Intradural Extramedullary Capillary Hemangioma with Long Segment of Transient Cord Edema: A Case Report

We present a case of intradural extramedullary capillary hemangioma of the thoracic spine with a long segment of transient cord edema. Spinal capillary hemangiomas are extremely rare vascular tumors and only a few cases have been reported. On the MR images, the mass showed hypointensity on the T1-weighted images, hyperintensity on the T2-weighted images relative to the spinal cord, and strong homogeneous enhancement on the contrast-enhanced T1-weighted images. The T2-weighted images showed a long segment of ill-defined hyperintense area in the spinal cord which was completely resolved after surgery.

Non-dysraphic Intramedullary Spinal Cord Lipoma: Case Report

Spinal cord lipomas are rare tumors with a reported incidence of 1% of all intraspinal tumors. We recently experienced a case of intramedullary lipoma without spinal dysraphism in a 58-year-old woman. MRI, CT, myelography and CT myelography showed the characteristic findings of a lipoma.

Intracranial and Spinal Ependymomas: Review of MR Images in 61 Patients

OBJECTIVE: To compare the age distribution and characteristic MR imaging findings of ependymoma for each typical location within the neuraxis. MATERIALS AND METHODS: During a recent eleven-year period, MR images of 61 patients with histologically proven ependymomas were obtained and retrospectively reviewed in terms of incidence, peak age, location, size, signal intensity, the presence or absence of cyst and hemorrhage, enhancement pattern, and other associated findings. RESULTS: Among the 61 patients, tumor location was spinal in 35 (57%), infrartentorial in 19 (31%), and supratentorial in seven (12%). In four of these seven, the tumor was located in brain parenchyma, and in most cases developed between the third and fifth decade. Approximately half of the infratentorial tumors occurred during the first decade. The signal intensity of ependymomas was nonspecific, regardless of their location. A cystic component was seen in 71% (5/7) of supratentorial, 74% (14/19) of infratentorial, and 14% (5/35) of spinal cord tumors. Forty- nine percent (17/35) of those in the spinal cord were associated with rostral and/or caudal reactive cysts. Intratumoral hemorrhage occurred in 57% (4/7) of supratentorial, 32% (6/19) of infratentorial, and 9% (3/35) of spinal cord tumors. In 17% (6/35) of spinal ependymomas, a curvilinear low T2 signal, suggesting marginal hemorrhage, was seen at the upper and/or lower margins of the tumors. Peritumoral edema occurred in 57% (4/7) of supratentorial, 16% (3/19) of infratentorial and 23% (8/35) of spinal cord tumors. Seventy-two percent (5/7) of supratentorial and 95% (18/19) of infratentorial tumors showed heterogeneous enhancement, while in 50% (17/34) of spinal cord tumors, enhancement was homogeneous. CONCLUSION: Even though the MR imaging findings of ependymomas vary and are nonspecific, awareness of these findings, and of tumor distribution according to age, is helpful and increases the likelihood of correct preoperative clinical diagnosis.

Spontaneous Herniation of the Thoracic Spinal Cord: A Case Report

Spontaneous herniation of the spinal cord is a rare disease entity in which spinal cord substance is herniated through a previously uninjured and/or untouched dura. It is a cause of myelopathy that is treatable but difficult to diagnose. We report the CT and MR findings of a case of spontaneous thoracic spinal cord herniation manifesting as ventrolateral protrusion of thoracic spinal cord through a dural defect.

MR Findings of Spinal Cord in Decompression Sickness

PURPOSE: To determine the MR imaging findings of spinal cord decompression sickness. MATERIALS AND METHODS: We retrospectively analysed the spinal MR images of eight patients (M : 6, F : 2) with decompression sickness affecting the cervical spine (n=1) or thoracic spine (n=7). The observed extent, location, continuity, signal intensity and contrast enhancement pattern of spinal cord lesions were analysed. RESULTS: The chief MR finding was continuous (n=2) or non-continuous (n=3) high signal intensity on T2-weighted images in the posterior paramedian spinal cord. In three cases, additional T2 signal abnormality in the ventral horn of the gray matter was observed. There was no signal intensity abnormality on T1- weighted images or abnormal enhancement on post-Gadolinium T1-weighted images. In one case, cord swelling in addition to T2 signal abnormality was observed. CONCLUSION: MR imaging is useful for evaluating spinal cord lesions in patients with decompression sickness.

MR Imaging Findings in Subacute Combined Degeneration of the Spinal Cord: A Case Report

Vitamin B12 deficiency can cause neurologic complications in the spincal cord, brain, and optic and peripheral nerves. Subacute combined degeneration is a rare disease of demyelinating lesions of the spinal cord, affecting mainly the posterior and lateral columns of the thoracic cord. We report the MR imaging findings of a case of subacute combined degeneration of the spinal cord in a patient with vitamin B12 deficiency and mega-loblastic anemia.

