Spinal cord infection: myelitis and abscess formation.

PURPOSEOur purpose was to describe the MR findings and evolution of spinal cord abscess and to define those MR features that allow differentiation of cord infection from other intramedullary abnormalities.METHODSWe retrospectively reviewed the MR studies of all patients in whom intramedullary spinal cord abscess was proved either by blood or cerebrospinal fluid culture or by serologic examination at our institution between January 1988 and January 1996. The study group included four adults and two children, 7 to 74 years old (mean age, 38 years).RESULTSInitial MR studies showed intramedullary high signal on T2-weighted sequences with poorly defined marginal enhancement on T1-weighted images. On follow-up contrast-enhanced T1-weighted studies, the lesions had well-defined enhancing margins with central low signal intensity. After the initiation of therapy, T2 signal abnormalities decreased markedly and contrast-enhanced studies showed ring enhancement. These T1 findings resolved with treatment over serial studies in four patients. The organisms identified were Streptococcus milleria, S pyogenes, atypical mycobacteria, Mycobacterium tuberculosis, and Schistosoma mansoni (both children).CONCLUSIONA characteristic sequence of imaging findings aids in the differentiation of cord infection from other intramedullary lesions.     

Spinal cord vascularity. II. Extraspinal sources of spinal cord arteries in the rat.

The arrangement of extravertebral sources of spinal cord arteries in the rat is similar to that in man. Some differences, however, do exist, concerning mainly the arrangement of spinal branches supplied by the subclavian-vertebral arteries. Contrary to the situation in man, the vertebral artery in the rat appears to be the sole source of blood supply to the cervical cord. A high incidence of variations or anomalies of the vertebral artery in the rat existed. Vascular variations in the upper left thoracic spaces were frequent in the rat and more complicated than in man. In both species, a poor supply of significant spinal cord feeders from the superior intercostal artery of the costocervical trunk was found. Variations in the origin and branching of the aortic segmental arteries occur in both species. In man the major variation consists of two or more intercostal arteries arising from a common stem, while the rat more often displays a rudimentary subcostal artery. Finally, the ileolumbar arteries in the rat are constant branches of the lumbar aorta. Despite these differences in the vascular anatomy, the rat seems to be well suited for experimental comparative investigations, not feasible in man.     

Spinal cord atrophy in injured rodents: high-resolution MRI.

Longitudinal magnetic resonance imaging (MRI) was performed in normal and spinal cord (SC)-injured rodents. A fast technique based on polar B-spline snake was developed to extract the SC contour from the MR images in order to estimate the cord atrophy. Based on pooled data from all of the imaging studies, the extracted contours correlated well with manually defined contours. Results from the injured group showed cord atrophy shortly after the contusion injury. The maximum amount of atrophy (9.7% +/- 3.5% decrease in the cross-sectional area (CSA)) occurred mainly at the epicenter around 14 days postinjury. The caudal and rostral segments in the injured group did not exhibit significant atrophy compared to the normal controls. The MRI-based atrophy measurements obtained in injured cords are consistent with previous histological findings.     

Spinal cord toxoplasma lesion in AIDS: MR findings.

Toxoplasma gondii is the cause of the most common opportunistic infection of the brain in AIDS but is extremely rare as the cause of a solitary lesion of the spinal cord. Symptoms are weakness of the lower limbs followed closely by paralysis unless diagnosed and treated early. We present such a case in an intravenous drug abuser with AIDS and emphasize that MRI is the diagnostic tool of choice and that the index of suspicion should be high in immunosuppressed patients.     

Spinal cord vascularity. I. Extraspinal sources of spinal cord arteries in man.

The arrangement of extraspinal sources of the spinal cord arterial supply in man is more complicated than previously described, especially with regard to the origin and branching of the aortic segmental arteries. The fact that other arteries in the neck than the vertebral artery, such as the costo-cervical trunk and the ascending cervical artery may contribute to the supply of the cervical cord is confirmed, and also the occurrence of two or more spinal branches from different sources entering the same intervertebral foramen. Frequent occurrence of two or more segmental arteries arising from a common stem and variations in the branching of the subcostal arteries were found; their functional significance on the spinal cord circulation is not known. The fact that no significant anterior root artery was ever seen at the level of the vascular anomaly suggests that the anomaly is of no clinical importance. Nevertheless, obstruction of a common stem entail the risk of spinal cord infarction due to involvement of an important posterior root artery. On the other hand, the spinal cord seems to be fairly well protected against ischaemic injury following limited interference with the extraspinal arteries due to a profuse supply of intra- and extraspinal collaterals.     

