FONAR Upright MRI Shows Chiari Related Cranial Settling

The following is a press release from FONAR, Inc.

March 13, 2008 - FONAR Corporation (NASDAQ-FONR), The Inventor of MR Scanning, announced that the value of the FONAR UPRIGHT© Multi-Position™ MRI in the diagnosis and evaluation of Chiari malformation patients has just been published by The Chiari Institute, North Shore-Long Island Jewish Health Systems, in the Journal of Neurosurgery: Spine, December 2007, Volume 7 http://thejns.org/doi/abs/10.3171/SPI-07/12/601 and www.northshorelij.com/workfiles/chiari/J%20Neurosurg%20Spine%20article%20Dec%2007.pdf

The authors were Thomas H. Milhorat, M.D., Paolo A. Bolognese, M.D., Misao Nishikawa, M.D., of the Department of Neurosurgery, The Chiari Institute, North Shore-Long Island Jewish Health Systems; Nazli B. McDonnell, M.D., PhD., of the NIH National Institute on Aging; and Clair A. Francomano, M.D. of the Greater Baltimore Medical Center. The article, titled, "Syndrome of occipitoatlantoaxial hypermobility, cranial settling, and Chiari malformation Type I in patients with hereditary disorders of connective tissue", examined patients with CT as well as the FONAR UPRIGHT® MRI.

The conclusion of the study was to report a previously unrecognized association between Chiari Malformation Type I (CM-I) and Hereditary Disorders of Connective Tissue (HDCT). The study occurred between January 2002 and April 2007 and involved 2, 813 patients, of which 45% were referred for evaluation after failed Chiari Malformation surgery.

picture FIG. 6. Results of vertical MR imaging in a 27-year-old woman with HDCT/CM-I. Midsagittal image in supine position (left) showing normal basion-dens interval (7.7 mm), normal basion- atlas interval (3.5 mm), normal clivus-axis angle (141°), large retroodontoid pannus, and low-lying cerebellar tonsils. On assumption of the upright position (right), there is evidence of cranial settling (2.6 mm decrease of basion-dens interval), posterior gliding of occipital condyles (4.3 mm increase of basion-atlas interval), anterior flexion of the occipitoatlantal joint (8° decrease of clivus-axis angle), increased basilar impression, and cerebellar ptosis with downward displacement of cerebellar tonsils to C-1 (white arrow). Note the greatly increased impaction of the foramen magnum anteriorly and posteriorly. Line C, superior plane of the clivus; Line D, plane of the posterior surface of the dens. Asterisk indicates the retroodontoid pannus.

The primary diagnostic tools utilized in the study were 2D reconstructed CT and upright X-ray radiography. The final stage of the study included examinations of patients in the FONAR UPRIGHT® MRI for comparison.

The authors described, for the first time, the phenomenon of "cranial settling", occurring in patients with both Chiari Malformation 1 (CM-I) and Hereditary Disorders of Connective Tissue (HDCT).

They reported, "Recent experience with vertical MR imaging has proved helpful in understanding the dynamic features of occipitoatlantoaxial hypermobility. As shown in Fig. 6, functional cranial settling was associated with notable displacements that included reduction of the basion-dens interval, posterior gliding of the occipital condyles, anterior flexion of the occipitoatlantal joint, increased basilar impression, and cerebellar ptosis with downward displacement of the cerebellar tonsils. These displacements are consistent with the often-pronounced symptoms and signs of lower brainstem dysfunction experienced by patients with cranial settling on assumption of the upright position."

Concluding this peer-reviewed paper, the acknowledgment by Dr. Milhorat, et al. kindly reported, "We thank Dr. Raymond V. Damadian (Fonar Corporation) for providing technical assistance and supervision of patients undergoing vertical MR imaging."

Dr. Damadian, president and chairman of FONAR said, "We are appreciative of Dr. Milhorat and his team for recognizing the FONAR UPRIGHT® MRI's power to visualize the full cranial settling, cerebellar ptosis, cerebellar tonsil descent and foramen magnum impaction that occurs in the Chiari Malformation-I/HDCT patients so they can be optimally addressed surgically."