MRI in intraspinal tuberculosis

We studied 20 patients with intraspinal tuberculosis (TB), to characterise the MRI features of tuberculous meningitis and myelitis. MRI leptomeningitis and intramedullary involvement in 11 patients, intramedullary lesions alone in 5, leptomeningitis alone in 2, and isolated extradural disease in 2. TB leptomeningitis was characterised by loculation of the cerebrospinal fluid (CSF), nerve root thickening and clumping (seen only in the lumbar region) or complete obliteration of the subarachnoid space on unenhanced images. Gd-DTPA-enhanced images proved useful in 6 cases, revealing linear enhancement of the surface of the spinal cord and nerve roots or plaque-like enhancement of the dura-arachnoid mater complex. Intramedullary lesions included tuberculomas (8), cord oedema (5) and cavitation (3). In seven cases of intramedullary tuberculoma multiple lesions with skip areas were seen, without significant cord swelling. One patient had an isolated lesion in the conus medullaris. The lesions were iso- or hypointense on T1-weighted images, iso-, hypo- or hyperintense on T2-weighted images and showed rim or nodular enhancement with contrast medium.     

Spinal tract pathology in AIDS: Postmortem MRI correlation with neuropathology

Vacuolar myelopathy (VM) and tract pallor are poorly understood spinal tract abnormalities in patients with the acquired immunodeficiency syndrome (AIDS). We studied the ability of magnetic resonance imaging (MRI) to detect these changes in spinal cord specimens postmortem and whether criteria could be formulated which would allow these conditions to be differentiated from other lesions of the spinal cord in AIDS, such as lymphoma, cytomegalovirus (CMV) and human immunodeficiency virus (HIV) myelitis. We imaged 38 postmortem specimens of spinal cord. The MRI studies were interpreted blind. The specimens included cases of VM myelin pallor, CMV myeloradiculitis, HIV myelitis, lymphoma as well as normal cords, both HIV+ve and HIV-ve. MRI showed abnormal signal, suggestive of tract pathology, in 10 of the 14 cases with histopathological evidence of tract changes. The findings in VM and tract pallor on proton-density and T₂-weighted MRI were increased signal from the affected white-matter tracts, present on multiple contiguous slices and symmetrical in most cases. The pattern was sufficiently distinct to differentiate spinal tract pathology from other spinal cord lesions in AIDS.     

MR imaging of intradural inflammatory diseases of the spine

Twenty-eight patients with intradural inflammatory disease of the spine were studied in order to characterize the MR imaging findings of infectious and inflammatory conditions. Patients were categorized according to the spinal compartment involved. Among the 12 patients in the intradural extramedullary group, unenhanced scans were either normal or nonspecific while contrast-enhanced scans were helpful in visualizing and localizing the lesion. Nevertheless, contrast-enhanced MR studies were unable to differentiate infection and inflammation from tumor in this compartment. Among 16 patients with intramedullary lesions, four had granulomatous disease and 12 had nongranulomatous disease. The granulomatous lesions resembled tumors and displayed MR characteristics of a focal lesion with large nodular enhancement. The patients with nongranulomatous intramedullary lesions exhibited two subsets of MR findings. In the first subset of nine patients, diffuse cord swelling and high signal were seen on long TR images, combined with either no enhancement or peripheral, diffuse, or speckled enhancement of the spinal cord on contrast-enhanced short TR images. In the second subset of three patients, minimal or no spinal cord swelling was displayed despite the visualization of high signal on long TR scans and nodular enhancement with contrast administration on short TR scans. Both subsets were sufficiently unique that nongranulomatous myelitis could usually be differentiated from spinal cord tumors.     

