Spinal cord magnetic resonance imaging: methods and applications / 生理学报

Spinal cord magnetic resonance imaging (MRI) is an advanced imaging technique (mainly in the cervical cord) and has been gradually used in basic scientific research such as human sensation and motor function, and clinical applications such as spinal cord injury, myelitis, and chronic pain, etc. The development of spinal cord MRI is still at the early stage compared with brain MRI and limited by the current MRI technology and data analysis methods. This review focuses on the methods and applications of spinal cord MRI technology in the basic research fields of cognitive neuroscience and clinical application. Firstly, we will introduce the imaging principle, methods, measurement standards, and applications of most commonly used multimodal spinal cord MRI techniques, including quantitative spinal cord MRI (such as structural, diffusion, spectroscopy, myelin water, magnetization transfer, and chemical exchange saturation transfer imaging, etc.) and spinal functional MRI (fMRI). Secondly, we will discuss the technical challenges and possible solutions of spinal cord MRI data processing from the three dimensions of denoising, data processing pipeline optimization, and repeatability and reliability. Finally, we will discuss the application status and development prospects of spinal cord MRI.

Simultaneous 3D Visualization of the Microvascular and Neural Network in Mouse Spinal Cord Using Synchrotron Radiation Micro-Computed Tomography / 神经科学通报·英文版

Effective methods for visualizing neurovascular morphology are essential for understanding the normal spinal cord and the morphological alterations associated with diseases. However, ideal techniques for simultaneously imaging neurovascular structure in a broad region of a specimen are still lacking. In this study, we combined Golgi staining with angiography and synchrotron radiation micro-computed tomography (SRμCT) to visualize the 3D neurovascular network in the mouse spinal cord. Using our method, the 3D neurons, nerve fibers, and vasculature in a broad region could be visualized in the same image at cellular resolution without destructive sectioning. Besides, we found that the 3D morphology of neurons, nerve fiber tracts, and vasculature visualized by SRμCT were highly consistent with that visualized using the histological method. Moreover, the 3D neurovascular structure could be quantitatively evaluated by the combined methodology. The method shown here will be useful in fundamental neuroscience studies.

Influence of age, sex, height and lumber stenosis on the position of the conus medullaris in adults / Influencia de la edad, sexo, altura y estenosis lumbar en la posición del cono medular en adultos

Anatomical orientation of the termination level of Conus Medullaris (CM) has imperative role clinically for anesthetists and neurosurgeons which is considered as an objective guide to perform spinal anesthesia and spinal punctures circumspectly with less chance to have serious injuries. The current retrospective study was carried on to determine the location of the CM and how its termination level can be influenced by age, sex, height and lumber stenosis spine disease. The study included 462 participants that consisted of 199 men and 263 women range from 21 to 80 years of age and height range between 150-190 cm. Also, it included 150 lumber stenosis patients. The location of the CM was imaged using a series of magnetic resonance images (MRI) for the lumbosacral spine at different levels including, T12, T12-L1, L1, L1-L2, and L2. The measurements revealed inconsiderable differences in the CM termination level in relation to age, sex and height in a healthy study population. Moreover, the results showed insignificant differences in the CM termination level between men and women whether they are healthy or having lumbar spinal stenosis. In conclusion, the most common level of CM termination is at L1 followed by L1-L2. It is safe to perform a lumbar neuraxial procedures at the level of L3-L4.

