Magnetic resonance (MR) imaging in the management of primary and secondary syringomyelic cavities, and of other cystic lesions of the spinal cord.

During the past three years 27 patients with medullary and/or brainstem cavities were examined with MRI at the Institute of Roentgenology, and we report the radiological MRI correlative findings. Five patients were operated: postoperative MRI examinations were compared with preoperative studies. Syringomyelia was present in 21 cases, syringobulbia in 2, and syringobulbomyelia in 4. Additional pathology such as the Arnold Chiari malformation or hydrocephalus was found at the craniospinal junction in 8 patients. Two instances of associated intraspinal tumours were noted too. In all cases the syringomyelic cavities involved the cervical cord and in most of them the lesion extended down to the thoracic or even lumbar level. Several patients were shown to have multilocular cavities. In the patients with syringomyelia a syringoarachnoidal shunting procedure was performed. This resulted in cyst collapse as proved by postoperative MRI examinations; neurological symptomatology was ameliorated too. Conventional radiological imaging with computed tomography (CT) and myelography was not as efficient as MRI in imaging syringomyelia. The extent of intramedullary cavities as well as the presence of associated pathology is best appreciated on sagittal MRI. The use of special surface coils clearly results in better image quality due to higher resolution. According to our experience MRI should be the primary examination in syringomyelia; myelography and CT are obsolete in the management of syringomyelia; the insertion of a syringoarachnoidal shunt is a convenient surgical procedure, resulting in clinical amelioration in most cases.