title: Three-dimensional constructive interference in steady-state magnetic resonance imaging in syringomyelia: advantages over conventional imaging.
abstract: OBJECTIVE
  Neuroradiology has become indispensable in detecting the pathophysiology in syringomyelia. Constructive interference in steady-state (CISS) magnetic resonance (MR) imaging can provide superior contrast at the sub-arachnoid tissue borders. As this region is critical in preoperative evaluation, the authors hypothesized that CISS imaging would provide superior assessment of syrinx pathology and surgical planning.
  
  
  METHODS
  Based on records collected from a database of 130 patients with syringomyelia treated at the authors' institution, 59 patients were prospectively evaluated with complete neuroradiological examinations. In addition to routine acquisitions with FLAIR, T1- and T2-weighted, and contrast-enhanced MR imaging series, the authors obtained sagittal cardiac-gated sequences to visualize cerebrospinal fluid (CSF) pulsations and axial 3D CISS MR sequences to detect focal arachnoid webs. Statistical qualitative and quantitative evaluations of spinal cord/CSF contrast, spinal cord/CSF delineation, motion artifacts, and artifacts induced by pulsatile CSF flow were performed.
  
  
  RESULTS
  The 3D CISS MR sequences demonstrated a contrast-to-noise ratio significantly better than any other routine imaging sequence (p < 0.001). Moreover, 3D CISS imaging can detect more subarachnoid webs and cavitations in the syrinx than T2-weighted MR imaging with less flow-void artifact. The limitation of 3D CISS imaging is a susceptibility to motion artifacts that can cause reduced spatial resolution. Lengthy acquisition times for axial segments can be reduced with multiplanar reconstruction of 3D CISS-generated sagittal images.
  
  
  CONCLUSIONS
  Constructive interference in steady-state imaging is the MR sequence of choice in the preoperative evaluation of syringomyelia, allowing significantly higher detection rates of focal subarachnoid webs, whereas standard T2-weighted MR imaging shows turbulent CSF flow voids. Constructive interference in steady-state MR imaging enables the neurosurgeon to accurately identify cases requiring decompression for obstructed CSF. Motion artifacts can be eliminated with technical variations.
authors.affiliation: Department of Neurosurgery, University of Tübingen, Germany. f.roser@gmx.de
authors.forename: Florian
authors.initials: F
authors.lastname: Roser
authors.forename: Florian H
authors.initials: FH
authors.lastname: Ebner
authors.forename: Søren
authors.initials: S
authors.lastname: Danz
authors.forename: Felix
authors.initials: F
authors.lastname: Riether
authors.forename: Rainer
authors.initials: R
authors.lastname: Ritz
authors.forename: Klaus
authors.initials: K
authors.lastname: Dietz
authors.forename: Thomas
authors.initials: T
authors.lastname: Naegele
authors.forename: Marcos S
authors.initials: MS
authors.lastname: Tatagiba
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001099:Arachnoid / Q000473:pathology; D016477:Artifacts; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D011446:Prospective Studies; D011673:Pulsatile Flow / Q000502:physiology; D013595:Syringomyelia / Q000134:cerebrospinal fluid / Q000175:diagnosis*
chemical_list: D003287:Contrast Media