Increased MR signal intensity secondary to chronic cervical cord compression

Takahashi, Masaji; Sakamoto, Yasuo; Miyawaki, Masayuki; Bussaka, H.

doi:10.1007/bf00350439

Cited by 134 publications

(65 citation statements)

References 10 publications

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“…However, contrast enhancement of the spinal cord occurs even more rarely in patients with chronic degenerative processes of the spinal cord [3,4,18]. To our knowledge, Takahashi et al [17] were first to describe MR outcomes of intramedullary Gd-DTPA enhancement in patients with cervical myelopathy. There are few reports of the prognostic value of enhancement MRI with respect to clinical outcomes in patients with cervical myelopathy [11].…”

Section: Discussionmentioning

confidence: 99%

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The relevance of intramedullary high signal intensity and gadolinium (Gd-DTPA) enhancement to the clinical outcome in cervical compressive myelopathy

Cho

Shin

et al. 2011

Eur Spine J

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Purpose We prospectively investigated whether high intramedullary SI and contrast [gadolinium-diethylenetriamine-pentaacetic acid (Gd-DTPA)] enhancement in magnetic resonance imaging (MRI) are associated with postoperative prognosis in cervical compressive myelopathy (CCM) patients. Methods Seventy-four patients with ventral cord compression at one or two levels underwent anterior cervical discectomy and fusion (ACDF) for CCM between March 2006 and June 2009. The mean follow-up period was 39.7 months (range, 12.7-55.7 months). The cervical cord compression ratio and clinical outcomes were measured using Japanese Orthopedic Association (JOA) scores for cervical myelopathy. Patients were classified into three groups based on the SI change in T2WI, T1-weighted images (T1WI), and contrast (Gd-DTPA) enhancement. Results The mean preoperative and postoperative JOA scores were 10.5 ± 2.9 and 15.0 ± 2.1 (P \ 0.05), respectively. The mean recovery ratio of the JOA score was 70.9 ± 20.2%. There were statistically significant differences in postoperative JOA and recovery ratio among three groups. However, post-surgical neurological outcomes were not associated with age, symptom duration, preoperative JOA, and cord compression. Conclusions We found that intramedullary SI change is a poor prognostic factor and the intramedullary contrast (Gd-DTPA) enhancement on preoperative MRI should be viewed as the worst predictor of surgical outcomes in cervical myelopathy. Contrast (Gd-DTPA) enhancement and postoperative MRI are useful for identifying the prognosis of patients with poor neurological recovery.

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Section: Discussionmentioning

confidence: 99%

“…Several studies have reported that patients with increased SI in T2WI tend to have poorer prognoses after surgery [8,9,13,17]; however, other studies have reported no such association [22]. Several studies have reported contrast (Gd-DTPA) enhancement in MR images in patients with cervical myelopathy [3,11].…”

Section: Introductionmentioning

confidence: 99%

The relevance of intramedullary high signal intensity and gadolinium (Gd-DTPA) enhancement to the clinical outcome in cervical compressive myelopathy

Cho

Shin

et al. 2011

Eur Spine J

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“…A localized area of high signal intensity seen within the spinal cord on T2-weighted or proton density spin-echo (SE) images in cases of compression of the spinal canal and cord is described. 35 In a brain study on proton density, the edema is bright. 36 The bone marrow categories with edema and osteonecrosis do not include high signal but low signal intensity on proton density-weighted images ( Table 7).…”

Section: Inclusion Criteria For Joints Without Osteoarthritismentioning

confidence: 99%

MR Evidence of Characteristics in Symptomatic Osteoarthritis of the Temporomandibular Joint: Increased Signal Intensity Ratio on Proton Density-Weighted Images of Bone Marrow in the Mandibular Condyle

Yajima¹,

Sano²,

Otonari-Yamamoto³

et al. 2007

CRANIO®

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The purpose of this study was to clarify the presence of pain and a correlation between pain and characteristics of signal intensity of mandibular bone marrow in temporomandibular joints (TMJ) with osteoarthritis (OA). A total of 196 joints in 98 patients with TMJ disorders were examined using magnetic resonance imaging (MRI). A pain score and signal intensity on mandibular bone marrow were analyzed in the TMJ with OA. TMJ with OA showed a higher degree of pain compared to those without (p<0.05). During opening, the joints in the higher signal intensity group showed a significantly higher degree of pain compared to the joints in the lower signal intensity group in those with OA on proton density weighted images (p<0.05). It was concluded that TMJ with osteoarthritis is related to pain and that a symptomatic osteoarthritic TMJ can accompany bone marrow changes in the condyle, showing an increased signal on proton density weighted images.

