MR imaging of spinal lymphoma.

Fourteen patients with spinal lymphoma examined by MR imaging were reviewed. Thirteen of them also had extraspinal lymphoma. Vertebral involvement was found in 12 patients, epidural in 10, and paraspinal in 8 patients. On the basis of MR imaging at 0.3 T, spinal lymphoma may be divided into three types of growth pattern according to the main location: paraspinal, vertebral, and epidural. Most frequently, all three locations were found simultaneously on MR (7/14). In one patient the location was vertebral with epidural extension, in one paraspinal with vertebral extension, in 3 it was entirely vertebral, and in 2 entirely epidural. Multiple plane T1-weighted imaging gave complete information about the extent of spinal lymphoma. The signal intensity was lower than or equal to muscle and lower than bone marrow in paraspinal and vertebral lesions on T1-weighted images and high on T2-weighted images. Epidural lesions showed a hypo- or isointense signal relative to the cord on T1-weighted images except in one case and a hyperintense signal on T2-weighted images. Compression of the cord and cauda equina due to bulging of diseased vertebral bodies and epidural lesions was well demonstrated. MR imaging was also found useful in the follow-up of treatment.     

MR imaging of intradural extramedullary tumors.

Thirty-one consecutive intradural extramedullary spinal tumors examined with MR at 0.3 T were reviewed. In 13 of the patients myelography had been performed. There were 11 patients with meningeoma, 14 with neuroma, one ependymoma, 3 metastases, and 2 lipomas. All tumors were surgically removed and verified by histology. The intradural extramedullary location of the tumors was accurately assessed by MR imaging in all patients and by myelography in 10 of 13. The MR diagnoses were in accordance with the histologic findings in 74% of cases. Compression of the spinal cord or cauda equina with widening of the subarachnoid space above and below the mass or outward displacement of epidural fat was characteristic of the intradural extramedullary tumors. The signal intensity of meningeoma as well as of neuroma was slightly lower or equal to that of the cord on T1-weighted images, and equal to or higher than cord signal on T2-weighted images. Neuroma had a lower signal intensity on T1-weighted images and a higher signal intensity on T2-weighted images than meningeoma. Meningeoma appeared more homogeneous than neuroma and had a broad base towards the dura.     

Epidural abscess of the cervical spine: MR findings in five cases.

Cervical epidural abscess is an uncommon infectious process of the spinal epidural space. Although this disorder is often unsuspected clinically, the patient's signs and symptoms may suggest other diagnoses that frequently lead to an MR examination. We retrospectively reviewed the MR examinations of five patients with surgically proved cervical epidural abscess in order to assist in the diagnosis of this clinically elusive disorder. Each epidural abscess was evaluated for MR signal intensity, location, extent, delineation, and enhancement pattern. We assessed the spinal cord for compression and signal intensity and analyzed the vertebrae, intervertebral disks, and paraspinal soft tissue. Compared with the spinal cord, the abscess was isointense or hypointense on T1-weighted spin-echo images and hyperintense on T2-weighted images. The abscess was hyperintense or isointense relative to the cord on T2* gradient-echo images. Enhancement of the abscess occurred in the two patients given an IV injection of gadopentetate dimeglumine. The epidural abscess was located anteriorly in three patients, posteriorly in one, and was circumferential in one. The abscess extended from two to nine vertebral bodies in length. In each case, the abscess caused some degree of spinal cord compression, and one patient had bright signal intensity within the cord on T2-weighted images. Three patients had MR changes of accompanying osteomyelitis and paravertebral abscess. MR imaging is useful in diagnosing cervical epidural abscess and in evaluating associated abnormality of the spinal cord, vertebral bodies, intervertebral disks, and paraspinal soft tissue.     