Magnetic resonance imaging in the management of suspected spinal canal disease in patients with known malignancy

AIM: The aim of this study was to examine the spectrum of spinal canal disease in patients with known malignancy using magnetic resonance imaging (MRI). MATERIALS AND METHODS: One hundred and fifty-five patients underwent a total of 159 spinal MRI examinations over a three-year period. Patients were examined using a 1.0T magnet and a phased array surface spine coil. Sagittal T1 weighted spin echo and STIR sequences were routinely employed. Axial T1 and T2 weighted spin echo images were obtained at sites of identified pathology. Contrast enhanced sagittal and axial T1 weighted spin echo images were acquired when the unenhanced appearances did not correlate with the clinical findings or when the images suggested intradural or intramedullary disease. RESULTS: Malignant disease affecting the spinal cord or cauda equina was noted in 104/159 (65%) patients (extradural n= 78, intradural n= 20, intramedullary n= 7); one patient had evidence of both intradural and intramedullary deposits. Multiple levels of extradural cord/cauda equina compression were present in 18/78 patients (23%). The thoracic spine was the most frequently affected (74%). Bone elements were the major component of extradural compression in 11/78 patients (14%). Intradural metastases were multiple in 15/20 patients (75%). Four of the six solitary intramedullary metastases were situated in the conus medullaris. CONCLUSION: Magnetic resonance imaging of the entire spine is the investigation of choice in patients with known malignancy and suspected spinal canal disease. Contrast-enhanced images should be acquired when the unenhanced appearances do not correlate with the clinical findings or when they suggest intradural or intramedullary disease.Loughrey, G. J. (2000). Clinical Radiology55, 849-855.     

单纯脊柱硬膜外病变12例报告及文献复习

目的 探讨单纯脊柱硬膜外病变的诊断和鉴别诊断.资料与方法 总结12例经手术病理证实的单纯硬膜外病变的MRI表现,并复习文献.结果 非创伤性硬膜外血肿的MRI表现特点是在T1WI上呈等、高信号,T2WI上呈高信号,或有低信号而呈混杂信号,多数不强化.海绵状血管瘤为T1WI上与脊髓等信号,T2WI上为极高的均匀信号,如有出血,则信号不均匀.病变有明显强化.如果肿块内有脂肪及血管成分,血管成分有明显强化,而脂肪成分不强化,则可能是血管脂肪瘤.T1WI和T2WI上与脊髓等信号的病变比较多,常见的有白血病、感染、转移瘤、脊膜瘤、骨髓瘤.较大囊肿应考虑硬膜外蛛网膜囊肿及棘球蚴囊肿,但以前者为多见.结论 MRI可以清楚显示单纯脊柱硬膜外病变的特点,并能对多数病例做出诊断.     

椎管内皮样囊肿破裂的MRI诊断（附13例报告）

目的 探讨椎管内皮样囊肿破裂（RDIC）的MRI诊断价值。材料与方法 13例RDIC原发灶均经手术和病理证实,皮样囊肿均位于T12以下椎管内,其中9例位于脊髓内,4例位于髓外硬膜下,均行脑和全脊柱MRISE序列T1WI、T2WI,7例有脊柱脂肪抑制序列。5例行脑CT检查,结果 4例髓外硬膜下皮样囊肿破裂MRI与CT均表现在脑池、脑沟或脑室内有脂肪滴,9例脊髓内皮样囊肿破裂者均见脊髓中央管内分布有脂肪滴,其中4例脑室内见脂肪滴,5例脑MRI发现脑底及后颅窝脂肪滴者,CT仅显示2例。脂肪滴MIE SE序列T1WI呈显著高信号,T2WI其信号略有衰减,脂肪抑制序列则呈极低信号;CT上脂肪滴则呈低密度,CT值-20--150HU。结论 MRI是诊断RDIC的最佳影像学方法,其显示RDIC脂肪滴在脑室、蛛网膜下腔和脊髓中央管内分布优于CT。CT与MRI联合应用能有效地鉴别RDIC脂肪滴抑或积气、碘化油滞留和血块。     

