MRI findings in cervical spondylotic myelopathy with gadolinium enhancement: Review of seven cases

Abstract

Cervical spondylotic myelopathy (CSM) is a clinical syndrome secondary to a spinal cord compression due to cervical spondylosis. In some cases, conventional MRI typically shows an intramedullary hyperintense signal on T2W imaging and contrast enhancement on post-gadolinium T1W imaging. We report a series of seven patients with CSM who had typical clinical presentation and imaging findings on T2W and contrast-enhanced T1W sequences. The imaging findings included degenerative changes of the cervical spine, intramedullary T2-signal hyperintensity, and an intramedullary enhancement on post-gadolinium T1W images. Our results support the statement that the presence of an intramedullary gadolinium-enhancement with a flat transverse pancake-like pattern (on sagittal images) and a circumferential pattern (on axial images), located within a T2-signal abnormality, in patients with cervical spondylosis and clinical myelopathy is indicative of spondylosis as the cause of the myelopathy.

Cervical spondylotic myelopathy presenting as a “pancake enhancement” on MRI of the spinal cord: A case report and review of literature

“…Other causes of myelopathy were also investigated and ruled out. 4 Regarding imaging findings, pancake enhancement of the cervical spine was first reported in 2014 by Flanagan et al 1 , who reported a similar case of upper extremity weakness and paresthesias. Since then, it has been acknowledged as an important, albeit rare, finding of compressive spondylotic myelopathy.…”

“…Dynamic imaging studies might be one of the keys to showing the cause. Other causes of myelopathy were also investigated and ruled out 4 …”

The Natural History of Degenerative Cervical Myelopathy

“…All 3 patients had T2WI changes whereas only 2 had T1WI changes on initial evaluation and were followed up at different time intervals. Two exhibited slow progression of their clinical symptoms, but the other exhibited partial recovery of symptoms 29. Despite the study’s obvious limitations, it hints that the clinical course from conservative management of DCM may not be readily predicted from MRI changes.…”

“…Two exhibited slow progression of their clinical symptoms, but the other exhibited partial recovery of symptoms. 29 Despite the study's obvious limitations, it hints that the clinical course from conservative management of DCM may not be readily predicted from MRI changes. An example of patient deterioration during the course of nonoperative follow-up is seen in Figure 1.…”

An Innovative Approach Towards The Treatment of The Cervical Myelopathy: A Case Study

“…Extradural mass (tumours), post-traumatic deformities, infections (tuberculosis), posttraumatic kyphosis, vascular disorders (vascular malformations, spinal cord infarct and epidural hematoma), nutritional disorders etc. could be some possible causes [14].…”