Correlation Between Histopathologic Features and Magnetic Resonance Images of Spinal Cord Lesions

Abstract Purpose: To evaluate the relationship between the T2 patterns of spinal cord multiple sclerosis lesions and their contrast uptake. Material and method: We retrospectively reviewed the appearance of spinal cord lesions in 29 patients (with relapsing-remitting multiple sclerosis) who had signs and symptoms of myelopathy on neurologic examination and at least one active lesion visualized on magnetic resonance examinations performed between 2004 and 2011. We correlated the T2 patterns of lesions with contrast enhancement and calculated sensitivity and specificity in predicting gadolinium enhancement. Results: Only focal patterns consisting of a lesion’s center homogenously brighter than its periphery on T2-weighed images (type I) correlated significantly with the presence of contrast enhancement (p = 0.004). Sensitivity was 0.307 and specificity 0.929. In contrast, enhancement was not significantly related to uniformly hyperintense T2 focal lesions (type II) or diffuse (type III) pattern defined as poorly delineated areas of multiple small, confluent, subtle hyperintense T2 lesions (p > 0.5 for both). Conclusions: We believe that information about the activity of multiple sclerosis spinal cord lesions in patients with myelopathy may be extracted not only from contrast enhanced, but also from non-enhanced magnetic resonance images.

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Thoracic spinal iophendylate-induced arachnoiditis mimicking an intramedullary spinal cord neoplasm

Journal of Neurosurgery Spine ◽

10.3171/spi/2008/8/3/292 ◽

2008 ◽

Vol 8 (3) ◽

pp. 292-294 ◽

Cited By ~ 12

Author(s):

Steven W. Hwang ◽

Rafeeque A. Bhadelia ◽

Julian Wu

Keyword(s):

Spinal Cord ◽

Magnetic Resonance ◽

Unusual Case ◽

Magnetic Resonance Images ◽

Intramedullary Spinal Cord ◽

Intramedullary Lesion ◽

Thoracic Spinal

✓Iophendylate (Pantopaque or Myodil) was commonly used from the 1940s until the late 1980s for myelography, cisternography, and ventriculography. Although such instances are rare, several different long-term sequelae have been described in the literature and associated with intrathecal iophendylate. The authors describe an unusual case of arachnoiditis caused by residual thoracic iophendylate imitating an expansile intramedullary lesion on magnetic resonance images obtained 30 years after the initial myelographic injection.

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Spinal Cord Biopsy: A Review of 38 Cases

Neurosurgery ◽

10.1227/01.neu.0000053223.77641.5e ◽

2003 ◽

Vol 52 (4) ◽

pp. 806-816 ◽

Cited By ~ 37

Author(s):

Aaron A. Cohen-Gadol ◽

Ofer M. Zikel ◽

Gary M. Miller ◽

Allen J. Aksamit ◽

Bernd W. Scheithauer ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Preoperative Magnetic Resonance Imaging ◽

Resonance Imaging ◽

Imaging Studies ◽

Benign Lesions ◽

Spinal Cord Lesions ◽

Clinicopathological Findings ◽

Preoperative Magnetic Resonance

Abstract OBJECTIVE Neurosurgeons are frequently asked to evaluate patients for spinal cord biopsies when preoperative magnetic resonance imaging studies demonstrate nonspecific features. These lesions often appear unresectable, but surgeons must decide whether a biopsy is warranted. To determine the best approach to these cases, we evaluated the clinicopathological findings for patients with unknown spinal cord lesions who underwent spinal cord biopsies. METHODS Thirty-eight consecutive patients who underwent spinal cord biopsies at the Mayo Clinic (Rochester, MN) between August 1988 and July 1998 were studied. A detailed review of the case histories, radiological results, surgical notes, histological findings, and outcomes was performed. RESULTS Spinal cord biopsies were performed for 21 male and 17 female patients (mean age, 42.1 yr) with progressive neurological deficits related to spinal cord lesions. All patients underwent preoperative magnetic resonance imaging evaluations. High T2-weighted signal intensity and spinal cord expansion were identified in 92 and 87% of cases, respectively. After gadolinium infusion, the majority (94%) of the inflammatory lesions demonstrated patchy and often peripherally situated enhancement. This neuroradiological pattern was less common for neoplasms (50%) and benign lesions (40%). The most common pathological findings were inflammatory changes of demyelination or sarcoidosis, which together accounted for 13 cases (34%). Nonspecific changes or benign lesions were observed in 10 cases (26%). Neoplasms were identified in eight cases (21%). One case of tuberculosis and one of schistosomiasis were found. Overall, 47% of the preoperative diagnoses made by the attending surgeon were correct. For 26% of the patients, specific treatment was based on the biopsy results. The average follow-up period was 12 months (standard deviation, 14 mo; range, 0–50 mo). CONCLUSION Preoperative laboratory and imaging studies are often diagnostically inconclusive in cases of spinal cord lesions with nonspecific features. Biopsies should be considered for patients with progressive symptomatic lesions.

