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Gilis N, Lebrun L, Lolli V, David P, Rodesch M, Bex A, Fricx C, De Maertelaer V, Salmon I, De Witte O. Radiological characterization of pediatric intramedullary astrocytomas: Do they differ from adults? BRAIN & SPINE 2023; 4:102671. [PMID: 38510632 PMCID: PMC10951691 DOI: 10.1016/j.bas.2023.102671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 03/22/2024]
Abstract
Introduction The incidence of intramedullary spinal cord tumors ranges from 2 to 4% of all central nervous system tumors. Only 6-8% are astrocytomas. The gold standard to diagnose a spinal cord tumor is the spinal cord MRI in toto. Specific radiological criteria orient the diagnosis of the intradural intramedullary lesion. Most of the authors studied adult populations of astrocytomas. However, pediatric astrocytomas present certain particularities. Research question This work aims to determine if the usual radiological criteria of intramedullary astrocytomas (IMAs) are different depending on the patient's age. Material & methods We evaluated the radiological features of IMAs in adult and pediatric groups through a retrospective study. Results We collected 31 patients with IMAs (11 children and 20 adults). We observed some trends but we did not highlight any statistically significant difference between all the radiological criteria studied (sagittal and axial spinal cord localization, T1-and T2-weighted characteristics, contrast uptake, infiltrating character, presence of necrosis, heterogeneous lesion, necrotic, hemorrhagic, presence of edema) and the patient's age. Discussion & conclusion Given the rarity of IMAs and the lack of large specific pediatric studies, it seems essential to routinely report all cases encountered and create multicentric pediatric databases to draw more robust conclusions.
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Affiliation(s)
- Nathalie Gilis
- Department of Neurosurgery, Erasmus Hospital, Route de Lennik 808, Brussels, Belgium
| | - Laetitia Lebrun
- Department of Pathology, Erasmus Hospital, Route de Lennik 808, Brussels, Belgium
| | - Valentina Lolli
- Department of Radiology, Erasmus Hospital, Route de Lennik 808, Brussels, Belgium
| | - Philippe David
- Department of Radiology, Erasmus Hospital, Route de Lennik 808, Brussels, Belgium
| | - Marine Rodesch
- Department of Pediatrics, Erasmus Hospital, Route de Lennik 808, Brussels, Belgium
| | - Alix Bex
- Department of Neurosurgery, Erasmus Hospital, Route de Lennik 808, Brussels, Belgium
| | - Christophe Fricx
- Department of Pediatrics, Erasmus Hospital, Route de Lennik 808, Brussels, Belgium
| | - Vivianne De Maertelaer
- Institute of Interdisciplinary Research (IRIBHM), Université Libre de Bruxelles, Route de Lennik 808, Brussels, Belgium
| | - Isabelle Salmon
- Department of Pathology, Erasmus Hospital, Route de Lennik 808, Brussels, Belgium
| | - Olivier De Witte
- Department of Neurosurgery, Erasmus Hospital, Route de Lennik 808, Brussels, Belgium
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Singh B, Chauhan A, Raj G. Imaging Features of Intramedullary Spinal Cord Lesions with Histopathological Correlation. ASIAN JOURNAL OF ONCOLOGY 2022. [DOI: 10.1055/s-0042-1750792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Purpose Most of the intramedullary spinal cord lesions have a component of insidious myelopathic changes at the time of diagnosis. Among the spinal cord lesions, intramedullary neoplasms are rare (25%). They represent 4 to 10% of all central nervous system tumors. But due to involvement of tracts, they are associated with significant neurological symptoms. Their imaging features can help early diagnosis and predict prognosis. We aim to narrow down differential diagnoses of intramedullary lesions based on imaging findings.
Materials and Methods This retrospective study included 40 patients as a sample that underwent magnetic resonance imaging spine at our institution (on 3T machine). Patient population had varied clinical complaints, ranging from headache, nausea, vomiting, motor weakness, bladder and bowel involvement, progressive paraparesis to paraplegia. Lesions were evaluated site, size, margin, associated cysts, signal intensity, enhancement, and associated syringohydromyelia.
Results This study obtained majority of the lesions to be ependymoma (15) and astrocytoma (11), followed by infection (4), hemangioblastoma (3), and metastasis (2). Five patients were either lost to follow-up or not operated on.