La orientación anatómica del nivel de terminación del Conus medullaris (CM) tiene un importante papel clínico para los anestesistas y neurocirujanos, que se considera una guía objetiva para realizar la anestesia espinal y las punciones de la columna circunspectivamente con menos posibilidades de provocar lesiones graves. Se llevó a cabo un estudio retrospectivo para determinar la ubicación del CM y cómo su nivel de terminación puede verse afectado por la edad, el sexo, la altura y una patología de la columna vertebral, la estenosis lumbar. El estudio incluyó 462 participantes que consistían en 199 hombres y 263 mujeres de 21 a 80 años de edad y una altura de entre 150-190 cm. Además, se incluyeron 150 pacientes con estenosis lumbar. La ubicación del CM se determinó mediante una serie de imágenes de resonancia magnética (RM) de la columna lumbosacra a diferentes niveles, incluidos T12, T12-L1, L1, L1-L2 y L2. Las mediciones revelaron diferencias considerables en el nivel de terminación de CM en relación con la edad, el sexo o la altura en una población de estudio saludable. Además, los resultados mostraron diferencias poco significativas en el nivel de terminación de CM entre hombres y mujeres, sanos o con estenosis espinal lumbar. En conclusión, se encontró que el nivel más común de terminación del CM es L1 seguido de L1-L2, considerándose seguro realizar procedimientos neuroaxiales lumbares a nivel de L3-L4.

Myelography in calves: a comparative study between the contrast agents iopamidol and iohexol / Mielografia em bezerros: estudo comparativo entre os meios de contrastes iopamidol e ioexol

Due to the scarcity of myelogenous studies in cattle, the present study aimed to evaluate the efficacy and distribution of iopamidol and iohexol contrast agents in calves, in order to determine guidelines for obtaining diagnostic radiographs of spinal cord disorders in these animals. Ten healthy Holstein calves, seven days to two months of age, were divided into two groups, according to the contrast medium applied. Myelographic studies of the spine were performed with the calves in lateral recumbency, with radiographs repeated 20 times during a two-hour period. On the radiographs, the contrast medium was analyzed for opacity, detail of the image, distension of the medullary canal, and progression of the contrast line. After seven days, the myelographic studies were repeated, with the contrast media exchanged between the groups. There were no significant differences in the quality of the images and speed of the spinal column filling between the two contrast media. Furthermore, the best quality radiographic images were obtained six to eight minutes after injection of the contrast in the cervical spinal segment, 80 minutes in the thoracic, and 20 minutes in the lumbar, sacral, and cauda equina segments.(AU)

Devido à escassez de estudos mielográficos em bovinos e relatos de complicações no procedimento, o presente estudo teve por objetivo avaliar a eficácia e a distribuição dos meios de contraste iopamidol e ioexol em bezerros, a fim de nortear a melhor conduta para o diagnóstico de afecções vertebrais e medulares nesses animais. Foram utilizados 10 bezerros Holandeses, hígidos, com idade entre sete dias e dois meses, distribuídos em dois grupos, conforme o meio de contraste aplicado. O estudo mielográfico da coluna vertebral foi realizado na posição laterolateral, repetido em 20 momentos, durante o período de duas horas. Nas radiografias, analisou-se o meio de contraste quanto à opacidade, detalhes da imagem, distensão do canal medular e progressão da linha de contraste. Após sete dias, foi realizado o segundo período experimental, que compreendeu a troca do meio de contraste dentro de cada grupo. Não houve diferenças significativas em relação à qualidade da imagem e à velocidade do preenchimento da coluna medular entre os dois meios de contraste. A partir da administração dos meios de contraste, a obtenção de imagens radiográficas de melhor qualidade deu-se após seis a oito minutos no segmento medular cervical, 80 minutos no torácico e 20 minutos nos segmentos lombar, sacral e cauda equina.(AU)

Foix-Alajouanine syndrome mimicking a spinal cord tumor / Síndrome de Foix-Alajouanine simulando um tumor intramedular espinal

Summary Subacute necrotizing myelopathy (SNM) or Foix-Alajouanine syndrome is a rare disease characterized by progressive neurological dysfunction caused by a spinal dural arteriovenous fistula (AVF). Radiological diagnosis is usually suspected when there is intramedullary nonspecific enhancement and perimedullary flow voids. Ring-enhancement is rarely reported in the scope of AVF, which poses a diagnostic challenge and raises the suspicion of a spinal cord tumor. In such situations, biopsy can be required and delay proper diagnosis. We report the case of a patient with SNM, who underwent biopsy on the assumption of it being a spinal cord tumor.

