Syringomyelia associated with adhesive spinal arachnoiditis: MRI

Abstract

We reviewed the MRI of seven patients with syringomyelia associated with surgically proven adhesive spinal arachnoiditis to describe clinical and MRI findings in this condition. Using 0.5, 1.0 or 1.5 tesla units, we obtained sagittal T1- and T2-weighted spin-echo and axial T1-weighted images. Additional sagittal T2-weighted images were obtained without using motion-artefact suppression. Contrast medium was given intravenously to five patients. The syrinx cavities were thoracic in five cases, cervicothoracic in one, and extended from C4 to L1 in one. No Chiari malformation or craniovertebral junction anomaly was demonstrated. Meningeal thickening was seen on T2-weighted sagittal images only in one case. Cord deformity due to adhesion or displacement due to an associated arachnoid cyst was seen in all cases best demonstrated on axial images. Focal blurring of the syrinx wall on axial images was seen in six patients. Flow voids were seen in the syrinx fluid in all cases on T2-weighted images obtained without motion-artefact suppression. No abnormal contrast enhancement was demonstrated.

Familial Adhesive Arachnoiditis Associated with Syringomyelia

“…Concerning the imaging of adhesive arachnoiditis associated with syringomyelia, according to Inoue et al, 32 the most striking MR imaging findings are the deformity of the cord at the level of the arachnoid thickening, blurring of a part of a syrinx wall, and the focal signal void within the syrinx. For imaging of the subarachnoid space and arachnoid pathology, T2-weighted imaging is the method of choice.…”

Surgical management of syringomyelia unrelated to Chiari malformation or spinal cord injury

“…Sagittal and axial T2-weighted MR images can now be correlated with cardiac-gated 2D phase contrast, which is the method of choice to detect CSF flow abnormalities. Specifically, subtle arachnoid scarring may be indirect evidence for cord deformity or focal blurring of the syrinx wall, as well as direct evidence for an arachnoid web or cyst, obtained using 1.5T MR or 3T MR or 3D constructive interference in steady state (CISS) sequences, in order of power of resolution and sensibility [34][35][36][37]. CSF flow void signs over the cardiac cycle (cine MR) give a dynamic picture showing a short period of cranial flow (diastolic phase) followed by a sustained period of caudal flow (systolic phase), which can be altered by CSF obstruction, being of particular significance at the craniovertebral junction [38,39].…”

A Giant Spinal Cord Cavity

“…The known causes of acquired or secondary spinal cord cavities include trauma, scoliosis, neoplastic tumors, arachnoiditis, and intradural arachnoid cysts. [1][2][3] The idiopathic primary form is rare. The pathogenesis of idiopathic hydromyelia and syringomyelia is still controversial.…”