Acute spinal cord injury: magnetic resonance imaging correlated with myelopathy

Thirty-one patients (29 males and two females, 13-87 years of age (mean, 46.7 years] with acute spinal cord injury were studied by MR (magnetic resonance) imaging and the results were correlated with neurological findings. Magnetic resonance images were obtained with a 0.5 T superconductive MR scanner (Phillips Gyroscan S5). Initial imaging was performed within 24 hours after trauma in 13 patients, 1-7 days in 13 patients and 7-14 days in five patients. Twenty-six patients underwent follow-up examinations with MR imaging. Cord abnormalities including cord compression (23 patients), cord swelling (seven patients), and abnormal signal intensities on either T1 or T2-weighted images (26 patients) were observed on initial examination. Multivariate analysis showed that cord compression and abnormal intensities on T1-weighted images were important prognostic indicators. Hyperintensity on T2-weighted images was non-specific but correlated well with clinical recovery. Magnetic resonance imaging is useful in predicting the prognosis and for planning treatment following spinal cord injuries.     

MRI of ossification of ligamentum flavum.

Magnetic resonance imaging of 28 patients with radiological and/or histopathologically proved ossification of the ligamentum flavum (OLF) was reviewed. The locations of OLF were cervical (n = 4), thoracic (n = 22), and lumbar (n = 2). On T1- and T2-weighted images, OLF demonstrated low signal intensity. Areas of high or intermediate signal intensity within the OLF on T1-weighted images were observed in three cases and were interpreted to be due to fat infiltration. In six cases, high intensity areas in the spinal cord caused by compressing OLF were demonstrated on T2-weighted images. Gadolinium-diethylenetriamine pentaacetic acid, which was used in four cases, showed cord enhancement at the level of compression by OLF in three cases.     

Paraplegia and sensory deficit caused by angiotropic large cell lymphoma

We report a case of angiotropic large cell lymphoma (ALCL) with central system involvement in which there was initially an isolated spinal cord stroke with paraplegia. MR imaging of the spinal cord demonstrated increased signal intensity in the center of the cord on T2-weighted images and subsequently a cerebral lesion in the right temporal lobe. The diagnosis of ALCL was established by brain biopsy. An enlarged spinal cord with enhancement after administration of contrast material and increased signal intensity on T2-weighted images, while not specific for ALCL, may be the first imaging findings of that disease.     

Spinal epidural abscess: evaluation with contrast-enhanced MR imaging.

Seven patients with spinal epidural abscess were evaluated with MR imaging. T1-weighted images were obtained before and after administration of gadopentetate dimeglumine, and contrast-enhanced images were compared with available T2-weighted images and unenhanced T1-weighted images. In all seven cases, the epidural infection was iso- to hypointense compared with the spinal cord on unenhanced T1-weighted images, and increased in intensity on proton-density- and T2-weighted images. Three patterns of enhancement were observed after contrast administration. In three patients the infection enhanced homogeneously, likely representing thickened, inflammed tissue with microabscesses and granulomatous material. In one patient, peripheral enhancement surrounded a central focus of low signal intensity, representing necrotic abscess. In two patients, a combination of both patterns was observed. One abscess infiltrated the posterior thoracic epidural fat, producing decreased signal within the high-signal fat on T1-weighted images. Enhanced T1-weighted images were equivalent to unenhanced T2-weighted images in detecting the extent of epidural involvement in three cases. In two cases, enhanced T1-weighted images were superior to T2-weighted images in differentiating the infectious component from surrounding CSF. In one case, contrast administration produced no discernible enhancement. Enhanced images also provided important information regarding the composition of the abscess (liquid versus solid). Contrast-enhanced MR images are valuable in the characterization of spinal epidural abscesses.     