Resumo Mielopatia necrotizante subaguda (MNS) ou síndrome de Foix-Alajouanine é uma doença rara que se caracteriza por disfunção neurológica progressiva causada por uma fístula arteriovenosa espinal dural. O diagnóstico radiológico é comumente suspeitado quando aparece captação não específica de contraste e de artefatos de fluxo (flow voids) perimedulares. Raramente, a captação de contraste exibe o aspecto em anel, constituindo um grande desafio diagnóstico. Nesses casos, o principal diagnóstico diferencial é um tumor intramedular, e os pacientes são encaminhados para biópsia da lesão, atrasando o diagnóstico definitivo. Relatamos o caso de uma paciente com MNS, a qual foi submetida à biópsia da lesão em virtude de suspeita de tumor intramedular.

Conus medullaris position in an adult population: analysis of magnetic resonance imaging / Posición del cono medular en una población adulta: análisis con imágenes de resonancia magnética

The objective of this study was to evaluate the variation in position of the conus medullaris (CM) in male and female patients without spinal deformity, to correlate the termination level in magnetic resonance (MR) images of the lumbar spine. 921 patients consisted of 607 men and 314 women were evaluated by MRI. The strength of T1 weighted MRI device was 1.5 Tesla. The patients were in supine position when measured. The termination level of the conus medullaris was recorded in relation to the upper, middle or lower third of the adjacent vertebra and the adjacent intervertebral disc. The patients in our study group were examined for low back pain. The members with spinal deformity were excluded. The distribution of conus medullaris localization was measured to range from T12 to L2-L3. There was a statistically significant difference in the mean conus medullaris position related to gender also a significant difference between increasing age and conus position in female patients. These findings suggest that the distribution of CM location in a large adult population was shown to range from the upper third of T12 to the lower third of L2-L3 disc space both in women and men.

El objetivo de este estudio consistió en evaluar la variación en la posición del cono medular (CM) en pacientes masculinos y femeninos sin deformidad espinal, para correlacionar el nivel de terminación en imágenes de resonancia magnética (RM) de la columna lumbar. Fueron evaluados por RM un total de 921 pacientes, 607 hombres y 314 mujeres. La fuerza ponderada del dispositivo de RM en T1 fue 1,5 Tesla. Los pacientes se ubicaron en posición supina al momento de la medición. El nivel de terminación del cono medular se registró en relación con el tercio superior, medio o inferior de la vértebra adyacente y el disco intervertebral adyacente. Los pacientes de nuestro grupo de estudio fueron examinados por dolor lumbar. Se excluyeron los individuos con deformidad espinal. La distribución de la localización del cono medular se midió, con variaciones entre T12 a L2-L3. Hubo una diferencia estadísticamente significativa en la posición media del cono medular relacionada con el sexo y también una diferencia significativa entre el aumento de la edad y la posición del cono medular en las mujeres. Estos hallazgos sugieren que la distribución de la ubicación del CM en una población adulta se encontró en un rango que se extendió desde el tercio superior de T12 al tercio inferior del espacio discal L2-L3, tanto en mujeres como en hombres.

Chlorfenapyr-Induced Toxic Leukoencephalopathy with Radiologic Reversibility: A Case Report and Literature Review

Chlorfenapyr is a widely used, moderately hazardous pesticide. Previous reports have indicated that chlorfenapyr intoxication can be fatal in humans. We reported the first non-fatal case of chlorfenapyr-induced toxic leukoencephalopathy in a 44-year-old female with resolution of extensive and abnormal signal intensities in white matter tracts throughout the brain, brain stem, and spinal cord on serial magnetic resonance imaging.

Síndrome de encefalopatía posterior reversible con afectación del tronco cerebral y médula espinal y retinopatía hipertensiva grado IV / Posterior reversible encephalopathy syndrome with brain stem and spinal cord involvement and grade iv hypertensive retinopathy