Spinal MR findings in continuous epidural analgesia without infection

BACKGROUND AND PURPOSE: Spinal epidural abscesses are major complications of epidural anesthesia, and their MR features have been reported. In patients receiving continuous infusion via an epidural catheter, MR findings may mimic those of spinal epidural abscess in the absence of infection. The purpose of this study was to assess the spinal MR findings associated with continuous epidural anesthesia. METHODS: Spinal MR findings in five consecutive patients receiving continuous epidural anesthesia were retrospectively evaluated. Axial and sagittal T1- and T2-weighted spin-echo and contrast-enhanced fat-suppressed T1-weighted spin-echo images were obtained. Infection was ruled out on microbiologic analysis three patients and on follow-up in two. Each lesion was evaluated for its MR signal intensity, location, extent, delineation, and enhancement pattern. In three patients, follow-up MR imaging was performed within 5-150 days, and the images were compared. RESULTS: Posterior epidural lesions were identified in all five patients. The lesions were isointense to hypointense relative to the spinal cord on T1-weighted images, isointense relative to CSF on T2-weighted images, and well enhanced on enhanced T1-weighted images. The anomalous enhancement involved two to seven vertebral bodies. In one patient, the enhanced lesion slightly compressed the spinal cord. On follow-up MR imaging, the epidural lesions decreased in two patients and did not change in one. CONCLUSION: Continuous epidural anesthesia can result in MR findings similar to those of epidural abscess, even in the absence of infection.     

Magnetic resonance imaging spectrum of spinal meningioma

PurposeTo evaluate magnetic resonance (MR) imaging findings of spinal meningioma and to determine the radiological subtypes based on the MR imaging findings and their respective clinical features.Material and methodsData for 105 patients with surgically treated and histopathologically diagnosed spinal meningiomas at our hospital between May 1, 2003 and May 1, 2017 were evaluated in this study. Two radiologists reviewed the characteristics of spinal meningiomas on MR images and categorized the spinal meningiomas into subtypes based on MR imaging findings.ResultsMost spinal meningiomas showed higher signal intensity than that of the spinal cord but lower than that of the subcutaneous fat on T2-weighted images (WI). 56 cases (54%) showed adjacent spinal cord signal changes. Meningiomas could be categorized according to MR imaging findings into type A: dural-based tumors with a homogeneous signal intensity and intense contrast enhancement (81 cases, 77%); type B: round or oval-shaped tumors with an internal hypointense portion on T2-weighted images (18 cases, 17%); type C: en plaque tumors (three cases, 3%); and type D: tumors with unusual findings and a heterogeneous appearance (three cases, 3%). All type C patients showed spinal cord signal changes.ConclusionsSpinal meningioma showed slightly high signal intensity rather than high signal intensity on T2-weighted images. Spinal cord signal changes were present in more than half of the cases. Clinical differences were observed among the different MR imaging types.     

CT and MR imaging of advanced Zollinger-Ellison syndrome

The CT and magnetic resonance (MR) findings in 13 patients with advanced Zollinger-Ellison syndrome are described. In eight patients (62%) one or more primary tumors were found with both methods. All patients with proven liver metastases (n = 7) were identified by MR. Computed tomography was positive in six of these patients. Three patients with lymph node metastases were identified on CT and MR and one patient had bone metastases. Computed tomography and MR were inferior to selective arteriography in the detection of multiple lesions of the pancreas in a patient with multiple endocrine neoplasia-I syndrome. On the T1-weighted MR images, the primary tumors demonstrated no consistency with regard to their signal intensity relative to the adjacent pancreatic parenchyma. All gastrinomas had an increased relative signal intensity on the T2-weighted images with the exception of a calcified tumor. Liver and lymph node metastases had a low signal intensity on the T1-weighted images and an increased signal intensity on the T2-weighted images. The signal intensity of primary tumors and metastases was independent of size. In conclusion, MR was able to detect abnormalities based on its outstanding lesion/normal tissue contrast, whereas CT diagnosis was based mostly on contour distortion. For the current technique, MR is considered at least equal to CT.     

High-intensity basal ganglia lesions on T1-weighted MR images in neurofibromatosis

Basal ganglia lesions, characterized on MR by increased signal intensity on T1-weighted images, were observed in seven patients with documented neurofibromatosis. These lesions most often involved the globus pallidus and internal capsules in a bilateral and symmetric fashion, and extended across the anterior commissure resulting in a "dumbbell" configuration. Smaller and less prominent foci of increased signal also were present on corresponding T2-weighted images. These lesions did not exhibit mass effect, edema, or enhancement with gadolinium-DTPA. They were not visible on CT (performed in two patients) and demonstrated no progression during a 2-year interval in three patients. Their signal characteristics and morphology suggest that they represent heterotopias containing Schwann cells and/or melanin deposits. Migrational abnormalities of these neural crest derivatives are known to occur in neurofibromatosis, and the presence of such heterotopias has been documented pathologically in patients with this disorder. While recent reports discuss foci of increased signal intensity on T2-weighted MR images in patients with neurofibromatosis, signal abnormalities on T1-weighted images have not yet been described. When lesions characterized by similar signal as well as morphologic characteristics are encountered on MR, the diagnosis of neurofibromatosis should be considered.     

