cervical spinal stenosis were demonstrated by the SPAMM technique, and this may be a useful method for evaluating CSF hydrodynamic change in cervical spinal stenosis.

Keyword

Magnetic resonance (MR), flow studies; Spine, MR; Spine, diseases

MeSH Terms

Cervical Vertebrae/pathology
Female
Human
Magnetic Resonance Imaging/*methods
Male
Middle Age
Rheology
Spinal Stenosis/*cerebrospinal fluid/pathology

Figure

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  Fig. 1 Diagram of ECG-triggered tagging sequence. A tagging RF pulse is used immediately after the trigger pulse, and this pattern was followed by a series of fast gradient-echo sequences. The number of gradient-echo measurements is adjusted according to the number of phases.

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  Fig. 2 Schema for the measurement of extent of bolus displacement. This distance (d) is measured from the trailing edge of the stationary tag (s) to that of the flow tag (f).

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  Fig. 3 Three patterns of SPAMM stripes in healthy volunteers and patients. A. Wave displacement of flow tag indicates flow movement, which was observed in healthy volunteers and low-grade stenosis patients. B. Wave separation of flow tags with double shape may reflect oscillation of jet-stream, which was observed in only half of all low-grade cases during the systolic phase. C. A continuous straight band indicates no flow movement, and this was observed mainly in cases of intermediate- and high-grade stenosis.

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  Fig. 4 Healthy volunteer. A. T2-weighted spin-echo image shows normal CSF space. B. Diastolic phase image of SPAM sequence shows upward flow tags (large arrow) corresponding to the direction of CSF movement. Trailing edge of upward flow tag is indicated by small arrow. C. Systolic phase image shows harmonious downward flow tags (large arrow) in the direction of CSF movement. Trailing edge of downward flow tag is indicated by small arrow.

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  Fig. 5 Low-grade cervical spinal stenosis due to herniated disc associated with posterior longitudinal ligament hypertrophy. A. T2-weighted spin-echo image shows multi-level extrinsic indentations along the anterior CSF space. B. Systolic phase image of SPAMM sequence shows wave separation of flow tags with double shape (arrows) through the anterior CSF space, and this may reflect oscillation of jet-stream. Because there is sufficient space for CSF movement, the same separation of flow tags is seen in the posterior CSF space (arrowheads).

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  Fig. 6 Intermediate-grade cervical spinal stenosis due to herniated disc. A. T2-weighted spin-echo image shows focal effacement of CSF space at the C5-6 level without signal intensity change in the spinal cord. B. Systolic phase image of SPAMM sequence shows continuous straight band (arrow) at the C5-6 level, with decreased distance between the trailing edge of the stationary tags and that of the flow tags.

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  Fig. 7 High-grade cervical spinal stenosis due to severely herniated disc. A. T2-weighted spin-echo image demonstrates a severely herniated focal cervical disc, with high signal intensity change in the spinal cord at the C3-4 level. B. Systolic phase image of SPAMM sequence shows continuous straight band (arrow), with markedly decreased distance between the trailing edge of the stationary tags and that of the flow tags. C. Systolic phase coronal image of SPAMM sequence shows accentuated downward flow tags (white arrows) through the lateral canal of the CSF space. Trailing edges of accentuated downward flow tags are indicated by black arrows.

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