Syringomyelia associated with adhesive spinal arachnoiditis: MRI

Area of Science:

• Neurology
• Radiology
• Neurosurgery

Background:

• Syringomyelia is a condition characterized by cyst formation within the spinal cord.
• Adhesive spinal arachnoiditis is a severe inflammatory condition affecting the arachnoid mater, potentially leading to adhesions and cord compromise.
• The interplay between syringomyelia and spinal arachnoiditis requires detailed imaging for accurate diagnosis and management.

Purpose of the Study:

• To elucidate the characteristic clinical and Magnetic Resonance Imaging (MRI) findings in patients presenting with syringomyelia associated with surgically confirmed adhesive spinal arachnoiditis.
• To correlate MRI features with the underlying pathology of adhesive spinal arachnoiditis in the context of syringomyelia.

Main Methods:

• Retrospective review of MRI scans from seven patients diagnosed with syringomyelia and adhesive spinal arachnoiditis.
• Standard MRI sequences including sagittal and axial T1- and T2-weighted spin-echo images were utilized.
• Acquisition of additional sagittal T2-weighted images without motion-artefact suppression and intravenous contrast administration in select cases.

Main Results:

• Syrinx cavities were predominantly thoracic (n=5), with locations varying across patients.
• All patients exhibited cord deformity due to adhesions or displacement from arachnoid cysts, best visualized on axial MRI.
• Focal blurring of the syrinx wall (n=6) and flow voids within the syrinx fluid on non-motion-suppressed T2-weighted images were consistently observed.

Conclusions:

• MRI, particularly axial imaging, is vital for detecting spinal cord deformities and associated arachnoid cysts in patients with syringomyelia and adhesive spinal arachnoiditis.
• Specific MRI findings like flow voids and syrinx wall blurring aid in the diagnosis and understanding of this complex condition.