High-intensity basal ganglia lesions on T1-weighted MR images in neurofibromatosis

Basal ganglia lesions, characterized on MR by increased signal intensity on T1-weighted images, were observed in seven patients with documented neurofibromatosis. These lesions most often involved the globus pallidus and internal capsules in a bilateral and symmetric fashion, and extended across the anterior commissure resulting in a "dumbbell" configuration. Smaller and less prominent foci of increased signal also were present on corresponding T2-weighted images. These lesions did not exhibit mass effect, edema, or enhancement with gadolinium-DTPA. They were not visible on CT (performed in two patients) and demonstrated no progression during a 2-year interval in three patients. Their signal characteristics and morphology suggest that they represent heterotopias containing Schwann cells and/or melanin deposits. Migrational abnormalities of these neural crest derivatives are known to occur in neurofibromatosis, and the presence of such heterotopias has been documented pathologically in patients with this disorder. While recent reports discuss foci of increased signal intensity on T2-weighted MR images in patients with neurofibromatosis, signal abnormalities on T1-weighted images have not yet been described. When lesions characterized by similar signal as well as morphologic characteristics are encountered on MR, the diagnosis of neurofibromatosis should be considered.     

Intradural schwannomas of the spine: MR findings with emphasis on contrast-enhancement characteristics.

Intradural extramedullary schwannomas are nerve sheath neoplasms that consist of focal proliferations of Schwann cells involving a spinal nerve. We reviewed the MR findings in seven patients with pathologically proved intradural schwannomas. The contrast-enhancement characteristics on MR images were determined and compared with the histologic features of the tumor. Six lesions were variably hyperintense on T2-weighted images and one was uniformly hypointense compared with the signal intensity of the spinal cord. Signal on T1-weighted images ranged from hypointense to isointense. All seven tumors showed heterogeneous enhancement; in five, the enhancement involved only the periphery of the lesion. The pattern of enhancement did not correlate with the signal characteristics noted on unenhanced T1- and T2-weighted images. Pathologically, hyaline thickening of vessel walls and cyst formation were prevalent in the peripherally enhancing lesions. However, enhancement did not correlate with the relative proportion of Antoni type A and type B tissue. Recognition of the MR characteristics of intradural extramedullary schwannomas may be helpful in the differential diagnosis of spinal tumors. In particular, peripheral contrast enhancement of an intradural extramedullary tumor on MR images should suggest the diagnosis of schwannoma.     

MRI of extradural spinal tumours at 0.3 T

Ninety-one patients with extradural spinal tumours were examined by magnetic resonance imaging. There were 76 metastases (6 from unknown primary tumours). Seven patients had primary spinal tumours and 8 had multiple myeloma. Sixteen had bulging, diseased vertebral bodies compressing the subarachnoid space and 67 had extradural tumour compressing the spinal cord. Sixty patients had paravertebral involvement. Intraspinal involvement did not correlate with the extent of spinal lesions. All patients had vertebral destruction, with hypointense or combined hypo- and isointense signal relative to bone marrow on T1-weighted images. In most of the 22 patients with T2-weighted images the tumours were isointense or slightly hyperintense. It was usually impossible to differentiate the various tumours on the basis of signal intensity and morphology. However, metastases from carcinoma of the prostate were often more hypointense than other tumours on T1- and T2-weighted images. An inhomogeneous pattern in which diffusely low signal is combined with focal lower signal on T1-weighted images may suggest myeloma. In the 22 patients examined with both T1- and T2-weighted images, T1-weighted images gave the best information in 18; in 3 they were equivalent and in 1 inferior to T2-weighted images; they are therefore recommended for routine imaging of epidural spinal tumours.     

CT and MR of neurofibromatosis of the bladder.

