The use of magnetic resonance phase-contrast cine in Chiari malformation with syringomyelia
- Author:
Goh Chin Hwee
1
;
Mohammad Radzi Hamzah
;
Regunath Kandasamy
;
Abdul Rahman Izaini Ghani
;
Wong Sii Hieng
;
Zamzuri Idris
;
Jafri Malin Abdullah
Author Information
- Publication Type:Journal Article
- Keywords: Chiari malformation; syringomyelia; MRI; CINE; CSF flowdynamics
- From: The Medical Journal of Malaysia 2020;75(6):666-671
- CountryMalaysia
- Language:English
- Abstract: mesodermal origin and is commonly associated withsyringomyelia. Foramen magnum decompression is thefirst-line of standard treatment in symptomatic patients witha confirmed radiographic diagnosis. Magnetic resonance(MR) cine allows accurate evaluation of cerebrospinal fluid(CSF) physiology at the craniovertebral junction but oftenthis is under-utilised in Malaysia. Methods: In this series, we looked into nine cases of CM withsyringomyelia from clinical and radiological perspectivebefore and after surgery. The radiological parameters wereherniated tonsillar length, syrinx: cord ratio, syrinx lengthand diameter. Flow velocity and morphologic changes inChiari were illustrated. Results: Seven patients showed either reduction in syrinxlength, syrinx: cord ratio or both postoperatively. Clinicalrecovery somewhat varied in motor and sensory symptoms.Four patients gained better functional grade in modifiedRankin scale (MRS) while the rest remained similar. Thestudy highlighted the advantage of CSF flow dynamicsinformation over MR anatomical radiographic improvementin addressing the neurologic and functional recovery. Wealso discussed the practicality of cine sequence inpreoperative patient selection, syrinx analysis andpostoperative flow evaluation in anticipation of clinicaloutcome. Conclusion: Phase-contrast cine MRI is a useful tooldictated by resource availability. We recommend its routineuse in preoperative analysis and subsequent observationalfollow-up after surgery.