Gadolinium-DTPA enhanced MR imaging of spinal dural arteriovenous fistulas

To evaluate the role of magnetic resonance (MR) in the diagnosis of dural arteriovenous (AV) fistulas and the resulting myelopathy, the MR examinations of 11 patients with symptoms and signs of slowly progressive myelopathy of the lower spinal cord have been reviewed. Patients with intradural or extradural AV malformations were excluded. Six patients have been examined without the use of a contrast agent. The other five patients were studied prior and after intravenous administration of gadolinium-diethylenetriamine pentaacetic acid (DTPA). Serpentine linear areas of low signal due to flow void effects within the subdural space have been detected in seven patients. The T1-weighted sagittal images and T2-weighted sagittal and axial images demonstrated signal intensity changes within the center of the cord due to prolongation of T1 and T2 relaxation times. In addition, a relatively abrupt increase of the sagittal and transverse diameters of the lower thoracic cord was found in all cases. In nine patients T1-weighted, proton-density and T2-weighted sagittal images presented "blurred" margins of the lower thoracic cord. After intravenous administration of Gd-DTPA (0.1 mmol/kg), contrast enhancement was present not only within these vessels but also within the lower spinal cord. There was only slight enhancement of the cord immediately after injection of the contrast agent, but significant enhancement was observed 40-45 min later.     

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.     

Syphilitic myelitis with diffuse spinal cord abnormality on MR imaging

Syphilitic myelitis is a very rare manifestation of neurosyphilis. The MRI appearance of syphilitic myelitis is not well documented and only a few cases have been reported. We present a 52-year-old woman with acute onset of paraplegia. Magnetic resonance imaging of the spine showed diffuse high signal intensity in the whole spinal cord on T2-weighted images. Focal enhancement was observed in the dorsal aspect of the thoracic cord on T1-weighted gadolinium-enhanced images. To our knowledge, diffuse spinal cord abnormality in syphilitic myelitis has not been reported in the international literature. Disappearance of the diffuse high-signal lesions with residual focal enhancement was noted after antibiotic therapy. The patient suffered significant neurological deficit despite improvement in the MR images. In this article we present the imaging findings and review the literature of this rare condition. Electronic Publication     

Acute spontaneous spinal epidural hematomas.

BACKGROUND AND PURPOSE: Although previous reports have characterized MR imaging features of spinal epidural hematomas (EDH), few cases have been reported during the acute or hyperacute phase within the first 48 hours. Our goal in this investigation was to correlate the MR imaging features of acute (< or =48 hours) spontaneous EDH with clinical management and outcome. METHODS: Eight patients with acute spontaneous EDH (five men and three women; age range, 31-81 years) underwent MR imaging at 1.5 T (T1-weighted, n = 8; T1-weighted after the administration of 0.1 mmol/kg contrast material, n = 6; T2-weighted, n = 8; and T2-weighted, n = 4). The interval from symptom onset to hospital admission ranged from immediate to 5 days. Two neuroradiologists reviewed the MR images for signal characteristics, contrast enhancement, and cord compression. Treatment and clinical outcome were correlated with the imaging findings. RESULTS: The EDH were located in the cervical (n = 3), cervicothoracic (n = 2), thoracolumbar (n = 2), and lumbar (n = 1) regions. On T1-weighted images, the signal intensity of the EDH was isointense to spinal cord in five cases, hyperintense in two cases, and hypointense in one case and did not correlate with time to imaging. Isointensity on T1-weighted images persisted for 5 days in one case. On T2-weighted images, all EDHs were hyperintense with focal, heterogeneous hypointensity. Cord compression was severe in six patients, moderate in one patient, and minimal in one patient. Four cases were treated conservatively with complete resolution or improvement of symptoms within 1 to 3 weeks. CONCLUSION: MR imaging findings were useful in establishing the diagnosis of EDH but did not influence management or predict outcome in this series. Heterogeneous hyperintensity to cord with focal hypointensity on T2-weighted images should suggest the diagnosis of acute spinal EDH. Severity of neurologic impairment had the greatest impact on management and outcome. Nonoperative treatment may be successful in cases with minimal neurologic deficits, despite cord compression revealed by MR imaging.     

Adrenal schwannoma: CT and MRI findings

We report a case of adrenal schwannoma, an extremely rare retroperitoneal neoplasm. The patient was a 33-year-old man who presented with an abdominal mass that was discovered at abdominal sonography. Computed tomography showed an 8-cm well-circumscribed homogeneous mass that enhanced slightly after intravenous administration of contrast material. Magnetic resonance imaging showed low signal intensity on T1-weighted images and heterogeneously high signal intensity on T2-weighted images. Although these imaging findings are nonspecific, adrenal schwannomas should be included in the differential diagnosis of solid nonfunctioning adrenal tumors.     