El síndrome de leucoencefalopatía posterior reversible se presenta con síntomas de edema cerebral e imágenes hiperintensas en las secuencias T2 y FLAIR en la resonancia magnética (RM) de cerebro. Las lesiones típicamente comprometen la región parietooccipital, aunque también pueden tener localizaciones atípicas. Presentamos el caso de una mujer de 33 años que consultó por trastornos visuales asociados con dolor de cabeza intenso e hipertensión grave (220/140 mmHg). El examen del fondo de ojo reveló retinopatía hipertensiva grado IV y la RM mostró lesiones hiperintensas en T2 y FLAIR a nivel centropontino, bulbo y médula espinal, las cuales regresaron tras el control sostenido de la presión arterial. (AU)

The posterior reversible leukoencephalopathy syndrome presents with symptoms of cerebral edema. On magnetic resonance imaging (MRI) of the brain, hyperintensities on T2 -weighted and FLAIR sequences typically affect the parietal-occipital region; however it may also have atypical locations. We report the case of a 33 year old patient with visual disturbances associated with intense headache and severe hypertension (220/140 mmHg). The Fundus examination revealed grade IV hypertensive retinopathy, and MRI showed hyperintense lesions in T2 and FLAIR affecting the pontine center, medulla and spinal cord, which regressed after sustain blood pressure control. (AU)

A comparative analysis of surface areas and ratio of the cervical spinal cord and the vertebral canal at the same levels via MRI on healthy individuals / Análisis comparativo de las áreas de superficie y proporción de la médula espinal cervical y el canal vertebral en los mismos niveles via resonancia magnética en individuos sanos

The determination of the normal values of the cross-sectional surface areas and ratios of the vertebral canal and the spinal cord on the healthy individuals is of great importance with regards to the fact that it provides convenience for the doctors to make correct pathological diagnosis because of the most suitable treatment. In this study, it has been aimed to determine the respective ratios between the vertebral canal and the spinal cord via measuring their cross-sectional surface areas at the C3­C6 vertebra levels. The study has been implemented on the Magnetic Resonance Images (MRI) of the cervical vertebral column from healthy individuals at the Department of Radiology, Meram Faculty of Medicine, Necmettin Erbakan University. The study has been applied to 67 (50 female-17 male) individuals whose ages varied between 14 and 59 and these individuals have been divided into two groups as below and over 40 years of age. During the cervical MRI examination, axial and sagittal images have been evaluated and measurements have been made on the non-pathological axial images. The vertebral canal and the spinal cord surface areas have been calculated in square millimeters at the C3­C6 levels. Also, we calculated the ratio between the spinal cord surface area and the vertebral canal surface area. The obtained data has been transferred on the computer and statistical analysis has been implemented via SPSS package program (for Windows, 15.0). The summary of the data has been stated as Mean±SD. It has also been compared with regard to sex and age groups (below and over 40 years of age) using the Student t-test. The relationship between parameters has been evaluated by means of Pearson correlation test. No significant discrepancy (P>0.05) has been determined between the male and the female subjects in terms of the vertebral canal and spinal cord surface area values. On the other hand, at the C4, C5 and C6 levels, a significant discrepancy (P<0.05) has been observed between male and female subjects in terms of the ratio of spinal cord surface to the vertebral canal surface, stating that the male have it larger than the female. A positive correlation (P<0.01) between the surface area and ratio data of both sexes has been determined. We believe that the results of this study will be useful for the fields of neurology, neurosurgery and physical therapy and rehabilitation, particularly in evaluating spinal atrophy.

