Abstract
Hyperintense fluid-signal anterior median fissure and hyperintense foci resembling the central canal are seen on cervical spine axial T2 MR imaging. They may also be associated with a channel-like T2-hyperintense craniocaudad line on sagittal images. We hypothesized that the hyperintense foci and the sagittal line may represent the base of the anterior median fissure. In this exploratory study, 358 cervical MR images were analyzed for recording and comparing the incidence/numbers of hyperintense foci, anterior median fissure, and sagittal line as hyperintense foci, anterior median fissure, and sagittal line per patient when present alone or together, both with and without the sagittal line. Hyperintense foci were identified on 238/358 (66.5%) studies; an anterior median fissure, on 218/358 (60.9%). The hyperintense foci/anterior median fissure ratio was 3.7/2.3 (P = .00001). Anterior median fissures were seen alone less commonly than hyperintense foci were seen alone (P = .045). We identified increased anterior median fissure/patient in a hyperintense foci +anterior median fissure group compared with an anterior median fissure-only group (4.0 versus 3.2, P = .05), with similar hyperintense foci/patient in the hyperintense foci+anterior median fissure and hyperintense foci-only groups (5.5 versus 5.8, P = .35), and proportional distribution of both across the hyperintense foci+anterior median fissure subgroups (hyperintense foci/anterior median fissure ratio, 1.3). The sagittal line in 89 (24.9%) patients was associated with increased hyperintense foci and anterior median fissure/patient. Greater correlation of anterior median fissure/patient to sagittal line presence was seen in sagittal line subgroup analysis. This exploratory analysis found an increased anterior median fissure per patient in conjunction with hyperintense foci presence, a proportional increase of both across the hyperintense foci+anterior median fissure group, and greater correlation of anterior median fissure per patient with the sagittal line. These findings suggest that anterior median fissure and hyperintense foci are structurally related, that hyperintense foci may commonly be the base of the anterior median fissure, and that the sagittal line is a manifestation primarily of an anterior median fissure, occasionally appearing as channels that may simulate the central canal.
Highlights
BACKGROUND AND PURPOSEHyperintense fluid-signal anterior median fissure and hyperintense foci resembling the central canal are seen on cervical spine axial T2 MR imaging
We identified increased anterior median fissure/patient in a hyperintense foci ϩanterior median fissure group compared with an anterior median fissure– only group (4.0 versus 3.2, P ϭ .05), with similar hyperintense foci/patient in the hyperintense fociϩanterior median fissure and hyperintense foci– only groups (5.5 versus 5.8, P ϭ .35), and proportional distribution of both across the hyperintense fociϩanterior median fissure subgroups
This exploratory analysis found an increased anterior median fissure per patient in conjunction with hyperintense foci presence, a proportional increase of both across the hyperintense fociϩanterior median fissure group, and greater correlation of anterior median fissure per patient with the sagittal line. These findings suggest that anterior median fissure and hyperintense foci are structurally related, that hyperintense foci may commonly be the base of the anterior median fissure, and that the sagittal line is a manifestation primarily of an anterior median fissure, occasionally appearing as channels that may simulate the central canal
Summary
A retrospective analysis of cervical spine MR imaging of 410 consecutive patients from a clinical scanning population in June and July, 2015, was performed. Imaging features were analyzed separately by 2 neuroradiologists in conjunction with a second-year medical student who recorded all observations on an Excel spreadsheet (Microsoft, Redmond, Washington) and who performed preliminary data analyses. The position of the HIF in an anteroposterior direction (the depth of the HIF) was measured as the distance from a tangent to the anterior surface of the cord to the HIF divided by the anteroposterior diameter of the cord at the same axial level. The length of the AMF was measured from the same tangent to its deepest portion, divided by cord sagittal diameter. The depth of the SL was measured on sagittal FSE-T2WI from the anterior cord to the sagittal line, divided by the cord anteroposterior diameter at the same level. The study was approved by the local investigational review board at the University of Cincinnati
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