MR imaging of bone metastasis]

One hundred and three patients with known malignancy and suspected bone metastasis underwent magnetic resonance imaging. In 93%, the metastatic lesions, detected both on plain films and radionuclide bone scans, showed decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images. All lesions, except one lesion showing much blastic change on plain films, showed contrast enhancement with Gd-DTPA administration. Although further investigation is needed, a correlation between the type of primary malignancy and the signal intensity of the metastatic lesion is suggested. Among 312 metastatic lesions detected by MR imaging, 272 lesions (87%) and 134 lesions (40%) were also detected by radionuclide bone scans and plain films, respectively. In five cases, MR imaging clearly revealed the lesion compressing the spinal cord, which helped us formulate a therapeutic plan. We conclude that MR imaging is the most sensitive examination for detecting bone metastasis and is necessary for planning treatment.     

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.     

Diffuse cerebral and leptomeningeal astrocytoma in dogs: MR features

Magnetic resonance (MR) imaging has increased sensitivity in detection of nonenhancing brain tumors and may show the extent of CNS neoplasia with greater detail than CT. Magnetic resonance images of the canine brain were acquired in two dogs with diffuse leptomeningeal and cerebral low grade astrocytoma. Abnormalities were identified with MR imaging when CT and CSF analysis were noncontributory. Changes seen with MR included decreased signal on T1-weighted images and increased signal on T2-weighted images consistent with vasogenic edema. Neither MR nor CT showed post-contrast enhancement. Magnetic resonance did not show the full extent of cellular infiltration, however. This was attributed to the diffuse submacroscopic distribution and absence of corresponding edema and contrast enhancement in certain regions of brain.     

High-resolution constructive interference in a steady state imaging of cervicothoracic adhesive arachnoiditis

PURPOSE: To assess the usefulness of constructive interference in a steady state (CISS) sequence for an evaluation of cervicothoracic adhesive arachnoiditis. METHODS: Seven patients with arachnoiditis underwent magnetic resonance imaging with T1- and T2-weighted fast spin-echo (FSE) and 3-dimensional CISS sequences. Three observers compared T2-weighted FSE and 3-dimensional CISS images with regard to image quality for spinal adhesive arachnoiditis. Magnetic resonance appearances accompanied with cervicothoracic adhesive arachnoiditis on CISS coupled with T2-weighted FSE sequences were also evaluated. RESULTS: The CISS images were superior to T2-weighted FSE images in the demarcation of spinal cord, dura matter, nerve root, and adhesive point. In our 7 cases with cervicothoracic adhesive arachnoiditis, dural thickening in 2 cases, syringomyelia in 6, arachnoidal cysts in 3, findings of presyrinx in 2, intramedullary microcyst in 2, and deformity of the spinal cord were present. CONCLUSIONS: A CISS sequence was more desirable for an evaluation of the cervicothoracic adhesive arachnoiditis than T2-weighted FSE images and could provide useful additional information.     

Serial MRI changes in radiation myelopathy

Using MRI we assessed the changes in signal, size, and contrast enhancement characteristics of the cervical spinal cord in radiation myelopathy developing after radio-therapy for nasopharyngeal carcinoma. We studied two men and five women, aged 40–77 years. The first MRI study was performed 1–4 months after the initial clinical manifestations of myelopathy, and follow-up MRI 2–22 months after the onset of symptoms. On the first study, all patients showed low signal intensity in a long segment of the cervical spinal cord on T1-weighted images, high signal on T2^*-weighted images, and focal contrast enhancement at C1-2. In five patients there was also swelling of the spinal cord. The site of eccentric focal contrast enhancement correlated with the clinical manifestations. Follow-up imaging less than 10 months after the onset of symptoms showed no significant changes in signal intensity. Focal contrast enhancement at C1–2 remained the same in three patients, was more dense and larger in one, and less dense in another. Subsidence of swelling was seen in two patients. Atrophy of the spinal cord at C1–2, without abnormal signal and with faint contrast enhancement at C1–2 was revealed as early as 10 months after the onset of symptoms, but the contrast enhancement disappeared by 22 months. There was no correlation between clinical manifestations and spinal cord atrophy on MRI.     

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.     

