Multiplanar metrizamide-enhanced CT imaging of the foramen magnum

Definition of masses and malformations at the foramen magnum has been less than optimal with traditional radiographic techniques. The use of intrathecal metrizamide with computed tomographic (CT) scanning improves contrast resolution and facilitates detection of abnormalities that may not be apparent on Pantopaque cisternography, plain films, or conventional axial CT alone. Fifty patients with clinically suspected foramen-magnum lesions were evaluated with this technique. Forty were abnormal with the following findings: 14 cases of the Chiari malformation (five cases had associated syringomyelia), five meningiomas, three neuromas, a chondrosarcoma, a chordoma, and five cervical and three brainstem gliomas. Six cases of syringomyelia, a large posterior-fossa subarachnoid cyst, and an anomaly of the cisterna magna were also diagnosed. Sagittal and coronal images were beneficial in defining tonsillar position, configuration of the fourth ventricle, and the relations of mass lesions to the spinal canal and subarachnoid space. Metrizamide CT cisternography provides superior spatial and contrast resolution of lesions at the foramen magnum not obtainable with other radiographic techniques. Morbidity is minimal because of the low dose of metrizamide used. Multiplanar reformations are particularly helpful in assessing anatomic detail not readily recognized on axial scans alone.