Utilization of Phase Contrast Magnetic Resonance Imaging to measure Cerebral Hemodynamic Changes
Before and After a NUCCA Atlas Correction – A Case Series
HC. Woodfield (1), WJ. Becker (2), DG. Hasick (3), MS. Rose (4), JN. Scott (5)
(1) Upper Cervical Research Foundation (UCRF), Minneapolis, MN;
(2) University of Calgary and Alberta Health Services, Foothills Hospital, Calgary, AB;
(3) Britannia Clinic, Calgary, AB;
(4) Rho Sigma Scientific Consultants, Calgary, AB;
(5) Departments of Diagnostic Imaging and Clinical Neurosciences, University of Calgary, Calgary, AB;
Background:
Following a National Upper Cervical Chiropractic Association (NUCCA) atlas vertebrae intervention, previous case study revealed a significant decrease in migraine symptoms with accompanying increased intracranial compliance (ICCI) and venous pulsatility decrease.
Objective:
To measure using Phase Contrast Magnetic Resonance Imaging (PC-MRI), changes in ICCI from baseline to week-four, and eight, following a NUCCA intervention of neurologist screened migraine subjects. Secondary outcomes comprised several Health Related Quality of Life (HRQoL) measures used specifically in documenting patient perceived changes in migraine status.
Methods:
After screening, candidates signed a consent form, completed baseline migraine-specific quality of life measures, then returned after 30-days with a baseline headache diary. Determining need for NUCCA care confirmed inclusion, allowing subjects to obtain baseline PC-MRI measures. Using a 1.5-Tesla GE 360 Optima MRI scanner to acquire flow data, analyses were completed using proprietary software, MRICP, version 1.4.35. Subjects received eight weeks of NUCCA care.
Results:
Eight females, and three males, average age 41 years, met inclusion criteria. At baseline, mean subject ICCI was 6.39(SD = 3.15); 6.25(SD = 1.76), at week-four and 7.32(SD = 3.59) by week-eight. Baseline Headache Impact Test-6 was 64.2, decreasing to 55.2(95% CI 4.7, 13.1) at week-four, to 53.8(95% CI 4.7, 13.1) by week-eight. Migraine Disability Assessment Test at baseline, 46.7(SD=27.7) decreased to 14.6(95% CI 13.2, 51.0) at week-twelve. 24-hours after intervention, ten subjects reported mild neck discomfort.
Conclusion:
One study limitation is lack of a control group for comparison of observed changes. HRQoL measures seemed to indicate resolution of many migraine symptoms in conjunction with a slight increase in ICCI.
The Phase Contrast Magnetic Resonance Imaging (PCMRI) Migraine study was a multidisciplinary project that created ongoing partnerships between NUCCA, University of Calgary Neurology and Elliot-Fong-Wallace (EFW) Radiology. It brought to Calgary new state-of-the-art, dynamic MRI technology to determine how the brain’s vascular system and brain function respond to an optimal NUCCA correction. Subjects reported positive results regarding migraine quality of life with no adverse reactions to care.
This study looked at the correlation of quality-of-life measures and physiological changes as measured from the PC-MRI (dynamic) evaluation, pre and post correction NUCCA x-ray evaluations and measured postural changes. Whereas many studies have a lot of patients with a few specific outcome measures, this pilot study had a few patients and a lot of data to scrutinize for the linked relationships. The cross references of data from x-ray, posture, MRI and Quality of Life measures was very revealing. The study manuscript has been published by BioMed Research International .