Spinal cord cavities: differential-diagnostic criteria in magnetic resonance imaging.

MRI examinations of 30 patients with idiopathic syringomyelia and 10 patients with cavities associated with an intramedullary neoplasm were evaluated with respect to typical MRI features in both groups. All tumor-associated cases resembled the idiopathic syringomyelias in some portions of the cavity. At the tumor site, however, tumor-associated cases demonstrated typical findings: the cavities showed abrupt changes of diameter (10/10) and position (8/10) and the surrounding spinal cord demonstrated an uneven thickness (10/10), an increased signal intensity on T2-weighted images (10/10) and pathological contrast enhancement (7/7). Displacement of cerebellar tonsils below the level of the foramen magnum (21/30) and enlargement of the spinal canal (7/29) were characteristic features of idiopathic cases. In conclusion, MRI provides valuable criteria to differentiate between idiopathic and tumor-associated cavities.     

Cisplatin- vs. oxaliplatin-based radiosensitizing chemotherapy for squamous cell carcinoma of the esophagus

Purpose

To compare the outcomes of two neoadjuvant radiochemotherapy (N-RCT) regimens for squamous cell carcinoma of the esophagus (ESCC).

Methods

The standard N-RCT regimen for ESCC at our institution between 2002 and 2011 was a total dose of 45 Gy (1.8-Gy fractions) with concomitant cisplatin (20 mg/m², days 1–5 and 29–33) and 5-fluorouracil (5-FU; 225 mg/m², 24 h continuous infusion on days 1–33). During the same period, a phase I/II study comparing the standard ESCC N-RCT protocol with a regimen identical except for the replacement of cisplatin with weekly oxaliplatin (40–50 mg/m²) was performed at our center. The standard regimen was used to treat 40 patients; 37 received the oxaliplatin regimen. All patients subsequently underwent radical resection with reconstruction according to tumor location and two-field lymph node dissection.

Results

Median follow-up time from the start of N-RCT was 74 months (range 3–116 months). The two patient groups were comparable in terms of demographic and baseline tumor characteristics. R0 resection was achieved in 37/39 patients (95?%) in the cisplatin-based N-RCT group, compared to 24/37 (65?%) in the oxaliplatin-based group (p?=?0.002). A pathological complete response (pCR) was seen in the resection specimens from 18/39 patients (46?%) in the cisplatin-based N-RCT group and in 8/37 (22?%) oxaliplatin-group patients. In the cisplatin group, 2- and 5-year overall survival (OS) rates were 67?±?8?% and 60?±?8?%, respectively (median OS 103 months), compared to 38?±?8?% and 32?±?8?%, respectively, for the oxaliplatin group (median OS 17 months; hazard ratio, HR 0.452; 95?% confidence interval, CI 0.244–0.839; p?=?0.012).

Conclusion

Oxaliplatin-based N-RCT resulted in poorer outcomes in ESCC patients and should not routinely replace cisplatin-based N-RCT.     

脊髓损伤与脊髓隐匿性基础病变病例分析

对收治的脊髓损伤典型病例进行回顾性分析,总结临床经验。作者经治的脊髓损伤的漏诊、误诊或延期诊断病例,绝大部分存在隐匿性病变。     

Spinal cord MRI in adult polyglucosan body disease.

MRI appearance of adult polyglucosan body disease is described. A 67-year-old man presenting with a chronic progressive degenerative neurologic disorder was found to have marked atrophy of the entire cord, without signal abnormalities on long TR images. Autopsy revealed atrophy of the cord, diffuse gliosis, and numerous corpora amylacea.     

Spinal cord compression due to costal Echinococcus multilocularis.

We present computerized tomography (CT) and magnetic resonance imaging (MRI) findings of a costal hydatid cyst (Echinococcus multilocularis) causing spinal cord compression. The hydatid disease was proved histologically. MRI was not only very useful for determining the spinal extension of the disease by its multiplanar imaging capability, but also gave important information about the texture of the cyst, thus aiding the preoperative diagnosis.