Abstract
Intraspinal paragonimiasis is a rare entity for which imaging findings have seldom been described. The present study investigated the MR imaging features of spinal paragonimiasis, thus providing diagnostic imaging evidence and exploring the possible pathogenesis of intraspinal paragonimiasis. The clinical and imaging findings of spinal paragonimiasis in 6 children were analyzed retrospectively. Spinal MR imaging was performed in all patients, 5 of whom also underwent enhanced MR imaging. The diagnosis was confirmed by enzyme-linked immunosorbent assay in all cases and postoperative pathology in 4 cases. All cases manifested as fusiform-shaped or beanlike masses in the extradural space in the thoracic spine. The extradural masses were connected with pleural lesions through the intervertebral foramen. The plain MR imaging scan showed mixed signals with predominant isointensity on T1WI and hyperintensity on T2WI, among which 5 (5/6) masses presented as patchy hemorrhage with hyperintensity on T1WI. On enhanced scans, all masses (5/5) showed heterogeneous marked enhancement, with thickening and enhancement in the adjacent spinal meninges (5/5). Various degrees of spinal cord compression and edema were found in 5 cases (5/6). MR imaging is sensitive for detecting and characterizing spinal paragonimiasis. The MR imaging features of intraspinal granulomas included localization to the extradural space and thoracic segment, connections between intraspinal lesions and pleural lesions through the intervertebral foramen, and hemorrhagic foci within the mass. These findings support an intraspinal mode of paragonimiasis pathogenesis: The Paragonimus larvae migrate from the chest into the extradural space through the intervertebral foramen.
Highlights
BACKGROUND AND PURPOSEIntraspinal paragonimiasis is a rare entity for which imaging findings have seldom been described
The MR imaging features of intraspinal granulomas included localization to the extradural space and thoracic segment, connections between intraspinal lesions and pleural lesions through the intervertebral foramen, and hemorrhagic foci within the mass. These findings support an intraspinal mode of paragonimiasis pathogenesis: The Paragonimus larvae migrate from the chest into the extradural space through the intervertebral foramen
In the axial direction of the spine, all 6 lesions involved the intraspinal extradural space; the 6 lesions were all connected with the pleural lesions through the intervertebral foramen (Figs 1C, -D and 2C, -D)
Summary
The clinical and imaging findings of spinal paragonimiasis in 6 children were analyzed retrospectively. Spinal MR imaging was performed in all patients, 5 of whom underwent enhanced MR imaging. The diagnosis was confirmed by enzyme-linked immunosorbent assay in all cases and postoperative pathology in 4 cases. This study was approved by the Research Ethics Committee of the Children’s Hospital of Chongqing Medical University. Informed consent was obtained from all patients included in the study. Six patients with spinal paragonimiasis (5 boys and 1 girl; ranging from 5 to 12 years of age, with a mean of 8.2 years) were selected from 83 patients with CNS involvement in a total of 723 patients with paragonimiasis diagnosed in our hospital during the past 10 years (January 2008 to January 2018). The diagnosis was confirmed by an enzyme-linked immunosorbent assay for Paragonimus-specific antibody (immunoglobulin G) in serum (6/6) and postoperative pathology (4/6)
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