Magnetic Resonance Imaging of Chiari Malformation Type I in Adult Patients with Dysphagia.

Zan Chen,Feng-Zeng Jian,Hao Wu,Feng Lu

doi:10.1155/2019/7485010

Abstract

Objective To explore the magnetic resonance imaging (MRI) characteristics of Chiari malformation type I (CMI) in patients with dysphagia. Methods Adult patients diagnosed with CMI were retrospectively and consecutively reviewed from January 2013 to December 2016. Symptoms and medical characteristics were recorded. According to the clinical manifestations, we divided the patients into two groups. The first group had 21 patients with symptoms of dysphagia and the second group had 71 patients with nondysphagia symptoms. Various length or angle measurements of the posterior cranial fossa (PCF), syringomyelia, and degree of cerebellar tonsillar herniation were investigated using magnetic resonance imaging (MRI). Univariate, correlation, and multivariate logistic regression analyses were used to compare and analyze the data of the two groups. Results The mean length of the clivus, height of PCF, and slope inclination angle of clivus significantly decreased in the dysphagia group compared to the nondysphagia group. The mean cranial spinal angle (CSA) and degree of cerebellar tonsillar herniation were significantly larger in the dysphagia group. There were no correlations between the age, sex, disease duration, and the length of cerebellar tonsillar herniation or CSA. There was a positive correlation between dysphagia level and CSA (r=-0.50; p=0.021). Among CSA, age, sex, the degree of tonsillar herniation, syringomyelia, and disease duration, CSA was the individual sign that correlated significantly with dysphagia (OR: 1.447; 95% CI: 1.182-1.698; P<0.001). Interactions between CSA and the degree of cerebellar tonsillar herniation, syringomyelia, and dysphagia existed (OR: 1.104; 95% CI: 1.042-1.170; P=0.001 and OR: 1.081; 95% CI: 1.023-1.142; P=0.006, respectively). Conclusions The CMI patients with dysphagia were more likely to have a large CSA on MRI compared with CMI patients without dysphagia. An increased probability with syringomyelia or length of cerebellar tonsillar herniation can enhance the contribution of CSA to dysphagia in patients with CMI.

Highlights

Chiari malformation type I (CMI) is a cerebellar tonsil herniation of the foramen magnum, which can lead to compression of posterior cranial fossa (PCF) contents or pathologic obstruction of fourth ventricle cerebrospinal fluid flow [1, 2]
CMI was diagnosed based on cerebellar tonsillar herniation of more than 5 mm below the foramen magnum as diagnosed by magnetic resonance imaging (MRI) T1weighted scans and clinical manifestations [14]
Fifty-three patients with syringomyelia were in the nondysphagia group, and 14 patients were in the dysphagia group, with a mean age of 43.9 and 45.7 years, respectively

Summary

Introduction

Chiari malformation type I (CMI) is a cerebellar tonsil herniation of the foramen magnum, which can lead to compression of posterior cranial fossa (PCF) contents or pathologic obstruction of fourth ventricle cerebrospinal fluid flow [1, 2]. Clinical manifestations are diverse and include occipital headaches, deep sensitivity disturbances, gait instability, dysphagia, and pyramidal bundle signs [3,4,5,6]. Among these symptoms, dysphagia is one of the most important because it can have fatal health consequences and negatively impact patient safety and well-being [7, 8]. The pathophysiologic mechanisms underlying dysphagia in CMI patients are still unclear

Methods

Results

Conclusion