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Magnetic resonance imaging of spinal cord lesions in multiple sclerosis.

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.52.4.459 ◽

1989 ◽

Vol 52 (4) ◽

pp. 459-466 ◽

Cited By ~ 52

Author(s):

L S Honig ◽

W A Sheremata

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Spinal Cord ◽

Magnetic Resonance ◽

Resonance Imaging ◽

Spinal Cord Lesions

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Traumatic Cervical Cord Injury at C3–4 without Radiographic Abnormalities: Correlation of Magnetic Resonance Findings with Clinical Features and Outcome

Journal of Orthopaedic Surgery ◽

10.1177/230949900201000205 ◽

2002 ◽

Vol 10 (2) ◽

pp. 129-135 ◽

Cited By ~ 18

Author(s):

M Takahashi ◽

Y Harada ◽

H Inoue ◽

K Shimada

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Magnetic Resonance ◽

Clinical Features ◽

Cervical Spinal Cord ◽

Magnetic Resonance Images ◽

Clinical Severity ◽

Neurological Involvement ◽

Sensory Level ◽

Cord Injury

Purpose. Clinical features and outcomes of 43 patients at the Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, were studied prospectively. These patients were not found to have radiographic abnormalities but magnetic resonance images showed acute cervical spinal cord trauma at the C3–4 disc level. Methods. Magnetic resonance images were analysed at presentation (immediately after the injury) and subsequent follow-up visits (at subacute and chronic stages, respectively) in an attempt to correlate imaging findings to clinical features and outcomes, respectively. Results. The injury mechanism was usually a yper-extension of the cervical spine. The level of neurological involvement was assessed in 9 patients with complete tetraplegia: the motor level was C5 in 6 patients and C4 in 3, whereas the sensory level was C5 in 7 patients, C4 in one, and C3 in one. Respiratory dysfunction in patients with severe paralysis, or numb and clumsy hands in patients with incomplete paralysis were the characteristic clinical features of cervical spinal cord injury at these lesions. Three patterns of signal change on magnetic resonance images were observed in patients with spinal cord injury at C3–4. A low-intensity area on T2-weighted images in the acute stage indicated a poor prognosis, while a high-intensity area at 2 to 3 weeks after injury indicated some degree of permanent paralysis. Conclusion. The serial signal changes of magnetic resonance images and the clinical severity or outcome seemed to be well correlated.

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Semi-automatic segmentation and modeling of the cervical spinal cord for volume quantification in multiple sclerosis patients from magnetic resonance images

10.1117/12.773055 ◽

2008 ◽

Cited By ~ 1

Author(s):

Pavlina Sonkova ◽

Iordanis E. Evangelou ◽

Antonio Gallo ◽

Fredric K. Cantor ◽

Joan Ohayon ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Magnetic Resonance ◽

Cervical Spinal Cord ◽

Automatic Segmentation ◽

Magnetic Resonance Images ◽

Multiple Sclerosis Patients

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Quantification of spinal cord atrophy from magnetic resonance images via a B-spline active surface model

Magnetic Resonance in Medicine ◽

10.1002/mrm.10162 ◽

2002 ◽

Vol 47 (6) ◽

pp. 1176-1185 ◽

Cited By ~ 47

Author(s):

O. Coulon ◽

S.J. Hickman ◽

G.J. Parker ◽

G.J. Barker ◽

D.H. Miller ◽

...

Keyword(s):

Spinal Cord ◽

Magnetic Resonance ◽

Active Surface ◽

Magnetic Resonance Images ◽

Surface Model ◽

Spinal Cord Atrophy ◽

B Spline

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An extramedullary plasmacytoma originating from the thoracic spinal cord: magnetic resonance imaging findings

Journal of Neurosurgery Spine ◽

10.3171/spi.2007.6.1.57 ◽

2007 ◽

Vol 6 (1) ◽

pp. 57-59 ◽

Cited By ~ 3

Author(s):

Bo Gao ◽

Xuejian Wang

Keyword(s):

Spinal Cord ◽

Magnetic Resonance ◽

Bone Marrow Involvement ◽

Magnetic Resonance Images ◽

Extramedullary Plasmacytoma ◽

Rare Tumor ◽

Histological Findings ◽

Resonance Imaging ◽

Thoracic Spinal Cord ◽

Thoracic Spinal

✓Extramedullary plasmacytoma (EMP) is a rare tumor. The authors report a case of an EMP originating in the thoracic spinal cord. To their knowledge this is the first report in which an EMP originating in this location is described. Isointense and hyperintense signals were seen on T1-weighted and T2-weighted magnetic resonance images, respectively, with marked irregular contrast enhancement and extensive edema. No evidence of bone marrow involvement or multiple myeloma was noted. The histological findings were compatible with an EMP.

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