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“…Takahashi et al [7] were first to describe the MRI findings of intramedullary high signal intensity in cervical spondylosis myelopathy. They considered intramedullary high signal intensity to be an indicator of poor prognosis, as they speculated that this change reflected myelomalacia or cord gliosis secondary to longstanding compression of the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

Do intramedullary spinal cord changes in signal intensity on MRI affect surgical opportunity and approach for cervical myelopathy due to ossification of the posterior longitudinal ligament?

et al. 2011

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Some controversy still exists over the optimal treatment time and the surgical approach for cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL). The aim of the current study was first to analyze the effect of intramedullary spinal cord changes in signal intensity (hyperintensity on T2-weighted imaging and hypointensity on T1-weighted imaging) on magnetic resonance imaging (MRI) on surgical opportunity and approach for cervical myelopathy due to OPLL. This was a prospective randomized controlled study. Fifty-six patients with cervical myelopathy due to OPLL were enrolled and assigned to either group A (receiving anterior decompression and fusion, n = 27) or group P (receiving posterior laminectomy, n = 29). All the patients were followed up for an average 20.3 months (12-34 months). The clinical outcomes were assessed by the average operative time, blood loss, Japanese Orthopedic Association (JOA) score, improvement rate (IR) and complication. To determine the relevant statistics, we made two factorial designs and regrouped the data of all patients to group H (with hyperintensity on MRI, n = 31), group L (with hypointensity on MRI, n = 19) and group N (no signal on MRI, n = 25), and then to further six subgroups as well: AH (with hyperintensity on MRI from group A, n = 15), PH (with hyperintensity on MRI from group P, n = 16), AL (with hypointensity on MRI from group A, n = 10), PL (with hypointensity on MRI from group P, n = 9), AN (no signal intensity on MRI from group A, n = 12) and PN (no signal intensity on MRI from group P, n = 13). Both hyperintensity on T2-weighted imaging and hypointensity on T1-weighted imaging had a close relationship with the JOA score and IR. The pre-and postoperative JOA score and postoperative IR of either group H or group L was significantly lower than that of group N (P \ 0.05), regardless of whether the patients had received anterior or posterior surgery. On the other hand, both the JOA score and IR of subgroup AH were higher than those of subgroup PH at 1 week, 6 and 12 months postoperatively (P \ 0.05), as well as between subgroup AL and PL; but in group N, there was no difference between the subgroup AN and PN (P [ 0.05). In conclusion, regardless of hyperintensity on T2-weighted imaging or hypointensity on T1-weighted imaging in patients with OPLL, severe damage to the spinal cord is indicated. Surgical treatment should be provided before the advent of intramedullary spinal cord changes in signal intensity on MRI. The anterior approach is more effective than posterior approach for treating cervical myelopathy due to OPLL characterized by intramedullary spinal cord changes in signal intensity on MRI.

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Increased MR signal intensity secondary to chronic cervical cord compression

Cited by 134 publications

References 10 publications

The relevance of intramedullary high signal intensity and gadolinium (Gd-DTPA) enhancement to the clinical outcome in cervical compressive myelopathy

The relevance of intramedullary high signal intensity and gadolinium (Gd-DTPA) enhancement to the clinical outcome in cervical compressive myelopathy

MR Evidence of Characteristics in Symptomatic Osteoarthritis of the Temporomandibular Joint: Increased Signal Intensity Ratio on Proton Density-Weighted Images of Bone Marrow in the Mandibular Condyle

Do intramedullary spinal cord changes in signal intensity on MRI affect surgical opportunity and approach for cervical myelopathy due to ossification of the posterior longitudinal ligament?

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