Conclusion Most of the intramedullary lesions were malignant and were showing postcontrast enhancement. Ependymomas were more frequently present in cervical region, central in location with well-defined margins and focal postcontrast enhancement. Among the total of 15 ependymomas, three cases were associated with neurofibromatosis-2. Ependymomas were more frequently associated with syringohydromyelia and peripheral hemorrhage (cap sign). Astrocytoma was more frequently seen in children, thoracic and eccentric in location with ill-defined margins. Enhancement in astrocytoma was dependent on the grade of tumor. Metastasis was a differential, with imaging characteristics dependent on type of primary. Intramedullary granuloma due to infection can also be confusing mimics of neoplasm. High-velocity signal loss due to flow voids is seen in the hemangioblastomas.
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Affiliation(s)
- Bhanupriya Singh
- Department of Radiodiagnosis, Dr. Ram Manohar Lohiya Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abhishek Chauhan
- Department of Radiodiagnosis, Dr. Ram Manohar Lohiya Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Gaurav Raj
- Department of Radiodiagnosis, Dr. Ram Manohar Lohiya Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Dos Santos AASMD. The importance of magnetic resonance imaging in the differential diagnosis of spinal cord injuries. Radiol Bras 2021; 54:V-VI. [PMID: 34866704 PMCID: PMC8630948 DOI: 10.1590/0100-3984.2021.54.6e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Alair Augusto Sarmet M D Dos Santos
- Professor Associado/Chefe do Departamento de Radiologia da Faculdade de Medicina da Universidade Federal Fluminense (UFF), Coordenador Médico do Centro de Imagens do Complexo Hospitalar de Niterói (CHN), Niterói, RJ, Brasil
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Use of Second Window ICG in spinal cord biopsy of a mildly contrast-enhancing lesion: Technical note and review of the literature. Neurochirurgie 2021; 68:239-242. [PMID: 34102223 DOI: 10.1016/j.neuchi.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Indocyanine green (ICG) is commonly used to visualize cerebral vasculature, particularly in the management of cerebral aneurysms. There have also been attempts to use ICG for visualization of tumors. Injection of ICG followed by immediate fluorescence microscopy is limited by the short time window for imaging and administration and restricted depth of imaging. Second Window Indocyanine Green (SWIG) addresses these issues by allowing for longer contrast times and the imaging of deeper regions of brain tissue. Biopsy of spinal cord lesions is often difficult for a variety of reasons, including the delicate nature of the tissue and differentiating normal from lesional tissue visually, especially in lesions with heterogeneous enhancement. METHODS In this case report, we describe the use of second window ICG to facilitate the visualization of a spinal cord lesion and subsequent biopsy of the lesion. RESULTS This patient is a 24-year-old female who had recurrence of a suprasellar germinoma. An MRI of the rest of the neuraxis was performed to assess for the presence of drop metastases. The spinal cord from C2-5 was expanded with areas of patchy enhancement; however, this lesion was asymptomatic. The patient's oncologist requested a biopsy of this lesion to help direct subsequent care of her recurrent germinoma. The day before surgery, the patient had an intravenous injection of ICG dye. She then underwent a C3-5 laminectomy for biopsy of her cervical intramedullary lesion. After opening of the dura, no visible abnormality of the spinal cord could be identified. A Stryker endoscope showed an area of ICG uptake in the cord at approximately the C3-4 level. A midline myelotomy was centered over the ICG demarcated area and several samples were taken for pathology. Final biopsy results determined the lesion to be spinal cord parenchyma with perivascular and intraparenchymal lymphocytes - not consistent with spinal cord tumor or germinoma. CONCLUSION Second Window ICG is effective in visualizing otherwise visually unremarkable spinal cord lesions. This technology can facilitate biopsy of these lesions and possibly their surgical resection.
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Intramedullary spinal cord lesions in an immunocompromised host due to Mycobacterium haemophilum. IDCases 2019; 19:e00674. [PMID: 32226763 PMCID: PMC7093745 DOI: 10.1016/j.idcr.2019.e00674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 11/22/2022] Open
Abstract
M. haemophilum can produce severe disease in persons living with HIV/AIDS or other immunocompromised patients. The spectrum of disease caused by M. haemophilum may produce life-threatening central nervous system disease. The treatment of M. haemophilum when involving the CNS is challenging requiring multi-drug therapy. Patients with M. haemophilum central nervous system disease, with and without HIV, should be monitored for IRIS.