Neurofibromatosis of the genitourinary system is rare. We present the CT and MR findings of neurofibromas of the bladder in three patients with von Recklinghausen disease (neurofibromatosis, Type 1). In one case, genitourinary involvement was the primary presentation of the disease. Both CT and MR imaging revealed diffuse and nodular bladder wall involvement, along with pelvic sidewall and adjacent soft tissue abnormalities. The CT attenuation coefficients measured near soft tissue density. On T1-weighted spin echo MR images the tumors revealed signal intensity slightly greater than that of skeletal muscle. Neurofibromas showed markedly increased signal intensity on T2-weighted images relative to the surrounding soft tissues, with marked enhancement in two cases imaged following Gd-DTPA administration. Obstructive hydronephrosis was present in all cases, presumably due to neurofibromas involving the trigonal region. Pelvic sidewall tumors were visualized as rounded, nodular masses extending into the obturator foramina. In the evaluation of patients with von Recklinghausen disease, MR imaging, compared with CT, more clearly defined tumor extent within the bladder, pelvic sidewalls, and surrounding soft tissues.     

Malignant lesions of the liver with high signal intensity on T1-Weighted MR images

Our purpose was to identify the histologic types of malignant liver lesions with high signal intensity (SI) on T1-weighted images and to describe the MR imaging features. Thirteen patients with malignant liver lesions high in SI on T1-weighted images were studied with a 1.5-T MR imager using pre- and serial postcontrast spoiled gradient-echo (SGE) sequences (all patients), T2-weighted fat-suppressed spin-echo sequences (all patients), precontrast T1-weighted fat-suppressed spin-echo sequences (five studies in five patients), and precontrast out-of-phase SGE sequences (seven studies in six patients). Images were reviewed retrospectively to determine number of lesions; lesion size; SI of lesions on T1-weighted, T2-weighted, and fat-attenuated T1-weighted images; distribution of high SI in lesions on T1-weighted images; and tumor enhancement pattern. Seven patients had multiple tumors high in SI on T1-weighted images and six patients had solitary tumors. Seventy-two lesions were less than 1.5 cm in diameter and 35 lesions were more than 1.5 cm in diameter. Nine patients had solid malignant lesions and four patients had cystic malignant lesions. All tumors more than 1.5 cm in diameter were heterogeneously high in SI on T1-weighted images, and all tumors less than 1.5 cm were completely homogeneous or homogeneous with a small central hypointense focus. All tumors were more conspicuous on T1-weighted fat-attenuated images, both on excitation spoiled fat-suppressed spin-echo or on out-of-phase SGE images with the exception of one fat-containing hepatocellular carcinoma (HCC). In one patient with melanoma metastases and one patient with multiple myeloma nodules, appreciably more lesions were detected on out-of-phase SGE images. Causes of hyperintensity were considered to be either fat, melanin, central hemorrhage, or high protein content, all of which may be seen in a variety of tumors. Fat-attenuation techniques are helpful in the detection of these lesions.     

Small hepatocellular carcinoma treated with percutaneous ethanol injection: MR imaging findings.

Fifty-seven magnetic resonance (MR) imaging examinations were obtained at 0.5 T in 19 patients before and after percutaneous ethanol injection (PEI) for 23 hepatocellular carcinoma (HCC) lesions less than 3.5 cm in diameter. Seventeen patients also underwent MR imaging 6 months after completion of therapy. In 11 patients, computed tomography was performed before and after treatment. After PEI, fine-needle biopsy specimens were obtained in all cases. Before treatment, HCC lesions had low signal intensity on T1-weighted images in 13 cases, had the same signal intensity as normal liver parenchyma in six, and had high signal intensity in four; all 23 tumors had high signal intensity on T2-weighted images. After treatment and at 6-month follow-up, all 21 lesions that contained no malignant cells at fine-needle biopsy had high signal intensity on T1-weighted images and had low signal intensity on T2-weighted images. The remaining two HCC lesions in which tumor necrosis was not achieved with PEI displayed a different MR pattern, since the residual neoplastic tissue showed no change in signal intensity on either T1- or T2-weighted images. The authors conclude that MR imaging may be useful for evaluating the effectiveness of PEI in achieving tumor regression.     

Acute bilateral basal ganglia lesions in diabetic uraemia: diffusion-weighted MRI

Methods We studied four patients with diabetes mellitus and chronic renal failure who developed sudden choreic movement disorders. The clinical manifestations, laboratory findings, MR imaging findings, and clinical outcome in each patient were evaluated. Results All four patients had long-term diabetes mellitus and severe azotaemia. Brain MR findings consisted of bilateral symmetric basal ganglia lesions, with decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images. All three patients who underwent diffusion-weighted MR imaging (DWI) showed signal intensities similar to those of the surroundings in regions corresponding to increased signal intensity on T2-weighted images, with slightly increased apparent diffusion coefficient (ADC) values. Two of the patients showed small focal areas of restricted diffusion within the basal ganglia lesions. After haemodialysis, follow-up MR imaging in all patients demonstrated that the basal ganglia lesions had regressed markedly, with some residual changes. The movement disorders also improved in all patients. Conclusion A syndrome associated with acute bilateral basal ganglia lesions in diabetic uraemic patients is rare, with reversible changes demonstrated by clinical and imaging findings. DWI showed that the bilateral basal ganglia lesions in this syndrome were primarily vasogenic in origin, although there were small foci of cytotoxic oedema within the lesions.     

