Quantitative analysis of cerebrospinal fluid flow in patients with cervical spondylosis using cine phase-contrast magnetic resonance imaging

OBJECTIVE: To investigate changes in the cerebrospinal fluid flow in patien ts with cervical spondylosis using cine phase-contrast magnetic resonance ( MR) imaging. METHODS: The participants included 44 healthy volunteers, 11 asymptomatic p atients with evidence of degenerative changes of the cervical spine reveale d by MR imaging but no neurological symptoms referable to those abnormaliti es, and 23 symptomatic patients with myelopathy who underwent surgery. Cerv ical spondylotic myelopathy was evaluated using the Japanese Orthopedic Ass ociation scores, and the percentage reduction of the transverse cord area a t the level of maximum cord compression was measured on T1-weighted magneti c resonance images. A cine phase-contrast MR pulse sequence with peripheral gating was used to measure the cerebrospinal fluid flow direction and velo city in the ventral subarachnoid spaces at the C1 and T1 levels. RESULTS: The velocity waveforms produced by plotting flow velocity at 16 in tervals during one cardiac cycle significantly differed among the healthy v olunteers, asymptomatic patients, and preoperative symptomatic patients. Ho wever, velocity waveforms did not differ between the healthy volunteers and the postoperative patients at the C1 level. Decreases of flow velocity wer e significantly correlated with the severity of myelopathy and the percenta ge reduction of cord area. Patients with severe myelopathy (Japanese Orthop edic Association score of 0-9 points) or greater than 30% reduction of cord area showed significantly decreased flow velocity compared with those with mild myelopathy (Japanese Orthopedic Association score of 10-17 points) or less than 30% reduction of cord area. Changes in flow velocity were not co rrelated with multiplicity of the lesion or the level of maximum cord compr ession. Postoperative improvement of flow velocity was not correlated with neurological recovery. CONCLUSION: Cine phase-contrast MR imaging allows quantitative and noninvas ive assessment of changes in cerebrospinal fluid flow in patients with cerv ical spondylosis.