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MRIs

The MRI (magnetic resonance imaging) is one of the main diagnostic tools in identifying Chiari.  Following are MRIs from Rick Labuda, both before and after surgery, plus excerpts from the radiologist's original report.  Although these are images from an adult, they are a good indication of what can be seen on an MRI.

Practical Tips For Patients

• It is very difficult to interpret MRIs.  We highly recommend you don't try to read your child's MRIs and wait until you see the doctor.  Speaking from experience, you can cause yourself unnecessary worry and concern.  The same rule applies with the radiologist's report.  It will be full of medical jargon and trying to decipher it before meeting with the doctor can be difficult. 

• However, you can ask your doctor to review the radiologist's report with you.  This way you can find out if your doctor agrees with the radiologist.  Once you have a general idea of the meaning of the report, you can do some research to understand the details.

• Keep a copy of all your MRIs, in case you move or want a second opinion.  You will probably not get a copy of the radiologist's report unless you ask the doctor's office to make you a copy.  Alternately, you can call the Imaging Center periodically to get a copy of the reports.

• Many imaging centers are now able to provide copies of the images in electronic format.  Find out if this is possible and ask for both hard copies and a disc.

• If possible, try to go to the same Imaging Center for all your MRIs.  That way the scans are done on the same equipment, the radiologist has old scans for comparison, and all your records are in one place.

Before Surgery

Excerpted From The Radiologist's Report

MRI OF THE CERVICAL SPINE WITHOUT CONTRAST

History:  Right-sided neck pain; headaches; abnormal X-ray

The cervical vertebrae appear normal in stature, alignment, and signal intensity; however, the odontoid process and anterior arch of C1 appear high on the sagittal images, suspicious for basilar impression....

...However, the cerebellar tonsils are ectopic, extending about 1.5 cm below the foramen magnum.  In addition, a syrinx is present which most prominent at the C2-C3 level where it has a maximum diameter of about 9 mm.  On some of the images, the syrinx is barely perceptible, although there is a re-expansion at the T2-T3 level where it measures about 4 mm in diameter....

Impressions:

1. The findings are consistent with a Chiari I malformation associated with a syrinx which is most prominent in the upper cervical region, although there is also a prominent are of expansion in the upper thoracic cord.

2. The outside radiographs were not available for correlation; basilar impression may be present.

3. No disc herniation or spinal stenosis.

4. Incidental note was made of the right vertebral artery coursing anterior the the spinomedullary junction at the foramen magnum.  This is of questionable clinical significance.

After Surgery (5 years post-op)   

Notes:

• Even years after surgery, the syrinxes are still present, however they are smaller and no longer are pushing the spinal cord out.

• The cerebellar tonsils are rounder and higher in the skull.

• Scoliosis (abnormal curvature of the spine) is common with syringomyelia, even in adults.  The MRI on the right shows scoliosis in the neck and upper back.