Diagnosis Of Spinal Cord Tumors Research Articles

Positive Predictive Value of Magnetic Resonance Imaging in Intradural Spinal Tumors Taking Histopathology as Gold Standard

Objective: To observe the positive predictive value of MRI, taking histopathology as gold standard in detecting spinal intradural tumors.Materials and Methods: Total 180 cases were included through non-probability purposive sampling, at Ganga Ram Hospital, Radiology department, Lahore. The radiological diagnosis obtained through MRI, was observed. The cases fit in inclusion criteria were underwent surgery and their histopathological findings were observed. Comparison between the outcomes of MRI and histopathology were undertaken, keeping histopathology as gold standard. Positive predictive value of MRI in the diagnosis of intradural spinal tumor was calculated andpresented in the form of percentages and frequency.Results: There were total 180 patients presenting in OPD with the mean age of 45.71 ± 13.57 years. There were 112 (62%) male. Male to female ratio was 1.6:1. There were 134 (74.4%) cases who were positive for malignant spinal intradural tumor on histopathology showing the PPV of MRI as 74.4%.Conclusion: Magnetic Resonance Imaging is very beneficial imaging tool for early diagnosis of spinal cord tumors.

Epidermoid Intramedullary Cyst: A Rare Case Report

Epidermoid cysts are tumors that ocur in most parts of the body and are often treated by neurosurgeons, but intramedullary localizations of epidermoid cysts are very rare. The incidence in adults is lower than 1% and in children lower than 3%.We report a case of a 27-year-old patient presenting with thoracic spinal cord compression syndrome (T11-12). The magnetic resonance imaging (MRI) showed an intramedullary cystic mass. It demonstrated low signal intensity on T1-weighted sequence and high signal intensity on T2-weighted sequences, with minimal peripheral enhancement following intravenous administration of gadoteric acid. After surgical removal of the tumor, the pathology confirmed the radiological diagnosis of spinal epidermoid cyst. MRI reduces the delay in diagnosis of spinal cord tumors but should be guided by clinical judgment. J Med Cases. 2019;10(3):67-71 doi: https://doi.org/10.14740/jmc3224

POSSIBILITIES OF DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF SPINAL CORD TUMORS

The review analyzes the data of modern literature on main methods for the diagnosis of spinal cord tumors. It reflects the possibilities of using diffusion-weighted MRI (DW-MRI), by constructing the maps of measured diffusion coefficients (ICD) and calculating the mean value of ICD in this pathology. The investigators have collected data on differential diagnosis and the assessment of the degree of malignancy of certain tumor groups on the basis of DW-MRI data. DW-MRI as compared with the data of standard T1- and T2-weighted images can serve as an additional method to diagnose spinal cord neoplasms of different nature at the preoperative stage for the determination of the volume of subsequent surgery.

Spinal lobular capillary hemangioma with an intramedullary component

Capillary hemangiomas are benign vascular neoplasms rarely involving the spinal cord, where their usual location is extramedullary. A 59-year-old man presented with a 7-month history of progressive numbness which began in the left lower extremity and progressed across the lower back, right flank, trunk and into the right lower extremity with associated pressure and pain in his lower back. On magnetic resonance imaging, there was an avidly-enhancing thoracic intradural lesion that contained an extramedullary intradural component posteriorly, with an apparent intramedullary component anteriorly. Laminectomy of T7 - 8 was performed, and intradural exploration revealed a highly vascular-appearing tumor below the arachnoid, which was not completely dissected because it was densely adherent to the spinal cord. The pathological diagnosis was lobular capillary hemangioma with extra- and intramedullary components. We suggest this lesion should be considered in the differential diagnosis of spinal cord tumors with an intramedullary component.

Primary malignant lymphoma in a spinal cord presenting as an epidural mass with myelopathy: a case report.

We report the case of a 47-year-old man who presented with progressive paraparesis and sphincter changes over 2 weeks. Magnetic resonance imaging revealed a spinal epidural mass from T9 to L2. We performed a decompressive laminectomy and mass removal. The histopathology was consistent with a small lymphocytic lymphoma. No metastatic lesion was noted in the chest and abdomen-pelvic computerized tomography (CT) and positron emission tomography computerized tomography (PET-CT) scan. The final diagnosis was primary spinal lymphoma, so we performed chemotherapy combined with radiotherapy. At one year follow-up, he had no neurological deficit and no recurrence on neurologic and radiologic exams. Primary spinal cord lymphomas should be considered in the differential diagnosis of spinal cord tumors. Early surgical management is mandatory to achieve a recovery of neurologic function, especially if the patient has a neurological deficit.

