Is this an abnormal cine MRI?

[Danaan]

I’ve had a cine MRI done that states:

EXAMINATION: MRI brain W/O- (29M/0004)
Technique: Sagittal T1, axial T2, axial diffusion-weighted images, coronal FLAIR
Findings: The cerebellar tonsils are mildly low-lying measuring up to 5mm below the level of the foramen magnum on the left side. Encroachment of the cerebralspinal fluid is seen at the level of the foramen magnum. Right frontal developmental venous anomaly. No evidence of an actual infarct. Re-demonstrated are nonspecific subcortical and periventricular white matter T2/FLAIR signal hyperintensities. Phase contrast imaging in neutral position demonstrates minimal flow posterior to the cerebellar tonsils. There is some flow anteriorly at the region of the foramen magnum. Flexion view demonstrates decreased flow anteriorly at the level of the foramen magnum and mildly increased flow posteriorly. Extension view demonstrates mildly increased anteriorly at the level of the foramen magnum.
Mild bilateral maxillary disease.

IMPRESSION:
Borderline Chiari malformation. Neutral position phase contrast sequences demonstrate minimal flow posteriorly at the level of the foramen magnum posterior to the cerebellar tonsils. Anteriorly, there is mildly decreased flow. On flexion view, there is predictably mildly decrease in the flow anteriorly and increase in the flow posteriorly at the level of the foramen magnum. Extension view demonstrates mildly increased flow anteriorly and no significant flow posteriorly at the level of the foramen magnum.

Probable right frontal developmental venous anomaly.

Non specific white matter changes.
       ***
Note:  I was given no contrast media (it was not ordered); my neurologist thought that’s a report error, & also said he had no idea what this MRI result meant.
1)  Do these "minimal flow" and "no significant" flow results mean I might have CSF blockage issues emerging?
2)  What other tests that should be done to allow specialists to review my case?
53, ♀, vertigo arrhythmia

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history and review your scan, I can not tell you what the implications of your MRI findings are. However I will try to provide you with some useful information.

A Chiari malformation is diagnosed when there is brain tissue (part of the back of the brain called the cerebellum) which is going down through a hole in the skull called the foramen magnum. Chiari malformations are graded based on how much tissue is passing through the hole; if the amount is 5 mm or less, it is considered grade I, which is minor. This develops as the skull and brain grow. More advanced cases of Chiari, grade II and higher, present mainly in infancy or childhood.

The concerns with Chiari malformations are that they could either obstruct flow of the fluid around the brain and spine (called cerebrospinal fluid, or CSF) and that they can cause pressure on brain structures.

When a Chiari malformation is present, surgery should only be done if (1) there is an obstruction of CSF flow and (2) if there are symptoms. The cine flow study is done to assess the CSF flow. These studies do provide useful information, but their interpretation should be by an experienced neuroradiologist, neurosurgeon, or neurologist, as they are not commonly done studies and require experience.

Surgery on Chiari malformations when they are not causing symptoms and when there is not significant obstruction to CSF flow is unnecessary, will not lead to symptom improvement, and may be associated with complications. On the other hand, if a Chiari is causing obstruction to flow and are causing symptoms that are localizable to this particular problem, surgery is indicated.

The report you describe above does suggest such limitation of flow. The extent of limitation is difficult to ascertain from the report. Evaluation of you and your images by an experienced neurosurgeon in a high-volume center (one that has experience with such cases) and preferably a tertiary care hospital (such as a university hospital) is recommended.

Thank you for using the forum I hope you find this information useful good luck.

[Danaan]

Thank you for your thoughtful response. Unfortunately, I've been symptomatic off and on for 6 years, with more severe and progressive symptoms these last 11 months. (Cardiology, ENT, & neurology consults this last year have not resulted in answers or relief.)

I have appointments with my PCP & neurologist to impart to them that -as you and others have noted- an evaluation by a Chiari specialist is now indicated.

Thanks again.