Mycobacterium haemophilum is a slow growing acid-fast bacillus (AFB) in the nontuberculous mycobacteria (NTM) group. M. haemophilum typically causes cervicofacial lymphadenitis in children, cutaneous diseases, septic arthritis and osteomyelitis. However, it rarely causes isolated spinal cord disease. We report the first case, to our knowledge, of isolated intramedullary spinal lesions secondary to M. haemophilum. This case involved a patient with newly diagnosed human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). He developed significant immune reconstitution inflammatory syndrome (IRIS) during his treatment. M. haemophilum should be on the differential for isolated intramedullary spinal lesions, particularly in immunocompromised patients. Given our patient’s severe IRIS, patients with HIV and M. haemophilum infection should be closely monitored for IRIS and treated aggressively. In high risk circumstances such as M. haemophilum spinal disease in patients with HIV, clinicians should consider pre-emptive treatment for IRIS.
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Chokshi FH, Law M, Gibbs WN. Conventional and Advanced Imaging of Spine Oncologic Disease, Nonoperative Post-treatment Effects, and Unique Spinal Conditions. Neurosurgery 2017; 82:1-23. [DOI: 10.1093/neuros/nyx491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 09/07/2017] [Indexed: 01/19/2023] Open
Abstract
Abstract
In this review, we discuss the imaging features of diseases and conditions ranging from neoplastic to nonoperative post-treatment effects to unique conditions of the spine. Additionally, advanced imaging may increase diagnostic certainty in cases where conventional imaging characteristics of benign lesions and malignant pathology are variable.
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Affiliation(s)
- Falgun H Chokshi
- Department of Radiology and Imaging Sciences, Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
| | - Meng Law
- Department of Neurosurgery, University of Southern California, Keck School of Medicine, Healthcare Consultation Center II, Los Angeles California
- Department of Radiology, University of Southern California, Keck School of Medicine, Healthcare Consultation Center II, Los Angeles California
- Department of Neurology, University of Southern California, Keck School of Medicine, Healthcare Consultation Center II, Los Angeles California
- USC Viterbi School of Engineering, Los Angeles, California
| | - Wende N Gibbs
- Department of Neurosurgery, University of Southern California, Keck School of Medicine, Healthcare Consultation Center II, Los Angeles California
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Spain JA, Cressman S, Marin H, Patel SC, Corrigan JJ, Griffith B. Cord Topographical Anatomy and its Role in Evaluating Intramedullary Lesions. Curr Probl Diagn Radiol 2017; 47:437-444. [PMID: 29054315 DOI: 10.1067/j.cpradiol.2017.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/06/2017] [Accepted: 09/15/2017] [Indexed: 12/13/2022]
Abstract
Intramedullary spinal lesions present a wide differential diagnosis including infectious, inflammatory, traumatic, ischemic, benign, or malignant neoplastic etiologies. Using knowledge of anatomy and physiology within the spinal cord, many similar appearing entities can be parsed into a prioritized differential. The purpose of this article is to review anatomy and pathophysiology of the spinal cord, with subsequent discussion of how this knowledge can be used to differentiate several similar appearing intramedullary pathologic processes. Discussion includes the pathophysiology, imaging findings, and clinical pearls of several intramural lesions including infarct, demyelinating lesions, traumatic injury, neoplasm, vascular malformation, and metabolic processes such as subacute combined degeneration.
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Affiliation(s)
| | - Scott Cressman
- Department of Radiology, Henry Ford Health System, Detroit, MI
| | - Horia Marin
- Department of Radiology, Henry Ford Health System, Detroit, MI
| | - Suresh C Patel
- Department of Radiology, Henry Ford Health System, Detroit, MI
| | - John J Corrigan
- Department of Radiology, Henry Ford Health System, Detroit, MI
| | - Brent Griffith
- Department of Radiology, Henry Ford Health System, Detroit, MI.