Intramedullary schwannoma: A case report

Intramedullary schwannoma are very rare, corresponding to 0.3% of all intraspinal tumors. MRI examination is the modality of choice for the diagnosis of spinal cord tumor. We report a case of intramedullary schwannoma explored by magnetic resonance imaging. The literature is reviewed about of this rare localization of schwannoma.

Magnetic Resonance Imaging for Spinal Cord Tumors

This paper discusses spinal cord tumors including imaging characteristics with emphasis on magnetic resonance imaging and advances in treatment. This is a retrospective study of 20 cases patients with neoplasms arising from the spinal cord. All of our cases were explored by magnetic resonance imaging (1.5T) using T1-weighted imaging (Spin Echo), T2-weighted imaging (Spin Echo) and T1-weighted imaging with Gadolinium administration. Pain is the earliest symptom, characteristically occurring at night when the patient is supine. Ependymoma were observed in 11 cases. Astrocytoma was noted in five cases. Other uncommon tumors were identified in four cases: oligodendroglioma (n=1), epidermoid cyst (n=1), hemangioblastoma and metastasis (n=1). In MRI most tumors are isointense or slightly hypointense compared to the normal cord signal with homogenous or irregular enhancement. We describe the characteristic magnetic resonance findings and differential diagnosis of spinal cord tumors. Spinal cord lesions comprise approximately 2-4% of all central nervous system neoplasms. Magnetic resonance imaging plays a central role in the imaging of spinal cord neoplasms.

Treatment of spinal cord tumors

Tumors associated with the spinal cord can have devastating effects on patient function and quality of life. Most of these tumors are from metastatic disease, usually to the epidural space. Less frequently, the tumors are intrinsic to the spinal cord itself (ie, primary tumor). Regardless of the etiology, spinal cord tumors often present first with progressive local or radicular pain, or both. Other symptoms include weakness, sensory changes, or sphincter dysfunction. The timeliness of diagnosis of spinal cord tumors and promptness of treatment are important, as they directly affect outcome. Dexamethasone, a corticosteroid, is used as a temporizing measure to improve or stabilize neurologic function until definitive treatment. For nonambulatory patients with epidural metastatic tumors, surgery followed by radiation therapy maximizes neurologic function and modestly lengthens survival. However, palliative radiotherapy alone is recommended for those with neurologic deficits lasting longer than 48 hours, survival prognosis less than 3 months, inability to tolerate surgery, multiple areas of compression, or radiosensitive tumors. An ambulatory patient with a stable spine should be considered for radiation treatment only. The role of chemotherapy for epidural metastatic tumors is not well established. For intramedullary metastases, the role of surgery and chemotherapy remains controversial and radiation is the mainstay. For low-grade or benign primary spinal cord tumors, resective surgery is of benefit and can be curative. For high-grade tumors, the benefit of resection is less clear, and radiotherapy and/or chemotherapy may be helpful. The use of chemotherapy for primary spinal cord tumors has rarely been assessed. Agents reported in the literature for treatment of spinal cord gliomas include temozolomide, irinotecan, cisplatin, and carboplatin. A multidisciplinary approach is often required to maximize the therapeutic and functional outcome of patients with metastatic and primary spinal cord tumors.

Why does delay exist in the diagnosis of intradural spinal cord tumor despite the availability of MRI?

To elucidate the reasons for delay in the diagnosis of spinal cord tumors despite the availability of MRI in Japan, we reviewed the clinical records of 60 patients with tumors with reference to histological diagnosis, initial symptoms, time interval between onset of the initial symptoms and the first visit to a physician, and the subsequent interval to diagnosis using MRI. The intervals from onset of the initial symptoms to diagnosis using MRI for cervical, thoracic, and lumbar tumors were 16.9, 16.8 and 8.1 months, respectively. Of the 20 patients with thoracic spine tumors, 10 had been examined with MRI at an incorrect level. The patients with cervical tumors tended to have delayed diagnoses due to the time taken before visiting a physician. Tumors in the thoracic spine were missed because the symptoms were similar to more common degenerative lumbar disorders and the absence of proper MRI screening. The possibility of thoracic spinal tumor should be kept in mind when unexplained low back pain persists in response to various treatments.

Tumors affecting the spinal cord of cats: 85 cases (1980–2005)

To determine the prevalence of lymphosarcoma and other tumors affecting the spinal cord of cats and to relate specific types of tumors with signalment, history, and clinical findings. Retrospective case series. 85 cats with tumors affecting the spinal cord. Medical records of cats with histologically confirmed primary or metastatic tumors of the spinal cord or tumors causing spinal cord disease by local extension from adjacent tissues examined between 1980 and 2005 were reviewed. Data on signalment; clinical history; results of neurologic examination, diagnostic imaging, and clinical pathologic evaluation; and location of tumor within the spinal cord were obtained from medical records and analyzed by use of logistic regression models. Lymphosarcoma was the most common tumor and affected the spinal cord in 33 (38.8%) cats, followed by osteosarcoma in 14 (16.5%) cats. Cats with lymphosarcoma were typically younger at initial examination, had a shorter duration of clinical signs, and had lesions in more regions of the CNS than did cats with other types of tumors. In 22 of 26 (84.6%) cats with lymphosarcoma, the tumor was also found in extraneural sites. Data for spinal cord tumors in this population of cats were analyzed by logistic regression analysis, which effectively distinguished cats with lymphosarcoma from cats with other types of tumors. Additional clinical information reported here will help to increase the index of suspicion or definitive antemortem diagnosis of spinal cord tumors of cats.

