Imaging Modalities for Ruling Out Tumor or Syringomyelia

Rationale for MRI as First Choice

MRI provides superior soft tissue contrast compared to CT, making it possible to better visualize the relationship of tumors to soft tissues, bone marrow, and neural structures 3, 4
MRI has demonstrated high sensitivity and specificity for detecting pathologies including syringomyelia and spinal dysraphism 1, 2
For spine lesions, MRI has been shown to be the most sensitive modality for detection of tumors, followed by FDG-PET/CT and CT 4

Complete spine MRI without IV contrast is typically sufficient for initial evaluation of syringomyelia 1, 5
MRI without and with IV contrast is recommended for suspected neoplasms 6, 5
Precontrast images are necessary to accurately assess enhancement after contrast administration 2, 6

There is no relevant literature to support the use of CT spine in initial imaging evaluation for detecting syringomyelia 2
While CT better defines destruction of cortical bone, it is suboptimal for evaluating intraspinal contents and paraspinal soft tissues compared to MRI 7, 4
CT myelography, historically used for intraspinal pathologies, has decreased in usefulness with the advent of MRI 6
In spine lesions specifically, CT has been shown to be less sensitive than MRI for tumor detection 4, 8

For pediatric patients with suspected syringomyelia, MRI is particularly important as it can also identify associated conditions such as tethered cord syndrome, low-lying conus medullaris, or fatty filum terminale 1, 2
In cases where MRI is contraindicated, CT with contrast may be considered as an alternative, though with recognized limitations 7