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Hazenfield JM, Gaskill-Shipley MF. Neoplastic and Paraneoplastic Involvement of the Spinal Cord. Semin Ultrasound CT MR 2016; 37:482-97. [DOI: 10.1053/j.sult.2016.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Spinal dual-energy computed tomography: improved visualisation of spinal tumorous growth with a noise-optimised advanced monoenergetic post-processing algorithm. Neuroradiology 2016; 58:1093-1102. [DOI: 10.1007/s00234-016-1733-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/19/2016] [Indexed: 01/14/2023]
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Morales H, Betts A. Abnormal Spinal Cord Magnetic Resonance Signal: Approach to the Differential Diagnosis. Semin Ultrasound CT MR 2016; 37:372-83. [PMID: 27616311 DOI: 10.1053/j.sult.2016.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
T2-hyperintense signal abnormalities within the spinal cord on magnetic resonance imaging can evoke a broad differential diagnosis and can present a diagnostic dilemma. Here, we review and provide a succinct and relevant differential diagnosis based on imaging patterns and anatomical or physiopathologic correlation. Clues and imaging pearls are provided focusing on inflammatory, infectious, demyelinating, vascular, and metabolic involvement of the spinal cord.
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Affiliation(s)
- Humberto Morales
- Section of Neuroradiology, University of Cincinnati Medical Center, Cincinnati, OH.
| | - Aaron Betts
- Section of Neuroradiology, University of Cincinnati Medical Center, Cincinnati, OH
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Current Management and Treatment Modalities for Intramedullary Spinal Cord Tumors. Curr Treat Options Oncol 2015; 16:39. [DOI: 10.1007/s11864-015-0358-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Zhovtis Ryerson L, Herbert J, Howard J, Kister I. Adult-onset spastic paraparesis: an approach to diagnostic work-up. J Neurol Sci 2014; 346:43-50. [PMID: 25263600 DOI: 10.1016/j.jns.2014.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/20/2014] [Accepted: 09/12/2014] [Indexed: 11/30/2022]
Abstract
Adult-onset, chronic progressive spastic paraparesis may be due to a large number of causes and poses a diagnostic challenge. There are no recent evidence-based guidelines or comprehensive reviews to help guide diagnostic work-up. We survey the literature on chronic progressive spastic paraparesis, with special emphasis on myelopathies, and propose a practical, MRI-based approach to facilitate the diagnostic process. Building on neuro-anatomic and radiographic conventions, we classify spinal MRI findings into six patterns: extradural; intradural/extramedullary; Intramedullary; Intramedullary-Tract specific; Spinal Cord Atrophy; and Normal Appearing Spinal Cord. A comprehensive differential diagnosis of chronic progressive myelopathy for each of the six patterns is generated. We highlight some of the more common and/or treatable causes of progressive spastic paraparesis and provide clinical pointers that may assist clinicians in arriving at the diagnosis. We outline a practical, comprehensive MRI-based algorithm to diagnosing adult-onset chronic progressive myelopathy.
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Affiliation(s)
| | - Joseph Herbert
- NYU Langone Multiple Sclerosis Comprehensive Care Center, New York, NY, USA
| | - Jonathan Howard
- NYU Langone Multiple Sclerosis Comprehensive Care Center, New York, NY, USA
| | - Ilya Kister
- NYU Langone Multiple Sclerosis Comprehensive Care Center, New York, NY, USA
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Intramedullary thoracic spine epidermoid cyst with myelopathic presentations: a report of a rare case. Clin Neurol Neurosurg 2012; 115:841-3. [PMID: 22959213 DOI: 10.1016/j.clineuro.2012.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 07/15/2012] [Accepted: 08/04/2012] [Indexed: 11/20/2022]
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Intradural spinal tumors: current classification and MRI features. Neuroradiology 2007; 50:301-14. [PMID: 18084751 DOI: 10.1007/s00234-007-0345-7] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 11/16/2007] [Indexed: 10/22/2022]
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Won KS, Kim JS, Ra YS, Sohn CH, Zeon SK. FDG PET of primary spinal glioblastoma initially mimicking a transverse myelitis on MRI. Clin Nucl Med 2007; 31:556-7. [PMID: 16921284 DOI: 10.1097/01.rlu.0000233030.35986.5f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kyoung Sook Won
- Department of Nuclear Medicine, Keimyung University School of Medicine, Daegu, Korea.
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Affiliation(s)
- J Keith Smith
- Department of Radiology, The University of North Carolina, Chapel Hill, NC 27599-7510, USA.
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