脊膜瘤MRI表现及其病理基础相关性研究

探讨脊膜瘤ＭＲＩ表现特征与病理关系。材料与方法，搜集行ＭＲＩ扫描且有手术病理结果的脊膜瘤１９例，观察肿瘤部位，数目，瘤体信号，肿瘤与脊髓交界带信号及硬脊膜改变，与手术病理结果对照并统计学处理。结果：肿瘤单发１８例，多发１例。     

MRI in the diagnosis and treatment of suspected malignant spinal cord compression

It remains unclear whether MRI is essential in all patients with suspected malignant spinal cord compression (MSCC), or whether some patients can be treated on the basis of plain radiographic findings and neurological examination. A prospective study was carried out of 280 consecutive patients with suspected MSCC, and the results of neurological examination plus plain radiographs were compared with MRI. 201 patients had MSCC (186 extradural, 5 intradural extramedullary and 10 intramedullary) and 11 patients had thecal sac compression without evidence of spinal cord compression. 25% of patients with MSCC had two or more levels of compression, 69% of these involving more than one region of the spine. A paraspinal mass was noted at the site of extradural spinal cord compression in 28%, and only one-third of these were detected on plain radiography. Focal radiographic changes and consistent neurology were present in 91 (33%) patients who had not had previous radiotherapy. MRI confirmed the presence of MSCC in 89/91 patients (specificity and positive predictive value of radiographic/clinical findings 98%) and the level of disease in all. MRI led to a change in the radiotherapy plan in 53% of patients (21% major change). The sensory level when present was four or more segments below the MRI level in 25/121 (21%) patients, and two or more levels above in 8/121 (7%) patients. Although focal radiographic abnormalities with consistent neurological findings, when present, accurately predicted the presence and level of MSCC, whole spine MRI is indicated in most patients with suspected MSCC because the additional information may alter the management plan. Treatment may be appropriately initiated on the basis of focal radiographic changes and consistent neurology if MRI is contraindicated or delayed, and in patients with a poor prognosis. In patients in whom there are no focal radiographic abnormalities and consistent neurological findings, urgent MRI is mandatory before radiotherapy is commenced.     

MRI全脊柱移床扫描对脊柱疾病的诊断

目的　探讨MRI全脊柱移床扫描在诊断脊髓及脊柱疾病中的应用价值。方法　对于 2 1例疑有脊髓及脊柱疾患的患者行全脊柱移床扫描 ,对接颈、胸、腰骶段脊柱图像而形成完整的全脊柱图像。与对接前的根据患者临床症状、体征 ,以某一椎体为中心的局部脊柱扫描图像进行对比 ,分析疾病的检出率和定位、定性的诊断效率。结果　 3例患者发现脊柱多发转移瘤 ,1例发现颈、腰段的多发神经鞘瘤 ,2例为全脊髓炎 ,4例患者为连续多椎体结核伴冷脓肿形成 ,2例患者发现外伤后多椎体及附件骨折 ,2例发现脊髓空洞。结论　MRI全脊柱移床扫描对于多发性、全身性、系统性脊髓及脊柱疾病的诊断具有重要作用     

Use of gadolinium chelates in MR imaging of the spine

Spinal disease can be divided into intramedullary, extramedullary-intradural, and extradural compartments. In the cord (intramedullary compartment), gadolinium chelates are useful to diagnose primary and metastatic tumors, inflammation, and demyelination, and to evaluate syringomyelia when a Chiari I malformation is not present. In the extra-medulullary-intradural compartment, gadolinium chelates are useful for the diagnosis of drop metastases, meningiomas, and schwannomas. In the extradural compartment, gadolinium chelates are most useful to distinguish recurrent disc herniation from epidural fibrosis in the postoperative back and may be useful to diagnosis the soft tissue component of osseous metastases.     

