MRI: Cord Compression

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MRI: Cord Compression

  1. 1. Presented by DR.ISHWARYA ANNAMALAI, M.D INTERNAL MEDICINE, I YEAR, PROF. DR.GOWRI SHANKAR UNIT.
  2. 2. CASE SUMMARY <ul><li>60 year old female patient rahamed beevi came wit the chief presenting complaints of </li></ul><ul><li>numbness both lower limbs-6 weeks, </li></ul><ul><li>weakness of both lower limbs-4 weeks, </li></ul><ul><li>urinary incontinence-2 weeks </li></ul><ul><li>Numbness-progressed from toes upto undersurface of breast.(all modalities of sensation lost). </li></ul><ul><li>2 weeks later patient developed weakness both lower limbs with difficulty in walking. </li></ul>
  3. 3. <ul><li>CNS examination in brief : </li></ul><ul><li>Higher functions are normal. </li></ul><ul><li>Cranial nerves function – intact </li></ul><ul><li>Sensory-pain,temperature-lost below T6 level, </li></ul><ul><li>vibration sense & joint position sense </li></ul><ul><li>impaired below T6 </li></ul><ul><li>Motor-both lower limbs hypertonic, </li></ul><ul><li>reflexes exaggerated, </li></ul><ul><li>b/l plantar extensor+ </li></ul><ul><li>Cerebellar functions-normal. </li></ul>
  4. 4. <ul><li>Imaging studies done for the patient : </li></ul><ul><li>CONTRAST MRI of dorsal spine </li></ul><ul><li>CT spine. </li></ul>
  5. 5. <ul><li>CONTRAST MRI OF DORSAL SPINE </li></ul><ul><li>SAGGITAL AND CORONAL VIEW </li></ul>
  6. 6. <ul><li>CORONAL AND AXIAL VIEWS </li></ul>
  7. 9. <ul><li>Contrast MRI of dorsal spine shows: </li></ul><ul><li>T1 hyperintense area with hypointensities and T2 hyperintensity noted in D4,D5 vertebral bodies. </li></ul><ul><li>The lesion has both extradural and intradural extra medullary components causing cord compression. </li></ul><ul><li>The axial view shows widening of neural foramina On the rt side. </li></ul><ul><li>Multiple vertebral bodies show T2 hyperintense lesions. </li></ul>
  8. 10. <ul><li>DIFFERENTIAL DIAGNOSIS </li></ul><ul><li>1. AGGRESSIVE HEMANGIOMA </li></ul><ul><li>2.Plasmacytoma </li></ul><ul><li>3.Aneurysmal bone cyst </li></ul><ul><li>4.Non hodgkin lymphoma </li></ul><ul><li>RARE POSSIBILITIES : </li></ul><ul><li>1.Neurofibroma </li></ul><ul><li>2.Meningioma </li></ul><ul><li>3.Schwannoma </li></ul>
  9. 11. <ul><li>4.Osteosarcoma(telangiectatic) </li></ul><ul><li>5.Osteoblastoma </li></ul><ul><li>6.Malignant peripheral nerve sheath tumor </li></ul><ul><li>7.angiolipoma </li></ul><ul><li>8.melanoma </li></ul><ul><li>9.rhabdomyo sarcoma </li></ul><ul><li>10.chondrosarcoma </li></ul>
  10. 12. AGGRESSIVE HEMANGIOMA
  11. 13. PLASMACYTOMA <ul><li>Features in favour: </li></ul><ul><li>site-vertebral body most common site </li></ul><ul><li>age-common after 55 yrs of age </li></ul><ul><li>similar MRI findings. </li></ul><ul><li>Features against this diagnosis: </li></ul><ul><li>More common in males. </li></ul><ul><li>More commonly involves posterior element of vertebral body </li></ul><ul><li>No involvement of contiguous vertebral body. </li></ul><ul><li>Vertebral body collapse common. </li></ul>
  12. 14. ANEURYSMAL BONE CYST <ul><li>Features in favour: </li></ul><ul><li>Site-spine frequently involved. </li></ul><ul><li>Lumbosacral>thoracic>cervical </li></ul><ul><li>Arises in neural arch </li></ul><ul><li>75 %-90% extend into vertebral body. </li></ul><ul><li>Features against this diagnosis: </li></ul><ul><li>Age-common in first 2 decades. </li></ul><ul><li>Occasionally T1w shows lobulated neural arch mass. </li></ul>
  13. 15. DIAGNOSTIC IMAGING METHOD IN AGGRESSIVE HEMANGIOMA <ul><li>AXIAL BONE ALGORITHM CT </li></ul><ul><li>Hypodense well circumscribed with coarse vertical trabeculae-white polka dots </li></ul><ul><li>CONCLUSION: </li></ul><ul><li>Clinical features and imaging features favour the diagnosis of aggressive hemangioma </li></ul><ul><li>. </li></ul>
  14. 16. THANK YOU

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