0.6 T MR imaging of the cervical spine: multislice and multiecho techniques

During a 6 month period, 50 patients with signs and symptoms referable to the cervical spine were studied with a 0.6 T superconducting magnetic resonance (MR) imaging unit. The last 23 of these 50 patients were studied with combined multislice and multiecho techniques. In 38 of the 50 patients, abnormalities were demonstrated on MR images. Intramedullary lesions included syringomyelia (three cases), primary tumors (two), metastatic neoplasm (one), cord atrophy secondary to trauma (one), and multiple sclerosis (one). Intradural, extramedullary lesions included two neurofibromas and two Chiari malformations. The rest of the lesions were extradural: degenerative changes (10), spinal stenosis with cord compression (five), disk degeneration and/or herniation (five), postoperative changes (four), metastases to bone/epidural disease (three), and neurofibromatosis (one). Two patients had more than one abnormality. The MR findings were compared with available routine radiographs, computed tomographic (CT) scans with and without metrizamide, and myelograms. MR imaging was consistently better than routine CT scanning in the detection of lesions of the spinal cord and in directly imaging the effects on the spinal cord of extrinsic abnormalities such as spinal stenosis. Metrizamide-enhanced CT scanning detected all cases of syringomyelia, but it involved an invasive procedure. Myelography alone was slightly less sensitive and considerably less specific than MR in detecting intramedullary lesions and in distinguishing cord neoplasms from syringomyelia. Multislice, multiecho techniques with up to 240 msec echo times (TEs) were particularly helpful in the detection and characterization of extradural processes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Magnetic resonance in multiple sclerosis

Summary Magnetic Resonance Imaging was performed in more than 200 patients with clinical suspicion or knowledge of Multiple Sclerosis. One hundred and forty-seven (60 males and 87 females) had MR evidence of multiple sclerosis lesions. The MR signal of demyelinating plaques characteristically has prolonged T1 and T2 relaxation times and the T2-weighted spin-echo sequences are generally superior to the T1-weighted images because the lesions are better visualized as areas of increased signal intensity. MR is also able to detect plaques in the brainstem, cerebellum and within the cervical spinal cord. MR appears to be an important, non-invasive method for the diagnosis of Multiple Sclerosis and has proven to be diagnostically superior to CT, evoked potentials (EP) and CSF examination. In a selected group of 30 patients, with the whole battery of the relevant MS studies, MR was positive in 100%, CT in 33,3%, EP in 56% and CSF examination in 60%. In patients clinically presenting only with signs of spinal cord involvement or optic neuritis or when the clinical presentation is uncertain MR has proven to be a very useful diagnostic tool for diagnosis of MS by demonstrating unsuspected lesions in the cerebral hemispheres.     

MR imaging findings in spinal infections: rules or myths?

PURPOSE: To systematically evaluate magnetic resonance (MR) imaging findings described as being indicative of spinal infection in patients with proven spinal infection. MATERIALS AND METHODS: Contrast material-enhanced spinal MR images obtained in 46 consecutive patients (22 women, 24 men; mean age, 58.2 years) with culture or histologic examination results positive for spinal infection were systematically evaluated by two observers. Tuberculous and postoperative infections were excluded. Disk signal intensity and disk height, presence of the nuclear cleft, vertebral signal intensity alterations, endplate erosions on T1-weighted MR images, and presence of paraspinal or epidural inflammation were evaluated. Patient charts and surgical reports were reviewed. RESULTS: In the 44 patients with disk infection, MR imaging criteria with good to excellent sensitivity included presence of paraspinal or epidural inflammation (n = 43, 97.7% sensitivity), disk enhancement (n = 42, 95.4% sensitivity), hyperintensity or fluid-equivalent disk signal intensity on T2-weighted MR images (n = 41, 93.2% sensitivity), and erosion or destruction of at least one vertebral endplate (n = 37, 84.1% sensitivity). Effacement of the nuclear cleft was only applicable in 18 patients (n = 15, 83.3% sensitivity). Criteria with low sensitivity included decreased height of the intervertebral space (n = 23, 52.3% sensitivity) and disk hypointensity on T1-weighted MR images (n = 13, 29.5% sensitivity). Involvement of several spinal levels occurred in seven (16%) patients. Other spinal infections included isolated vertebral osteomyelitis (n = 1) and primary epidural abscess (n = 1). CONCLUSION: Most MR imaging criteria commonly used to diagnose disk infections offer good to excellent sensitivity. In atypical manifestations of proven spinal infections, however, some of the classically described MR imaging criteria may not be observed.     