Pediatric Spinal Cord Tumors and Masses

Background/Objective: Spinal cord tumors are a relatively rare diagnosis, accounting for 1% to 10% of all pediatric central nervous system tumors. Understanding the etiology and clinical outcomes of these tumors is therefore very important. This study presents detailed information regarding clinical presentation, histological findings, outcomes, functional assessment, and management of a series of patients with this diagnosis.Method: Retrospective, descriptive study.Subjects: Thirty-five children with a final diagnosis of spinal cord tumor or mass, excluding dysraphism.Results: Neurodevelopmental tumors (dermoid tumors, epidermoid tumors, and teratomas) were the most common tumor type (31 %), followed by astrocytomas (29%) and neuroblastomas (14%). Other types included schwannomas, meningiomas, giant cell tumors, extradural cystic masses, leukemic-related masses, and masses related to neurofibromatosis. Mean age at diagnosis was 6.6 years (SD = 5.5 y) and did not vary significantly by tumor type except for children with neuroblastoma (mean = 0.4 y, SD = 0.5 y). More boys (57%) were identified in the series than girls (43%); however, there was no association between tumor type and sex. Presenting complaints of pain were noted in 57% and were localized to the back, neck, or extremities. Extremity weakness was reported as an initial presenting symptom in 46%. Three children had scoliosis as a presenting issue and 14 had gait abnormalities. Regardless of treatment modality, mobility was retained in 83% of children with or without gait aids. Neurogenic bowel and/or bladder were present in 23% of the population.Conclusions: This study corroborates other studies indicating that intramedullary tumors are the predominant form of pediatric spinal cord tumor. This population, however, presented with an unusually large number of developmental tumors, contrary to several published studies. The disparity may be the result of this institution acting as a regional referral center, thus increasing the number of this type of patient. The population is too small to make any other conjecture. The predominance of astrocytomas and neuroblastomas among those patients with poor outcomes and the prevalence of developmental tumors suggest the need for broader investigation. Although, in general, spinal cord tumors are relatively rare, this preliminary study supports the need to further evaluate associations between tumor type, presenting symptoms, treatment, and functional outcome in children with spinal cord tumors.

Childhood scoliosis revealing spinal cord tumors

Spinal cord tumors typically show slow and insidious growth and scoliosis may be the only presenting feature of these lesions. The aim of this study is to determine the clinical and/or imaging signs that can contribute in uncovering the underlying etiology of a presumed “idiopathic” scoliosis. We retrospectively reviewed seven cases of histologically confirmed spinal cord tumors presenting as scoliosis and diagnosed with MRI in our institution between 1996 and 2003. The children (six males and one female) were aged from 3 to 10 years. The scoliosis was associated with spinal pain and/or stiffness in all cases. Accurate neurological evaluation showed a motor deficit and/or mild neurological signs in all cases. Plain radiographs showed widening of the spinal canal in three patients. MRI allowed the diagnosis of spinal cord tumor in all patients. Associated syrinx was noted in five cases. Of which one child was presented with a “torticolis”, one with a localized thoraco–lumbar hyperkyphosis, three with left-sided thoracic curve and two with right-sided thoracic curve. All patients underwent surgical resection. Histological study concluded to astrocytomas (n=4), ependymoma (n=2) and epidermoid cyst (n=1). Scoliosis should be considered as idiopathic only occult causes have been excluded. Neurological evaluation of these patients must be accurate. Early age of onset, male gender spinal pain and/or stiffness, left-sided curve, neurological signs, radiographic widening of the spinal canal are considered as atypical features and must lead to further investigation by MRI.

ＭＲＩによる神経鞘腫と髄膜腫の鑑別診断

MRI is very useful in the diagnosis of spinal cord tumors. It has been proposed that in most cases, differentiation of the spinal schwannoma and meningioma can be differentiated by MRI, but contradictory opinions have also been reported. Generally schwannomas show low or iso intensity signals on T1-weighted images, high intensity signals on T2-weighted images compared with that of the spinal cord, and are heterogeneous inside the tumor. On the other hand, meningiomas show iso intensity signals on both Ti-weighted images and T2-weighted images, and are homogeneous inside the tumor. In retrospec, 21 cases with schwannoma and 10 cases with meningioma operated on from 1988 to 1998 were reviewed by an orthopedician who had not attended there surgeries in order to confirm if the differential diagnosis of these two tumors could be performed by MRI. The accordant rate between MRI diagnosis and histological diagnosis was 100% in Schwannomas and 80% in Meningiomas respectively, this confirming that the differential diagnosis of spinal schwannoma and meningioma can be performed by MRI.

