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空洞症におけるクモ膜下腔および空洞内の髄液の拍動現象について,pre-saturation pulseを用いて髄液を標識し,この移動をトレースする事で髄液拍動の定量的解析を試みた。Chiari奇形の空洞内には髄液拍動が著明に見られるが,外傷性の空洞には拍動がほとんど見られず,Chiari奇形の空洞内の髄液の拍動パターンは,正常なクモ膜下腔の拍動パターンとよく類似しているが,その拍動の位相は症例によってまちまちであった。空洞内の髄液拍動には頭蓋頸椎移行部の状態が深く関与していることが示唆された。空洞内の髄液の拍動の原因としては,下垂した小脳扁桃ならびに脳幹下部が,直接脊髄実質を介して頭蓋内脈波を空洞内に伝播するか,大孔レベルのクモ膜下腔の髄液を介して頭蓋内脈波を空洞内に伝播するか,の2通りの伝播経路が推察された。空洞内の髄液と,脊髄クモ膜下腔の髄液の拍動の"位相差"が病態解析のためのポイントであると考えられた。
Some reports show the qualitative analysis of cerebrospinal fluid (CSF) pulsation in the subarach-noid space and the syrinx using cine magnetic reso-nance imaging (MRI) . However, few reports stud-ied the quantitative analysis of CSF pulsation. We report here the results of quantitative analysis of CSF pulsation using the cine MRI with pre-satura-tion pulse. Using flow phantom, we calibrated the correlation between the true velocity and calculated velocity acquired from the movement of pre-satur-ated low signal. Three cases of syringomyelia with Chiari malformation, two cases of traumatic syrin-gomyelia, and three normal volunteers were examined using this technique, and we could obtain time-velocity curves of CSF in both subarachnoid spaces and syrinx.
Although obvious pulsation of CSF was observed in the syrinx of all Chiari malformations, no pulsa-tion of CSF was observed in the syrinx of traumatic syringomyelia. CSF in the syrinx moves upward in the early systolic cardiac cycle, dOwnward in the systolic cycle, and upward again in the diastolic cycle. Patterns of CSF pulsation in syrinx were similar to those in the subarachnoid space, but "phase" of these pulsations differed from case to case.
These results suggest the close relationship between CSF pulsation in the syrinx and CSF obstruction at the cranio-vertebral junction. Disso-ciation of the "phase" of CSF pulsation in the syrinx and subarachnoid space may be significant in the analysis of the pathogenesis of syringomyelia.
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