MRI of spinal epidural lymphoma

We reviewed the MRI features in eight patients with spinal epidural lymphoma (clinically primary in 4 patients); one patient had multiple lesions. The cervical spine was involved in one patient, the thoracolumbar spine in 5 and the sacrum in two. Mean longitudinal extension of the epidural lesion was 2.6 vertebral segments. The tumours were homogeneously isointense with the spinal cord on T1-weighted images and isointense or hyperintense on proton-density and T2-weighted images. The spinal cord was compressed in four patients but showed signal changes in only one. In five patients the lesions communicated through the intervertebral formaina with paravertebral soft tissue masses. In all but one of the patients diffuse signal changes in the vertebral body marrow consistent with osteolytic or osteobalstic changes were identified adjacent to or at distance from the epidural lesion. Vertebral collapse was observed in two patients.     

Application of turbo fluid-attenuated inversion-recovery MRI in evaluation of intraspinal tumors

PURPOSE: Although fluid-attenuated inversion-recovery (FLAIR) magnetic resonance imaging (MRI) is widely applied to diagnose central nervous system diseases, its role in diagnosis of intraspinal tumors is unclear. In this study, we evaluated the potential clinical application of a turbo FLAIR sequence for imaging of intraspinal tumors. MATERIALS AND METHODS: Forty-eight consecutive patients with intraspinal tumors underwent MRI with turbo FLAIR and turbo spinal echo (TSE) sequences. Turbo FLAIR images were then qualitatively and quantitatively compared with T2-weighted TSE images. RESULTS: Turbo FLAIR images were evaluated as superior to T2-weighted TSE images for image artifact, extradural tumor conspicuity, and intradural extramedullary tumor conspicuity and detection. Intramedullary tumor conspicuity with turbo FLAIR was less than T2-weighted TSE. Similar capabilities in detection of extradural and intramedullary tumors were found between turbo FLAIR and T2-weighted TSE. Turbo FLAIR and T2-weighted TSE displayed similar normal spinal cord signal-noise ratio (SNR) and tumor-to-cerebrospinal fluid (CSF) contrast-to-noise ratio (CNR). In addition, turbo FLAIR yielded significantly higher tumor-to-CSF contrast than T2-weighted TSE. However, tumor SNR, tumor-to-normal spinal cord contrast and CNR with turbo FLAIR images were lower than those with T2-weighted TSE images. CONCLUSION: This study demonstrated (a) a superiority of turbo FLAIR to T2-weighted TSE in displaying and detecting intradural extramedullary tumors, (b) a superiority of turbo FLAIR to T2-weighted TSE in demonstrating extradural tumors, and (c) less usefulness in displaying intramedullary tumors with turbo FLAIR than with T2-weighted TSE.     

Evaluation of spinal trauma by multi detector computed tomography and magnetic resonance imaging

Aim of work

The aim of this work is to assess the role of multi-detector computed tomography (MDCT) and magnetic resonance imaging (MRI) in evaluation of spinal trauma.

Patients and methods

Between January 2013 and April 2014, 98 patients (78 males and 20 females) with spinal injuries were investigated by MDCT and MRI. Assessment of the radiological findings of spinal injury was performed and the following were investigated: vertebral compression fractures, bursts and dislocations, posterior element fractures, C1 and C2 lesions, vertebral listhesis, bone marrow edema, spinal canal compression, disk herniation, extradural hematoma, spinal cord contusions, spinal cord swelling and posterior ligamentous complex injuries.

Result

A total of 271 lesions were diagnosed as follows: 217 lesions were diagnosed using MRI alone, 1 54 lesions were diagnosed using MDCT alone and 100 lesions were diagnosed using MRI and MDCT conjointly. By using MRI 117 more lesions were detected than using MDCT. MRI was significantly superior to MDCT in the diagnosis of bone marrow edema, posterior ligamentous complex injuries, disk herniations, spinal canal compressions, and spinal cord contusions and edema. In cervical spine injuries, MRI was useful for the evaluation of the supporting ligaments and the spinal cord after the patient has been stabilized. The average times required to perform CT and MRI were 1.38 ± 19.83 and 2.00 ± 19.58 days, respectively; this difference was significant (p?0.05) according to the Mann–Whitney test.

