Clinical Application of Diffusion Tensor Imaging in Chiari Malformation Type I– Advances and Perspectives. A Systematic Review

Diffusion Tensor Imaging in Syringomyelia Secondary to Chiari Malformation in Cavalier King Charles Spaniel—A Preliminary Study

“…Due to the discrepancy described in the literature between the severity of clinical symptoms of CM-MS syndrome and structural changes visible on standard MRI of the spinal cord, an objective DTI sequence was used in this study [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 24 , 25 ]. We hypothesized that DTI would be a good candidate for prediction regarding the prevalence of the symptomatic CM-SM course and that this would be of great value in canine and human patients.…”

“…All standard structural MRI sequences (transverse and sagittal T2) of the spinal cord of all dogs were assessed and graded by the authors (AB, KOS) and validated by a diplomate veterinary neurologist (MW) using the standardized British Veterinary Association (BVA) scale [ 16 , 17 , 18 , 19 ]. Syringomyelia was graded as follows: Grade 0: normal (no central canal dilation, no presyrinx, no syrinx), Grade 1: central canal dilation (CCD) <2 mm in diameter, and Grade 2: syringomyelia (central canal dilation which has an internal diameter ≥2 mm, separate syrinx or pre-syrinx with or without central canal dilation) [ 11 ]. Based on these findings, dogs were divided into 2 groups: without MRI signs of SM (non-SM) and a study group with visible syringomyelia (SM) ( Figure 1 ).…”

“…The most common MRI findings include occipital bone hypoplasia, central canal dilatation and syringomyelia. Owing to the non-specific nature of the disease, it is difficult to determine its severity based on clinical symptoms, especially when they have subtle characteristics in both human and veterinary medicine [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. The reason for the low correlation between the severity of clinical symptoms and structural changes in the spinal cord visible on MRI is still unknown.…”

“…DTI parameters have been used for detecting subtle damage to the spinal cord in the course of syringomyelia in humans, but those reports are limited and based on a small number of patients and a small size of SM [ 6 ]. Published data suggest that as the integrity of the white matter fibres in the spinal cord deteriorates, ADC values increase, and FA values decrease [ 6 , 7 , 8 , 9 , 10 , 11 , 19 , 20 ]. Based on the above, we hypothesized that in the course of SM, the ADC value will increase, and the FA value will decrease.…”

Precise Management of Chiari Malformation with Type I

“…In addition, the abnormality of CSF flow was linked to the poor prognosis, the presence of both ventral and dorsal CSF flow abnormalities on pre-operative MRI was closely relevant with a 2.6-fold reduction in the risk of postoperative recurrence for clinical symptoms ( 8 ). Other advanced imaging techniques, which were used for assessment of patients with CM-I, as follows: (1) CSF flow imaging at the foramen magnum with cardiac-gated phase-contrast MRI; (2) cerebellar tonsillar pulsatility at the foramen magnum with cardiac-gated cine MRI ( 9 ); and (3) diffusion tensor imaging (DTI), the severity of white matter injury on DTI might be useful for evaluating the postoperative outcome ( 10 , 11 ). In addition, the X-ray of head and entire spine would help ruling out craniosynostosis and scoliosis ( 12 ).…”