From the Guidelines
MRI with contrast is the preferred imaging modality for evaluating syringomyelia, as it provides better visualization of the syrinx cavity boundaries and helps differentiate between syringomyelia and other conditions like tumors or inflammatory processes. According to the American College of Radiology Appropriateness Criteria, contrast-enhanced imaging is recommended for the initial diagnostic evaluation of myelopathy, which includes syringomyelia 1. The use of both non-contrast and contrast-enhanced sequences is crucial, as it allows for a comprehensive evaluation of the spinal cord and associated conditions.
Key components of an MRI protocol for syringomyelia include:
- Sagittal and axial T1-weighted images
- T2-weighted images
- Post-contrast T1-weighted images of the entire spine
- Particular attention to the area of suspected syringomyelia
- FLAIR sequences may also be helpful
The contrast agent enhances visualization of the syrinx cavity boundaries and helps differentiate between syringomyelia and other conditions like arachnoid cysts or tumors 1. For patients with contraindications to gadolinium, non-contrast MRI can still provide valuable information about the syrinx cavity's size, location, and extent, though it may not fully characterize all associated pathologies. It is essential to inform the radiologist about the specific clinical suspicion of syringomyelia to ensure appropriate imaging protocols are used and the relevant areas are thoroughly examined.
From the Research
MRI for Syringomyelia
- MRI is the preferred method of investigation for diagnosis and differential diagnosis of syringomyelia 2
- It is possible to study fluid flow in the vertebral canal and the movements of the syrinx fluid using MRI 2
- MRI is important for the postoperative follow-up of patients with syringomyelia, including tracking the cyst and detecting complications 2
Use of Contrast in MRI for Syringomyelia
- There is no direct evidence in the provided studies that compares the use of MRI with or without contrast for syringomyelia
- However, a study from 1985 compared the effectiveness of plain computed tomography (CT), metrizamide CT, conventional myelography, and magnetic resonance (MR) imaging for the examination of cystic spinal cord lesions, including syringomyelia 3
- The study found that MR imaging was as accurate as metrizamide CT in the diagnosis of intramedullary cavities that result in spinal cord enlargement, but it was less sensitive in detecting cavities within normal-sized or diminished spinal cords 3