Which imaging modalities are recommended for confirming a diagnosis of Chiari malformation in primary care?

Magnetic Resonance Imaging (MRI) is the recommended imaging modality for confirming a diagnosis of Chiari malformation in primary care due to its superior ability to visualize the cerebellar tonsils, brainstem, and spinal cord anatomy in detail.

MRI provides high-resolution images that can detect the downward displacement of the cerebellar tonsils through the foramen magnum, which is the hallmark of Chiari malformation, as well as associated syringomyelia or other structural abnormalities.

Computed Tomography (CT) is generally not preferred for initial diagnosis because it offers limited soft tissue contrast and is less sensitive in detecting the subtle anatomical changes characteristic of Chiari malformations.

Therefore, when Chiari malformation is suspected clinically in primary care, referral for MRI brain and cervical spine imaging is the appropriate next step to confirm the diagnosis and guide further management.

This approach aligns with UK clinical practice guidelines emphasizing MRI for detailed neuroanatomical assessment ¹ and is supported by neuroradiological literature highlighting MRI as the gold standard for Chiari malformation diagnosis (Chiapparini et al., 2011; Vannemreddy et al., 2010; Rusbridge et al., 2018).