Magnetic resonance imaging of intramedullary spinal cord tumors.

The advent of MRI has significantly changed the diagnosis of spinal cord tumors. Standard imaging provides excellent localization and characterization of the tumor in a noninvasive fashion. Exact histologic diagnosis of the two most common tumors, ependymoma and astrocytoma, remains elusive but there are some suggestive imaging characteristics. It is hoped that some of the newer MR imaging sequences will improve characterization of the tumor and thereby influence therapy. Several of these pulse sequences are already used routinely in brain imaging. Evaluation of new imaging sequences in the spine has lagged behind brain MR imaging, mainly due to technical factors. Work on animal spine models and extrapolation from brain imaging studies suggest that it is only a matter of time before some of these techniques become clinically relevant.

Spinal arachnoiditis mimicking a spinal cord tumor: A case report and review of the literature

We report on an unusual case of idiopathic arachnoiditis mimicking a spinal cord tumor in a 50-year-old man with progressive paraparesis. The medical imaging work-up showed an enlarged terminal cone with adjacent cysts. Although there was no enhancement of the terminal cone or the surrounding structures, the diagnosis of spinal cord tumor was maintained and surgery was carried out. Exploration of the cauda equina and the tissue surrounding the terminal cone did not reveal a tumor. The patient improved dramatically after surgery but the symptoms recurred 1 year later. We review arachnoiditis, its pathology, and its treatment with special attention drawn to the primary form of spinal arachnoiditis.

Intramedullary epidermoid cysts of the spinal cord

Epidermoid cysts are tumors familiar to neurosurgeons, but intramedullary epidermoid cysts are rare. The authors report the case of a 6-year-old girl presenting with progressive paraparesis. A midthoracic intramedullary mass was revealed on myelography and magnetic resonance (MR) imaging and confirmed as an intramedullary epidermoid cyst at surgery, at which time the cyst was removed. This is the fourth report documenting a purely intramedullary epidermoid cyst occurring in a child. The pathology and etiology, epidemiology, clinical features, radiology (including MR image characteristics), and surgical treatment of such rare intramedullary benign tumors are discussed. Magnetic resonance imaging reduces the delay in diagnosis of spinal cord tumors but should be guided by clinical judgment.

Cavernomas of the Spinal Cord: Report of Two Cases

Two cases of intramedullary cavernomas are presented. Both patients showed progressive neurological deficit. Cavernoma must be considered in the differential diagnosis of spinal cord tumors. (Neurosurgery 22:143-144, 1988)

Arachnoiditis presenting as a cervical cord neoplasm

Neurological evaluation supplemented by myelography has been highly successful in diagnosing spinal cord tumors. Our experience shows that a widening of the cord on myelography is not always diagnostic of spinal cord tumors. Two patients who presented clinically with evidence of spinal cord tumor and had a widening of the cord on myelography were found to have severe cervical arachnoiditis without any evidence of intrinsic cord abnormality. Hence, cervical arachnoiditis should be considered in the differential diagnosis of spinal cord tumor on myelography. (Neurosurgery 12:120-122, 1983)

Computed tomography in the diagnosis of spinal cord tumor (author's transl)

During the period from October, 1977 through September, 1979, 1 1 cases of the spinal cord tumors were studied by either an EMI whole Body Scanner, CT 5005 (slice thickness: 13 mm) or EMI Head Scanner, CT 1010 (slice thickness: 10 mm). In eight cases except for lipomas, enhancement with intravenous injection of contrast medium (150 ml of 65% angiografin) was performed. Five cases received an intrathecal injection of metrizamide (170-250mgI/ml, 7-10 ml). The diagnoses were neurinomas in four cases, lipomas in three cases, meningiomas in two cases and astrocytomas in two cases. Plain spinal CT is of diagnostic value in detecting bone changes and lipoma. Meningioma and neurinoma showed positive contrast enhancement and the extraspinal extension of the tumor is accurately outlined by spinal CT. CT metrizamide myelography visualizes the subarachnoid space and makes it possible to localize the tumor in the spinal canal in relation to the spinal cord. Localization of the tumor in axial plane is difficult and it is impossible to demonstrate the vascularity of the tumor and its relationship to the vessels.

Localization and diagnosis of spinal cord tumors.

Localization and diagnosis of spinal cord tumors.