Multiple Sclerosis of the Spinal Cord: MR Imaging Findings

PURPOSE: To evaluate the MR appearance of multiple sclerosis in the spinal cord. MATERIALS AND METHODS: Between January 1990 and December 1996, we retrospectively analyzed 27 spinal MR images of 18 patients in whom-onthe basis of Poser's diagnostic critera-multiple sclerosis of the spinal cord had been diagnosed. Eleven patientswere men and seven were women, and they were aged between 18 and 58(mean, 37) years. Using T1-weightedsagittal(n=27), T2-weighted axial(n=26) and sagittal(n=27), and contrast enhanced T1-weighted(n=14) images,lesions were analyzed for multiplicity, location, length, cross-sectional area and location, cord size, andenhancement pattern. Brain MR images(n=15) were also evaluated. RESULTS: In 14 of 18 patients, a solitary lesionwas seen on initial MR imaging. Four of the 14 had double lesions, and on follow-up MR imaging at 2_5 months, fivewere seen to have double lesions. Eleven lesions were found in the cervical cord, and 12 in the thoracic cord, twowere in the cervicothoracic and two in the thoracolumbar region. The length of 12 lesions was less than twovertebral heights, while 15 extended for more than two vertebral heights. Six lesions occupied less than 50% ofthe cross-sectional area of the cord and the other 20 occupied more than 50% of this area. Cord size was enlargedin 17 cases, unchanged in eight, and atrophic in two. Eight lesions in 14 patients who underwent enhanced MRimaging showed focal contrast enhancement; there was patchy enhacement in two, nodular enhancement in two, andlinear enhancement in four. Among 15 MR images of the brain, high-signal intensity lesions, compatible withmultiple sclerosis, were demonstrated in seven cases. CONCLUSIONS: Multiple sclerosis plaques in the spinal cordfrequently extend for more than two vertebral body heights of either the cervical or thoracic level, occupy morethan 50% of the cross-sectional area and manifest as enlarged cord. But the MR imaging findings, however, arenonspecific. Abnormalities were seen in approximately 50% of MR images of the brain.

MRI Findings of Guillain-Barre Syndrome

PURPOSE: To evaluate MRI findings of Guillain-Barre syndrome. MATERIALS AND METHODS: In six patients with Guillain-Barre syndrome diagnosed by clinical, cerebrospinal fluid and electrophysiologic findings, a retrospective review of MR findings was conducted. Follow-up MRI scans were carried out in two patients showing minimal clinical improvement. RESULTS: Marked or moderate enhancement of thickened nerve roots was seen in all cases on gadopentetate dimeglumine enhanced axial T1-weighted images. Two patterns were seen ; one was even enhancement of both anterior and posterior nerve roots (n=1) and the other was enhancement of anterior nerve roots only (n=5). Enhancement and thickness of nerve roots was seen to have slightly decreased on MRI follow-up at 32 and 50 days ; clinical and electrophysiologic examination showed minimal improvement. CONCLUSION: Although MRI findings of nerve root enhancement are nonspecific and can be seen in neoplastic and other inflammatory diseases, the enhancement of thickened anterior nerve roots within thecal sac suggests Guillain-Barre syndrome.

MR Imaging of Cord Transection without Skeletal Injury: A case Report

Spinal cord transection in children may occur following severe trauma such as a motor vehicle accident, and often without evidence of underlying skeletal injury. We report one case which showed cervical cord transection, where no evidence of underlying skeletal injury was seen on MR imaging, four weeks after trauma. When a neurologic deficit is present despite normal routine plain radiographs, further MR imaging is warranted to exclude a cord transection, as demonstrated in our patient.

MR Imaging of Intramedullary Tumors of the Spinal Cord

PURPOSE: The purpose of this study was to evaluate the characteristic MR findings of intramedullary spinal cord tumors according to histologic diagnosis. MATERIALS AND METHODS: MR images of 34 patients with surgically-proven intramedullary spinal cord tumor were retrospectively reviewed. Histologic diagnosis revealed 15 ependymomas, ten astrocytomas, three hemangioblastomas, two oligidendrogliomas, one malignant schwannoma, one glioblastoma multiforme, one neuroblastoma and one ganglioglioma. MR images were analyzed for location, size, shape, signal intensity, and degree and pattern of contrast enhancement of the tumors. RESULTS: All tumors showed cord expansion and a varying extent of involvement ranging from 1.5 to 30cm. Variable degrees of contrast enhancement were seen in all cases. Cervical, cervico-thoracic, thoracic, and thoraco-lumbar spinal ependymomas accounted for three, two, six, and four cases, respectively, while four, two, and four cases of cervical, cervico-thoracic, and thoracic spinal astrocytomas respectively, were seen. Other tumors were located most commonly in the thoracic spinal cord. A sharply-defined tumor margin was seen in 13 of 15 ependymomas, in all three hemangioblastomas, one neuroblastoma and one ganglioglioma. Tumors usually showed slightly low- or iso-signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Peritumoral cysts were seen in nine ependymomas, one hemangioblastoma, and one astrocytoma, while peritumoral hemorrhage was seen only in three ependymomas. Relatively homogeneous enhancement was seen in nine of 13 ependymomas, all hemangioblastomas and one neuroblastoma. All ten astrocytomas showed a poorly defined tumor margin and heterogeneous enhancement. CONCLUSION: On the basis of characteristic MR findings, intramedullary cord tumors may be histopathologically diagnosed.