Conclusion

MRI was significantly superior to MDCT in the diagnosis of bone marrow edema, posterior ligamentous complex injuries, disk herniations, spinal canal compressions, and spinal cord contusions and edema. In cervical spine injuries, MRI was useful for the evaluation of the supporting ligaments and the spinal cord after the patient has been stabilized.MDCT and MRI are complementary to each other in evaluation of spine injuries.     

MRI in the investigation of patients with myelopathy thought to be due to multiple sclerosis

The role of cerebral and spinal cord MRI was investigated in 65 patients with myelopathy suspected of having demyelinating disease. Cerebral MRI demonstrated lesions compatible with demyelination in 80% and spinal cord MRI in 68.6%. In 28.5% of our patients brain lesions were present with normal spinal cord images, but in 17% spinal cord lesions were depicted with a normal brain MRI. The combination of the two examinations demonstrated lesions in 97% of the patients. The frequency of coexistent cerebral lesions in patients with spinal cord lesions was over 85% in patients with chronic disease but only 28.5% in patients with acute myelitis.     

Lupus-related myelitis: serial MR findings.

PURPOSETo correlate the MR findings in transverse myelitis secondary to systemic lupus erythematosus with clinical findings during disease exacerbation and remission.METHODSFour patients (ages 33 to 47 years) with episodes of transverse myelitis secondary to systemic lupus erythematosus were identified. Three patients had recurrent transverse myelitis episodes (one patient with two recurrences), for a total of eight episodes. MR examinations (six after contrast administration) were performed during each transverse myelitis episode, as well as during four periods of remission (in three patients) after therapy with steroids and/or immunosuppressive agents. MR examinations were reviewed for the presence of spinal cord enlargement, intramedullary signal abnormality, and contrast enhancement.RESULTSProlongation of T1 or T2 signal (or both) was seen in eight episodes (100%). Spinal cord enlargement was seen in six (75%) of eight transverse myelitis episodes, although it was mild during two episodes. Contrast enhancement was seen in three of six transverse myelitis episodes (dense, inhomogeneous enhancement during two episodes in one patient, and a small focus of enhancement in one patient). During periods of remission, spinal cord diameter returned to normal, and no contrast enhancement was seen, although abnormal signal was present in three examinations performed within 2 months of a transverse myelitis episode.CONCLUSIONSpinal cord widening and signal abnormalities are common MR findings during episodes of transverse myelitis related to systemic lupus erythematosus, and contrast enhancement is less frequently seen. Improvement or resolution of these findings correlates with clinical improvement.     

Imaging of tumors of the spine and spinal cord

Imaging of the spine and spinal cord has traditionally been accomplished with plain radiography, myelography, and CT. Recently, MR imaging has become the technique of choice in the assessment of lesions of the spine and spinal cord. MR imaging provides accurate localization of intramedullary, intradural extramedullary, and extradural tumors. Ependymomas and low-grade astrocytomas are the most common intramedullary tumors. MR imaging findings are distinguishable by the delineation and size of the lesion, and the signal intensity on T2-weighted images. Other less common tumors include malignant astrocytomas, hemangioblastomas, and intramedullary metastasis. Numerous foci of high-velocity signal loss are seen in the hemangioblastomas. Metastasis, meningiomas, and schwannomas are the most common intradural extramedullary tumors. Meningiomas are characterized by dural enhancement on postcontrast T1-weighted images. Schwannomas and neurofibromas often erode bony structures and appear to be dumbbell-shaped. Epidural metastasis accounts for the majority of extradural tumors. Primary malignant extradural tumors include lymphomas, chordomas, and so on. The most common primary benign extradural tumor is hemangioma, which often appears to be hyperintense on both T1-weighted and T2-weighted images. Intramedullary non-neoplastic lesions include demyelinating, vascular, and infectious diseases. Diffuse, peripheral, or speckled contrast enhancement, and lack of contrast enhancement may suggest non-neoplastic lesions.     

