Angiography as a Potential Alternative to Diagnose Chiari I Malformation in Developing Countries Where CTA or cine-phase Contrast MRI Are Not Available

Introduction: In Chiari type I malformation, imaging tools such as CTA or MRI are utilized to obtain accurate diagnosis. Cine phase-contrast MRI is utilized to detect the motion of the cerebellar tonsils in Chiari patients. This advanced dynamic MRI tool utilizes and integrates a sequence of axial and sagittal cine phase-contrast sequences to aid in detecting, visualizing, and quantifying the abnormal pulsatile motion of the cerebellar tonsils at the foramen magnum. Such abnormal motion obstructs CSF flow from the cranial cavity to the spine. Also, the degree of abnormal tonsillar motion abnormality is associated with the extent of symptoms severity. Around the globe, many healthcare facilities lack the resources to afford advanced technological imaging tools such as CTA or MRI. Hence, traditional angiography may be a promising alternative tool in such circumstances.

Methods: In a patient-case with Chiari I malformation, an angiogram was utilized to visualize the abnormal tonsillar pulsation movement through observing the up-down bouncing motion of the PICA during systolic-diastolic phases (PICA excursion). Also, the amplitude of the PICA excursion was measured.

Results: The findings indicated that the degree of PICA excursion, revealed by angiogram, conforms to the pathophysiologic mechanisms and the severity of the associated symptoms.

Conclusion : This finding elucidates on a presurgical techniques that can potentially aid in the assessment of Chiari patients with exertional symptoms. Due to the availability of traditional angiogram in developing countries, the bouncing PICA can be a sign to clinch diagnosis where MRI or CTA availability maybe limited.