Magnetic resonance imaging of myositis ossificans: analysis of seven cases

Myositis ossificans typically presents as soft tissue swelling with progressive ossification on radiographs. Since magnetic resonance imaging (MRI) is commonly used to evaluate soft tissue masses, we analyzed eight MR examinations in seven patients with myositis ossificans to determine if typical patterns were present. One acute lesion had homogeneous intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Two subacute lesions had low signal intensity margins with slightly increased signal intensity centers on T1-weighted images and very high signal intensity on T2-weighted images. Five chronic lesions had two different patterns. All five were well-defined with low signal intensity borders. Three had signal intensity patterns characteristic of fat on T1-weighted and T2-weighted images. The other two lesions had intermediate signal intensity on T1-weighted images and slightly increased signal intensity on T2-weighted images.We conclude that typical MR appearances of myositis ossificans do exist. A low signal intensity rim is a common finding. However, these patterns are not unique to myositis ossificans and resemble those that have been reported in other lesions. It is important to be aware of the spectrum of MR findings of myositis ossificans when considering the differential diagnosis of a soft tissue mass.     

Magnetic Resonance Imaging Characteristics of Primary Intraspinal Peripheral Primitive Neuroectodermal Tumour

Purpose

The purpose of our study was to describe the salient magnetic resonance imaging (MRI) findings in primary intraspinal peripheral primitive neuroectodermal tumour (PNET).

Methods

A retrospective review of the clinical and MRI images of 7 pathologically proven cases of intraspinal peripheral PNETs was performed. The various parameters, such as vertebral level of involvement; tumour location, size, focality, and margin; signal intensity of the lesion; the presence of hemorrhage or calcification; any signal voids; assessment of the adjacent cord for cord compression; cord dilatation; the presence of paraspinal tissue mass; or vertebral or other bony changes, were analysed.

Results

All 7 patients had lesions in the thoracolumbar region. Three patients had extradural lesions, 4 had intradural extramedullary lesions, and none had intramedullary lesions. Six lesions were well circumscribed. Only 1 patient had multifocal involvement. All lesions were of hypointense or isointense signal on T1-weighted imaging, whereas all but one were hyperintense on T2-weighted imaging. Lesions enhanced heterogeneously except 1 intradural extramedullary lesion, which enhanced homogeneously. A paraspinal mass was noticed in 2 patients. Vertebral collapse was present in 1 patients.

Conclusion

Intraspinal peripheral PNETs are rare spinal tumours. Although imaging characteristics are not specific, a focal circumscribed lesion in a young individual at the intramedullary, extramedullary intradural, or extradural spinal location that shows hypointense and hyperintense signal on T1- and T2-weighted images, respectively, requires PNET to be considered in the differentials.     

Chronic cervical cord compression: clinical significance of increased signal intensity on MR images

Magnetic resonance (MR) imaging was performed in 668 patients with chronic compressive lesions of the cervical spinal canal. High signal intensity was observed within the spinal cord on T2-weighted or proton density spin-echo images in 99 patients (14.8%). Frequency of this finding was directly proportional to severity of clinical myelopathy and degree of spinal canal compression seen on MR images. Patients with a high-signal-intensity area responded less favorably than those without to surgical or medical treatment. More than 60% of the patients had this finding when grade of myelopathy or degree of canal compression was moderate to marked. Among 10 patients who received contrast material during MR imaging, one patient had definite enhancement and another had questionable enhancement in the high-signal-intensity area. The finding disappeared after decompressive surgery and medical treatment in some cases: Three of four of the patients who underwent surgery showed good clinical improvement. High signal intensity of the spinal cord produced by compressive lesions appears to be an important indicator for predicting prognosis.