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Research ArticleSpine Imaging and Spine Image-Guided Interventions

MRI T2-Hyperintense Signal Structures in the Cervical Spinal Cord: Anterior Median Fissure versus Central Canal in Chiari and Control—An Exploratory Pilot Analysis

T.A. Tomsick, L.L. Wang, M. Zuccarello and A.J. Ringer
American Journal of Neuroradiology March 2021, DOI: https://doi.org/10.3174/ajnr.A7046
T.A. Tomsick
aFrom the Department of Radiology (T.A.T., L.L.W.)
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L.L. Wang
aFrom the Department of Radiology (T.A.T., L.L.W.)
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M. Zuccarello
bNeuroradiology Section and Department of Neurosurgery (M.Z.), University of Cincinnati Medical Center, Cincinnati, Ohio
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A.J. Ringer
cMayfield Clinic (A.J.R.), Cincinnati, Ohio
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  • FIG 1.
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    FIG 1.

    A patient with Chiari I with 19 HIF up to 3 mm in diameter, 1 AMF, no AMF>HIF, and an SL of various hyperintensity and diameter from C4 through T1, consistent with hydromyelia.

  • FIG 2.
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    FIG 2.

    Postdecompressive craniectomy patient with Chiari I with 9 HIF, 4 AMFs, 1 AMF>HIF, and sharp and hyperintense SLs at C6–C7 and less hyperintense, sharp, and defined SLs at C2–C6.

  • FIG 3.
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    FIG 3.

    Control patient with 15 HIF, 3 AMFs, 3 AMF>HIF, and SL with variably hyperintense and variably sharp dots and dashes from C3–4 to C7. Note hyperintense pixels immediately anterior to the AMF on axial images, despite crescentic flow-related signal loss immediately anterior to the cord on most images.

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    FIG 4.

    Postoperative patient with Chiari I with 19 HIF, 3 AMFs, and 2 AMF>HIF, with a faintly hyperintense ventral line at C6–T1.

Tables

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    Table 1:

    Age, sex, incidence (%), and frequency (No./Pt), for HIF, AMF, SL, and AMF>HIF in the Chiari I and non-Chiari I control groups

    Age (Median)Sex (F) (%)HIF (%)HIF/Pt.AMF (%)AMF/Pt.SL (No.) (%)AMF>HIF (Mean)
    Chiari I (n = 25)4023 (92%)25 (100%)8.5a24 (96%)4.0b14c (56%)2.2
    Control (n = 25)4017 (68%)24 (96%)3.9a22 (88%)2.7b7c (28%)1.0
    • ↵a P = .0004.

    • ↵b P = .025.

    • ↵c P < .02 (χ2).

    • View popup
    Table 2:

    Incidence HIF and AMF/pt., SL incidence, and number of AMFs extending to HIF (AMF>HIF) in Chiari I without an operation versus patients having undergone postdecompressive craniectomy

    HIFAMFSLAMF>HIF
    %HIF/Pt.%AMF/Pt.No. (%)No.
    Chiari I no surgery (n = 15)1008.91004.05 (33%)a1.9b
    Chiari I post-op (n = 10)1008.1904.38 (80%)a2.8b
    • Note:—Post-op indicates postoperative.

    • ↵a P = .009.

    • ↵b P = .07.

    • View popup
    Table 3:

    Number patients, HIF/pt., AMF/pt., HIF to AMF ratio, and AMF>HIF/pt. in HIF or AMF-only, HIF+AMF, and AMF>HIF subgroups for all Chiari I and control groups, with and without SL

     No.HIF/Pt.AMF/Pt.RatioAMF>HIF
    All Chiari I258.64.12.12.2
    All control253.92.71.41
    All Chiari I and controls
     HIF only
      Chiari I17NANA2.3
      Control112NANA1.0
     AMF only0NANANANA
     HIF+AMF
      Chiari I248.64.32.02.1
      Control233.931.31.1
      AMF-HIF
      Chiari I227.94.71.72.5
      Control164.43.31.31.5
     No AMF→HIF
      Chiari I313.71.78.20
      Control931.71.80
     SL
      Chiari I1410.14.62.22.9
      Control773.42.11.3
     HIF+AMF
      Chiari I1410.14.62.22.2
      Control66.241.61.5
     AMF-HIF
      Chiari I128.651.72.9
      Control57.241.81.8
     No SL
      Chiari I116.63.51.91.9
      Control182.72.41.10.8
     HIF+AMF
      Chiari I116.83.91.72.1
      Control172.930.90.9
     AMF-HIF
      Chiari I974.21.72.2
      Control113.131.11.2
    • Note:—NA indicates not applicable.

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T.A. Tomsick, L.L. Wang, M. Zuccarello, A.J. Ringer
MRI T2-Hyperintense Signal Structures in the Cervical Spinal Cord: Anterior Median Fissure versus Central Canal in Chiari and Control—An Exploratory Pilot Analysis
American Journal of Neuroradiology Mar 2021, DOI: 10.3174/ajnr.A7046

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MRI T2-Hyperintense Signal Structures in the Cervical Spinal Cord: Anterior Median Fissure versus Central Canal in Chiari and Control—An Exploratory Pilot Analysis
T.A. Tomsick, L.L. Wang, M. Zuccarello, A.J. Ringer
American Journal of Neuroradiology Mar 2021, DOI: 10.3174/ajnr.A7046
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