Clinical and Imaging Findings in Spinal Cord Arteriovenous Malformations

PURPOSE: To evaluate the findings of magnetic resonance (MR) imaging and selective spinal angiography of spinal cord arteriovenous malformations (SCAVMs) and to investigate the correlation of these findings with the development of clinical symptoms. MATERIALS AND METHODS: In 16 patients diagnosed as suffering from SCAVMs, MR imaging and selective spinal angiograms were retrospectively analyzed and correlated with clinical symptoms. Clinical data were reviewed, especially concerning the mode of onset of clinical symptoms, and MR images of SCAVMs were evaluated with regard to the following parameters: spinal cord swelling with T2 hyperintensity, cord atrophy, intramedullary hemorrhage, and contrast enhancement of the spinal cord. Selective spinal angiographic findings of SCAVMs were also evaluated in terms of the following parameters: type of SCAVM, presence of aneurysms, and patterns of venous drainage. Imaging findings were also correlated with the development of clinical symptoms. RESULTS: Neurologic deficits, either acute (n=4) or insidious (n=11), were noted in 15 patients. One case without any neurologic deficit was found incidentally. MR showed spinal cord swelling (10/6), atrophy (2/16), intramedullary hemorrhage (0/16), and contrast enhancement of the cord (8/12); spinal angiograms showed the presence of associated aneurysms (6/16) and radicular venous drainage (8/16). SCAVMs. were metameric (n=4), intramedullary (n=9), or fistular (n=3). Nine of 11 patients with insidious onset showed spinal cord swelling and no radicular venous drainage with prominent perimedullary venous dilatation. Aneurysms were present in all four patients with abrupt symptoms. CONCLUSION: Systematic evaluation of the findings of MR imaging and angiography provides detailed information on the type of AVM and status of the spinal cord parenchyma, and this can be correlated with clinical manifestations of SCAVM. In patients suffering from this condition, spinal cord dysfunction due to venous congestion appears to be the main cause of clinical symptoms.

MR Findings of Transverse Myelitis : Focusing on T2WI

PURPOSE: The purpose of this study is to describe the MR findings of transverse myelitis, especially on T2 weighted images and to determine if there are any MR findings characteristic of transverse myelitis that may bevaluale in the differentiation from intramedullary tumor. MATERIALS AND METHODS: The MR images of 13 patients with the diagnosis of transverse myelitis were retrospectively reviewed. The diagnosis was based on both the clinical and follow-up MR images, and was confirmed by open biopsy in four patients. The MR features were analyzed in terms of the the position and extent of the lesion, signal intensity on all sequences, enhancement patterns(nodular, patchy, linear, punctate, ring, and mixed), and the presence or absence of hemorrhage, cyst, andsyrinx. On T2-weighted images, existence of focal abnormal signal areas compatible with the enhancing lesions and shape of both rostral and caudal ends of the lesions were also evaluated. RESULTS: On MR images, there was fusiform swelling of the spinal cord over variable length from 2 to 10 vertebral segments. The lesions showed diffuse isosignal intensity on T1 weighted images and high signal intensity on T2 weighted images. Contrast-enhanced T1 weighted images revealed variable enhacement pa- tterns ; nodular in 7, patchy in 6, linear in 3, punctate in 2, ring in 1 and mixed in 6 cases. The enhancement occurred usually within the central portion of highsignal intensity lesion of the swollen cord. The cranial and caudal ends of the high signal lesion usually showed smooth tapered appearance in 12 cases(both ends in 10 and one end in 2). There was no focal abnormal signal lesion compatible with the enhancing area. No case demonstrated any hemorrhage, cyst, and syrinx. CONCLUSION: Segmental cord swelling, diffuse high signal intensity with tapered appearance of both cranial and caudal ends, and no focal abnormal signal intensity that is compatible with the enhancing lesion, suggest transverse myelitis. Therefore, if above MR findings are seen, follow-up study is recommended to avoid the invasive surgical procedures.

Thoracic Intramedullary Schwannoma: 2 Cases Report

Two cases of thoracic intramedullary schwannoma confirmed by surgery and pathology are reported. These tumors were hypointense on T1WI, and hyperintense on T2WI with good enhancement on MRI. One case showed typical intramendullary tumor, associated with peritumoral cord swelling and syrinx, and another showed both intramedullary and extramedullary location. Schwannomas of the spinal cord, although very rare, Should be included in the differential diagnosis of intramedullary tumor.