La determinación de los valores normales de las áreas de superficie de la sección transversal y las proporciones del canal vertebral de la médula espinal en los individuos sanos es de gran importancia para los médicos, para realizar un diagnóstico patológico correcto y un tratamiento más adecuado. Este estudio se llevó a cabo para determinar las respectivas proporciones entre el canal vertebral y la médula espinal a través de la medición transversal de áreas de superficie, entre los niveles de las vértebras C3­C6. El estudio se realizó através de imágenes de resonancia magnética (IRM) de la columna vertebral cervical de individuos sanos en el Departamento de Radiología, de la Facultad de Medicina de Meram, Universidad de Necmettin Erbakan. En el estudio participaron 67 sujetos (50 mujeres, 17 hombres) entre 14 y 59 años de edad. Los sujetos fueron divididos en dos grupos, menores y mayores de 40 años de edad. Durante el examen de IRM cervical, se evaluaron imágenes axiales y sagitales, estas mediciones se realizaron en las imágenes axiales no patológicas. El canal vertebral y las áreas de superficie de la médula espinal fueron calculados en milímetros cuadrados entre los niveles C3­C6. Además, se calculó el cociente entre el área de superficie de la médula espinal y la superficie del canal vertebral. Los datos obtenidos de superficie del canal vertebral, fueron transferidos al equipo y el análisis estadístico se implementó a través del programa SPSS (para Windows, 15.0). El resumen de los datos fue declarado como Media±DE. También fueron comparados grupos entre ambos sexos y por edad (menores y mayores de 40 años de edad) através de la prueba t de Student. La relación entre los parámetros fue evaluada mediante la prueba de correlación de Pearson. No se observó discrepancia significativa (P>0,05) entre hombres y mujeres en términos del canal vertebral, y los valores de la columna vertebral de la zona de superficie dorsal. Por otro lado, a nivel C4, C5 y C6, se observó una discrepancia significativa (P<0,05) entre hombres y mujeres, en términos de la proporción de la superficie de la médula espinal y la superficie del canal vertebral, indicando que fue mayor en los hombres. Se determinó una correlación positiva (P<0,01) entre el área de superficie y los datos de proporción de ambos sexos. Creemos que los resultados de este estudio serán de utilidad en las áreas de la neurología, neurocirugía, como también en terapia física y rehabilitación, en particular en la evaluación de la atrofia espinal.

Varicella-zoster virus longitudinally extensive myelitis in animmunocompetent patient / Mielite longitudinalmente extensa secundária ao vírus varicela-zóster em paciente imunocompetente

Longitudinally extensive myelitis is a severe rare complication of varicella-zoster virus infection. We report a case in a 20-year-oldimmunocompetent patient who presented with a two-week history of lower-limb paresis and paresthesia below dermatome T12, andsphincter dysfunction. He presented with a zoster rash a week prior tothe onset of neurological symptoms. Spinal cord magnetic resonanceimaging revealed a C5-T12 intramedullary lesion and cerebrospinalfluid showed lymphocytic pleocytosis and elevated varicella-zostervirus immunoglobulin G. Patient had not gained much improvement after acyclovir and pulse therapy with methylprednisolone, which prompted a five-day course of plasmapheresis. He partially recovered, but remained with sphincter impairment.

Mielite longitudinalmente extensa é uma rara e grave complicação da infecção pelo vírus varicela-zóster. Relatamos o caso de um pacientede 20 anos de idade, imunocompetente, que há duas semanas apresentou paresia de membros inferiores e parestesias abaixo dodermátomo T12, associadas com disfunção esfincteriana. Ele apresentouum rash cutâneo sugestivo de herpes uma semana antes do início dos sintomas neurológicos. A ressonância magnética de medula espinhal demonstrou uma lesão intramedular de C5 a T12, e o líquido cerebroespinhal revelou uma pleocitose linfocítica com aumento de imunoglobulina IgG para o vírus varicela-zóster. O paciente não apresentou melhora após uso de aciclovir e pulsoterapia com metilprednisolona, o que motivou um curso de cinco dias de plasmaférese.Houve recuperação parcial, porém ele permaneceu com distúrbio esfincteriano.

Primary dorsal spine hydatid cyst

Primary dorsal hydatid cyst is rare and one of the important health conditions to be addressed in endemic countries and nations where the affected individuals may migrate. A twenty-seven years old female presented with gradual onset of mid-back pain and progressive numbness and weakness of both legs. MRI dorsal spine images showed multiple peripherally enhancing cystic lesions located in the posterior mediastinum with extension to adjacent vertebrae D4-5 causing destruction with kyphotic deformity and extension to posterior element. A small cystic lesion is extending to right aspect intra-spinal canal causing displacement and compression of spinal cord at D4-5 level. The clinical presentation, diagnosis and treatment of this case are discussed and review of the literatures is presented

Vertebro-cerebral cryptococcosis mimicking tuberculosis: A diagnostic dilemma in countries with high burden of tuberculosis.