Cross-sectional imaging of primary osseous hemangiopericytoma

The aim of this study was to assess cross-sectional imaging features and the value of CT and MRI in primary hemangiopericytoma of bone. In five patients with histologically proven primary osseous hemangiopericytoma CT and MR scans were evaluated retrospectively. Both CT and MRI were available in four patients each. In three patients both imaging techniques were available. On CT primary hemangiopericytoma of bone presents as an expansive lytic lesion with bone destruction and inhomogeneous contrast enhancement. Magnetic resonance imaging depicts osseous hemangiopericytoma as hyperintense lesion on T2-weighted images with intermediate signal intensity on T1-weighted images. Curvilinear tubular structures of signal void in the tumor matrix on T1-weighted images and corresponding hyperintense structures on T2-weighted and on fat-suppressed short tau inversion recovery images were present in three patients. Although cross-sectional imaging findings are non-specific, they add to the diagnosis and provide valuable information about the extent of bone destruction and local tumor spread in patients with primary osseous hemangiopericytoma. While CT demonstrates the extent of bone destruction best, MRI better visualizes medullary and soft tissue extension of the tumor. Curvilinear signal abnormalities support the diagnosis of hemangiopericytoma of bone. This imaging pattern is best visualized on fat-suppressed or contrast enhanced T1-weighted MR images.     

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.     

Unusual manifestation of vertebral osteoid osteoma: case report

We report the case of a 64 year-old man with a clinical history suggesting a low thoracic-cord involvement, in which an unexpected vertebral osteoid osteoma was discovered. The patient underwent MRI of the thoraco-lumbar spine, which included sagittal and axial T1-weighted images, and sagittal double-echo T2-weighted images. Subsequently, CT scan was carried out with 2-mm-thick axial sections, aimed at T10 vertebra. Magnetic resonance imaging disclosed an extra-axial mass at T10 level. Computed tomography scan suggested an osteoid osteoma of the tenth thoracic vertebra, involving the lamina with marked sclerosis and prevalently endocanalar extension. Histology following surgical resection confirmed the diagnosis. In the reported case CT scan provided the correct pre-operative diagnosis of osteoid osteoma despite its unusual clinical--anamnestic presentation. Magnetic resonance imaging was useful in establishing the relationship of the neoplasm with the spinal cord.     

Ossification of the posterior longitudinal ligament and ligamentum flavum: imaging features

Ossifications of the posterior longitudinal ligament and ligamentum flavum are both special subcategories of degenerative diseases responsible for compression of the spinal cord. Ossification of the ligaments is well demonstrated by plain radiography and computed tomography. Magnetic resonance imaging noninvasively provides useful information about the degree and extent of spinal cord compression as well as the character of the ossification. T2-weighted sequences are most effective to evaluate both spinal cord compression due to the ossification and abnormal signal intensity of the spinal cord.     

Feasibility and limitation of constructive interference in steady-state (CISS) MR imaging in neonates with lumbosacral myeloschisis

Introduction The aim of this study was to evaluate three-dimensional Fourier transformation-constructive interference in steady-state (CISS) imaging as a preoperative anatomical evaluation of the relationship between the placode, spinal nerve roots, CSF space, and the myelomeningocele sac in neonates with lumbosacral myeloschisis. Methods Five consecutive patients with lumbosacral myeloschisis were included in this study. Magnetic resonance (MR) CISS, conventional T1-weighted (T1-W) and T2-weighted (T2-W) images were acquired on the day of birth to compare the anatomical findings with each sequence. We also performed curvilinear reconstruction of the CISS images, which can be reconstructed along the curved spinal cord and neural placode. Results Neural placodes were demonstrated in two patients on T1-W images and in three patients on T2-W images. T2-W images revealed a small number of nerve roots in two patients, while no nerve roots were demonstrated on T1-W images. In contrast, CISS images clearly demonstrated neural placodes and spinal nerve roots in four patients. These findings were in accordance with intraoperative findings. Curvilinear CISS images demonstrated the neuroanatomy around the myeloschisis in one slice. The resulting images were degraded by a band artifact that obstructed fine anatomical analysis of the nerve roots in the ventral CSF space. The placode and nerve roots could not be visualized in one patient in whom the CSF space was narrow due to the collapse of the myelomeningocele sac. Conclusion MR CISS imaging is superior to T1-W and T2-W imaging for demonstrating the neural placode and nerve roots, although problems remain in terms of artifacts.