CASE REPORTS Koshevnikov syndrome in apatient with MELAS plus syndrome:electron microscopic and neuroimage studies

ＣＡＳＥＲＥＰＯＲＴＳＫｏｓｈｅｖｎｉｋｏｖｓｙｎｄｒｏｍｅｉｎａｐａｔｉｅｎｔｗｉｔｈＭＥＬＡＳｐｌｕｓｓｙｎｄｒｏｍｅ：ｅｌｅｃｔｒｏｎｍｉｃｒｏｓｃｏｐｉｃａｎｄｎｅｕｒｏｉｍａｇｅｓｔｕｄｉｅｓＴｈａｊｅｂＰｅｔｅｒｕｓ戴道恩，ＨｕａｎｇＫｏ...     

MRI appearance of spinal lesions: metastatic tumors or infections?

Three patients with pathologically verified spinal osteomyelitis and another three with metastatic tumors of the spine were investigated. MRI of the spine of four patients show-ed several unusual findings. The preservation of intervertehral discs and endplates did not predict accurately the diagnosis of either infections or tumors. The pepper and salt appearing feature may also occur in a metastatic tumor. Plain radiographs. CT. and radioisotope bone scans were less sensitive than MRI to disclose the lesions. In cases of osteomyelitis, the systemic sources of infections were frequently not found. and the responsible microorganisms could not be identified even from the surgical specimens of two patients. However, mycobacterium tuberculosis was found in the surgical specimen of a patient with cervical spinal lesion whose MRI was indistinguishable from a metastatic tumor. Surgicopathological diagnosis was therefore crucial and mandatory in these in stances.