We report a case of a 30-year-old immunocompetent man with disseminated cryptococcosis who was initially treated with antitubercular therapy due to clinical and radiological diagnosis of vertebro-cerebral tuberculosis. The diagnosis of Cryptococcus infection was made due to incidental isolation of this fungus from blood culture with negative cerebrospinal fluid culture results. Though disseminated cryptococcosis with central nervous system, skeletal, and skin involvement is an uncommon manifestation of Cryptococcus neoformans infection, a high clinical suspicion and early initiation of therapy is needed to recognise and treat such patients efficiently.

Evaluation of brain and cervical MRI abnormality rates in patients with systemic lupus erythematosus with or without neurological manifestations

Central nervous system [CNS] involvement has been observed in 14-80% of patients with systemic lupus erythematosus [SLE]. Magnetic resonance imaging [MRI] is an appropriate method for evaluating CNS involvement in these patients. Clinical manifestations and MRI findings of CNS lupus should be differentiated from other mimicking diseases such as multiple sclerosis [MS]. The aim of this study was to evaluate the prevalence and extent of brain and cervical cord MRI lesions of lupus patients. The relationship between neurological signs and symptoms and MRI findings were evaluated as well. Fifty SLE patients who had been referred to the rheumatology clinic of our hospital within 2009 were included in a cross sectional study. All patients fulfilled the revised 1981 American College of Rheumatology [ACR] criteria for SLE. We evaluated the neurological signs and symptoms and brain and cervical MRI findings in these patients. Forty-one patients [82%] were female and nine [18%] were male. The mean age was 30.1 +/- 9.3 years. Twenty eight [56%] patients had an abnormal brain MRI. No one showed any abnormality in the cervical MRI. The lesions in 20 patients were similar to demyelinative plaques. Seventeen patients with abnormal brain MRI were neurologically asymptomatic. There was only a significant relationship between neurological motor manifestations and brain MRI abnormal findings. Unlike the brain, cervical MRI abnormality and especially asymptomatic cord involvement in MRI is quite rare in SLE patients. This finding may be helpful to differentiate SLE from other CNS disorders such as MS

Comparison of conventional myelography with computed tomograrhic myelography

This study was conducted over a period of six months in the department of radiology of Mayo Hospital, Lahore with the sole objective of comparing the conventional myelography with the newer, relatively, the computed tomographic myelography. We evaluated the results and compiled the data for the same reason. 30 patients who were symptomatic were collected from the neurology and the neurosurgery department's. The symptoms of the patients varied from having complete quadriplegia to simple tingling sensations. The conventional myelography was conducted on X-ray Machine under fluoroscopic control. After the procedure the patients were taken to the CT machine for the CT scan and the area under investigation was scanned. While compiling the data it was found that out of 30 patients 9 were normal as far as the myelography was concerned. 15 had extradural compression on the cord, 5 had intramedullary lesions while 1 patient had intradural but extra medullary lesion. And there were 3 cases in which the conventional myelography showed false results. In 2 the result was interpreted as intramedullary on conventional myelography but the CT showed it to be clearly extradural. The results were later compared with the patient out come. All intramedullary lesions went for surgical management and results were 100 percent correct. So we concluded that the conventional myelography was 94 percent specific in localizing the lesion as compared with the 100 percent of the CT scan. But due to the cost effectiveness and the availability of modality and the relatively low radiation dose the conventional myelography has to be the modality of initial choice. And CT should only be done at the areas of interest to avoid any unnecessary radiation

Intradural intramedullary bilharsioma of the spinal cord, report of 10 cases and review of literature

Neurological complications arising from schistosomiasis are uncommon, but may occur when eggs reach the central nervous system and elicit an inflammatory response. In this study we report 10 cases [8 males and 2 females] presented with intradural intramedullary granulomatous lesion proved histopathologically, to be bilharsziomas. Clinical, radiological and pathological studies are discussed in detail with both medical and surgical treatment. We emphasis on the neurological complications of this disease and its presentation in population at increased risk for acquiring or reactivating this infection with review of literatures