The purpose of this article is to review the physiology of normal brain and spinal cord motion in the subarachnoid space, principles of cine balanced steady-state free precession (bSSFP) magnetic resonance imaging (MRI), clinical applications, and the pitfalls encountered with this technique.
The brain and spinal cord are dynamic structures that move with each heartbeat due to transmitted arterial pulse waves. Conventional MRI sequences do not allow anatomic evaluation of the pulsatile movement of the neural structures in the subarachnoid space due to limitations in temporal resolution. Cine bSSFP MRI uses cardiac gating to evaluate dynamically the brain and spinal cord with high contrast and temporal resolution.
Cine bSSFP can be used in the evaluation of idiopathic syringomyelia to assess an underlying treatable cause, including arachnoid bands, which are usually not well visualized with conventional MR sequences due to motion artifact. This MRI technique is also useful in the evaluation of intraspinal and intracranial arachnoid cysts and the degree of mass effect on the cord. Other applications include preoperative and postoperative evaluation of Chiari I malformation and the evaluation of lateral ventricular asymmetry. The major limitation of cine bSSFP is the presence of banding artifacts, which can be reduced by shimming and modifying other scan parameters.
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Movie 1 Cine bSSFP sequence. Normal brain motion is pulsatile, with caudal movement of the brainstem and cerebellar tonsils during systole, with return to neutral position in diastole
Movie 2 Cine bSSFP sequence demonstrates a fine arachnoid membrane posterior to the spinal cord at the lower level of the syrinx at T4/5
Movie 3 Intraoperative video demonstrates the presence of an arachnoid band dorsal to the spinal cord. Microneurosurgical lysis of the arachnoid band is performed
Movie 4 Sagittal cine bSSFP sequence clearly demonstrates superior wall of arachnoid cyst and associated mass effect on the spinal cord
Movie 5 Cine phase-contrast scan demonstrates turbulent flow at the superior margin of the arachnoid cyst
Movie 6 Cine bSSFP shows the superior and inferior cyst walls. Further compression of the spinal cord is seen with each heartbeat
Movie 7 Sagittal cine bSSFP: the cyst walls are more clearly appreciated with dynamic imaging
Movie 8 Coronal cine bSSFP: the cyst walls are more clearly appreciated with dynamic imaging
Movie 9 Sagittal cine bSSFP shows more clearly the cyst walls, with exaggeration of the mass effect on the spinal cord seen each heartbeat
Movie 10 Cine bSSFP sequence shows that with each heartbeat, there is downward displacement of the brainstem exacerbating ventral compression of the medulla. Tonsillar impaction on the dorsal dura is also seen
Movie 11 Impaction of the medulla on the dens is seen with exaggerated tonsillar motion. There is effacement of the subarachnoid spaces at the foramen magnum
Movie 12 Following posterior fossa decompression, mass effect on the medulla has decreased
Movie 13 Sagittal cine bSSFP sequence demonstrates dorsal tethering of the medulla, inferior cerebellar vermis, and upper cervical cord due to adhesions. There is loss of normal pulsatile motion at the cervicomedullary junction
Movie 14 Cine bSSFP following repeat posterior fossa decompression and adhesiolysis. Subtle motion of the upper spinal cord is now seen
Movie 15 Corresponding cine bSSFP shows fine septations within syrinx
Movie 16 Sagittal cine bSSFP sequence shows several thick band artifacts obscuring the thoracic cord syrinx
Movie 17 The field of view is repositioned to reduce the banding artifact and allow better visualization of the thoracic syrinx. Some banding artifacts are still present
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Li, A., Wilkinson, M., McGrillen, K. et al. Clinical Applications of Cine Balanced Steady-State Free Precession MRI for the Evaluation of the Subarachnoid Spaces. Clin Neuroradiol 25, 349–360 (2015) doi:10.1007/s00062-015-0383-1
- Balanced steady-state free precession
- Magnetic resonance imaging (MRI)
- Arachnoid adhesions
- Arnold–Chiari Malformation
- Cerebrospinal fluid (CSF)