MRI Cerebrospinal fluid flow
14/08/2017 18:27:00.000
Anatomic site: MRI Cerebrospinal fluid flow
Clinical History : Thoracic spinal cord herniation operated in 2016 then developed adhesions further surgery 25/4/17. Persistent symptoms and legs giving away. MRI spine +CSF flow studies around the area of the herniation T2-3
Result
MRI Spine Cervical : Sagittal T1, T2, CISS sequences cover the whole spine in 2 blocks. Axial T1 and T2 sequences have been acquired in the upper thoracic region. Sagittal and axial CSF flow studies in the upper thoracic region. Comparison is made with the previous (early postop) study of 27/4/17. Instead of following a smooth craniocaudal course, the spinal cord is now deviated, first contacting the dorsal theca in the midline at T2 and then passing forward from here to contact the left anterior theca at T3. This portion of the spinal cord returns a new T2 high signal. No separate arachnoid cysts are identified but there is suggestion of a possible small epidural fluid collection anterior to the thickened theca at the level of the T2-3 disc. There is also a small septated fluid collection behind the theca within the laminectomy defect.
The most useful flow study sequences are series 35 and 37 (sagittal); series 39 and 43 (axial through T3); 44 and 46 (axial through the T3-4 disc). Sagittal images show interruption of flow anterior to the cord at T2-3 with a suggestion of turbulence in this region. Flow posterior to the cord in the midline is seen down to C5 and from T3 downwards. The axial images confirm the presence of turbulent flow (opposite cranial/caudal flow anterior and posterior to the cord) in the CSF at the level of the T3-4 disc. A jet of CSF flow is also indicated on the sagittal T2 weighted images anterior to the cord at the level of T3.
The remainder of the spinal examination is unremarkable. The spinal cord ends in a normal position at L1
MRI Spine Cervical : There is evidence of spinal cord adhesions within the upper thoracic region with new cord oedema since the early post-operative MR.