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High-resolution diffusion tensor imaging of the cerebellum and brainstem in Type I Chiari Malformation: Associations with attention and pain

Poster Session E - Monday, March 9, 2026, 2:30 – 4:30 pm PDT, Fairview/Kitsilano Ballroom

James Houston¹ (), Tara Kirkpatrick¹, Anna Robison², Shaun Burgess³, Allison Throm¹, Elizabeth Key¹, Talia Sanford¹, Mallory Smith¹, Erika Prante¹, Tiffany Rogers¹, Philip Allen⁴; ¹Middle Tennessee State University, ²University of South Florida, ³Western Carolina University, ⁴University of Akron

Background. Chiari Malformation Type I (CMI) is a congenital neurological condition in which the cerebellar tonsils are displaced into the spinal canal. Common symptoms include pain, motor disturbances, cognitive dysfunction, and anxious-depressive symptomatology. Our prior research has revealed elevated fractional anisotropy (FA) in CMI patients compared to matched controls using whole-brain diffusion tensor imaging (DTI). Higher FA coincided with worse attention performance, even after controlling for chronic pain. In the present study, we utilize high-resolution, partial brain DTI to replicate our previous findings and better characterize affected white matter tracts proximal to the cervico-medullary junction. Methods. High-resolution diffusion weighted images (DWI), attention performance data, and symptomatology data were analyzed from 18 CMI patients and matched healthy controls. DWI were processed using an FSL diffusion toolbox pipeline, using the DTIFIT, Tract-Based Spatial Statistics, Randomise, and GLM tools. Results. CMI patients exhibited significantly higher FA in the three cerebellar peduncles and medial lemniscus compared to controls after controlling for attention performance and self-reported pain symptoms. Elevated FA in these regions correlated with attention and pain measures, wherein higher FA was associated with worse attention performance and higher self-reported pain and disability symptoms. Conclusion. Our findings align with prior observations of increased FA in CMI, though the underlying mechanisms remain debated. While greater FA in CMI could reflect increased compression of white matter pathways proximal to the cervico-medullary junction, we postulate that elevated FA may instead be the consequence of central pain sensitization and a disrupted neuroinflammatory process in CMI patients.

Topic Area: ATTENTION: Other