Physiology-based MR imaging assessment of CSF flow at the foramen magnum with a Valsalva maneuver

R. A. Bhadelia, N. Madan, Y. Zhao, M. E. Wagshul, C. Heilman, J. P. Butler, S. Patz

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


BACKGROUND AND PURPOSE: MR imaging is currently not used to evaluate CSF flow changes due to short-lasting physiological maneuvers. The purpose of this study was to evaluate the ability of MR imaging to assess the CSF flow response to a Valsalva maneuver in healthy participants. MATERIALS AND METHODS: A cardiac-gated fast cine-PC sequence with ≤15-second acquisition time was used to assess CSF flow in 8 healthy participants at the foramen magnum at rest, during, and immediately after a controlled Valsalva maneuver. CSF mean displacement volume V̄CSFduring the cardiac cycle and CSF flow waveform Appwere determined. A work-in-progress real-time pencil-beam imaging method with temporal resolution ≤56 ms was used to scan 2 participants for 90 seconds during which resting, Valsalva, and post-Valsalva CSF flow, respiration, and HR were continuously recorded. Results were qualitatively compared with invasive craniospinal differential pressure measurements from the literature. RESULTS: Both methods showed 1) a decrease from baseline in V̄CSFand Appduring Valsalva and 2) an increase in V̄CSFand A immediately after Valsalva compared with values measured both at rest and during Valsalva. Whereas fast cine-PC produced a single CSF flow waveform that is an average over many cardiac cycles, pencil-beam imaging depicted waveforms for each heartbeat and was able to capture many dynamic features of CSF flow, including transients synchronized with the Valsalva maneuver. CONCLUSIONS: Both fast cine-PC and pencil-beam imaging demonstrated expected changes in CSF flow with Valsalva maneuver in healthy participants. The real-time capability of pencil-beam imaging may be necessary to detect Valsalva-related transient CSF flow obstruction in patients with pathologic conditions such as Chiari I malformation.

Original languageEnglish (US)
Pages (from-to)1857-1862
Number of pages6
JournalAmerican Journal of Neuroradiology
Issue number9
StatePublished - Sep 2013

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology


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