MRI at 1.5 T of intramedullary ependymoma and classification of pattern of contrast enhancement

We retrospectively reviewed the MRI findings in 28 patients with an intramedullary spinal cord ependymoma who underwent surgical treatment. There were 26 tumours in the cervical and two in the thoracic spine. T1- and T2-weighted and contrast-enhanced images at 1.5 T were obtained in all cases. T1-weighted imaging showed solid tumour as isointense in 13 patients, high-signal in ten and low signal in five. In contrast, T2-weighted imaging showed all tumours as high signal. Contrast enhancement was heterogeneous 13 patients, homogeneous 10, heterogeneous with cyst wall enhancement in three, and a nodule on a cyst wall was seen in two. Cases with these latter patterns require careful differential diagnosis from astrocytoma or haemangioblastoma. Received: 5 August 1999 Accepted: 24 April 2000     

Aortic pathology revealed by MRI in patients with clinical suspicion of spinal disease

In five patients with clinical suspicion of spinal disease, MRI of the spine revealed unexpected aortic pathology explaining the symptoms. No significant intraspinal pathology was found on MRI. However, in one patient with clinical suspicion of spinal stenosis, an aortic occlusion was detected on MR images of the spine. The lower extremity ischaemia, caused by the occlusion, was responsible for the symptoms. In another patient a paravertebral haematoma from a ruptured aortic aneurysm resulted in spinal nerve compression, thought before MRI to be caused by a spinal tumour. In three patients aortic aneurysm or dissection resulted in spinal cord ischaemia with symptoms mimicking those of compressive spinal disease. Thus, if MRI of the spine does not provide an explanation for the patient's symptoms, examination of the aorta is recommended.     

MR imaging of intraspinal tumors—Capability in histological differentiation and compartmentalization of extramedullary tumors

Summary Magnetic resonance (MR) images of 29 consecutive patients with intraspinal neoplasms (9 intramedullary tumors, 20 extramedullary tumors) were reviewed to evaluated the utility of MR imaging in distinguishing the intraspinal compartmental localisation and signal characteristics of each lesion. Compartment and histology of all neoplasms were surgically proven. MR correctly assigned one of three compartments to all lesions, 9 intramedullary, 14 intradural extramedullary (6 schwannomas, 3 neurofibromas, 5 meningiomas), and 6 extradural (3 schwannomas, 1 meningioma, 1 cavernous hemangioma, 1 metastatic renal cell carcinoma). All intramedullary tumors showed swelling of the spinal cord itself. In all five extradural tumors a low intensity band was visualized between the spinal cord and tumor. On the other hand, a low intensity band was demonstrated in no cases with intradural tumors. Visualization of this low intensity band is important in differentiating extradural from intradural-extramedullary lesions. We call this low intensity band, the extradural sign. Signal intensity of intradural tumors varied with histology. In extramedullary tumors, signal intensity of schwannomas was similar to that of the cerebrospinal fluid (CSF) both on T1 weighted (inversion recovery) and T2 weighted spin echo (SE) images. On the other hand, meningiomas tended to be isointense to the spinal cord on both T1 and T2 weighted SE images. We found relatively reliable signal characteristics to discriminate meningioma from schwannoma.     

Imaging of thoracic and lumbar spinal extradural arachnoid cysts: report of two cases

Extradural arachnoid cysts are uncommon expanding lesions in the spinal canal which may communicate with the subarachnoid space. Usually in the lower thoracic spine, they may cause symptoms by compressing the spinal cord or nerve roots. We report cases of thoracic and lumbar arachnoid cysts studied by cystography, myelography, CT and MRI. These techniques showed extradural cystic lesions containing cerebrospinal fluid, with variable communication with the subarachnoid space, causing anterior displacement and flattening of the spinal cord. Received: 3 November 1995 Accepted: 16 April 1996