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PubMed1992

Neoplasms and related disorders.

Spinal neoplasms may be primary or metastatic, benign or malignant. In adults, metastatic involvement of the spine will represent the most important neoplastic disease of this region. However, hemangiomas are the most common spinal neoplasms. The vast majority of intradural, extramedullary neoplasms that will be identified in the spine are meningiomas and neurofibromas. Both lesions may be sporadic or associated with phakomatoses. Intramedullary spinal cord and filum terminale tumors are relatively rare and are far less common than intramedullary brain tumors. As is the case in the brain, these are overwhelmingly glial neoplasms, with ependymomas and low-grade astrocytomas representing the majority of the lesions. Hemangioblastoma deserves mention because of its often characteristic imaging findings and its association with von Hippel-Lindau disease.

Humans↗
PubMed1990

Magnetic resonance imaging contrast agents: theory and application to the central nervous system.

The theoretical aspects of magnetic resonance (MR) imaging contrast agents are reviewed, and their current applications to the central nervous system (CNS) and their future applications are discussed. Profound differences exist between contrast agents used for MR imaging and computerized tomography (CT). In MR imaging, the contrast agents are not imaged directly but rather act on adjacent protons to shorten T1 and T2 relaxation times. This in turn results in signal intensity changes. The lanthanide metal, gadolinium, in the form of gadopentetate dimeglumine, has been found to be both safe and efficacious as the only currently approved contrast agent for MR imaging. Magnetic resonance imaging revolutionized the detection and treatment of disease affecting the brain and spine. Initially, it was thought that signal characteristics on MR imaging would allow differentiation of specific pathology. It was soon found that MR studies were able to detect more abnormalities but were less able to characterize them. The recent development of contrast agents for MR imaging has allowed this modality to surpass CT for the evaluation of most CNS lesions. At present, contrast-enhanced MR imaging is generally accepted as the study of choice for evaluating acoustic neurinomas, pituitary lesions, meningeal disease, primary and secondary brain tumors, active multiple sclerosis, intradural spinal neoplasms, intramedullary spinal disease, and postoperative states in both the spine and brain. Even when contrast-enhanced CT can detect the same abnormalities, evaluation of the lesions in multiple planes on MR imaging can sometimes yield invaluable information, especially prior to surgery. Future developments of contrast material for MR imaging include non-gadolinium compounds, intrathecal contrast media, cerebral blood flow and volume evaluation, and, possibly, antibody-labeled contrast agents.

Animals↗
PubMed1992

Spontaneous brain and spinal cord/nerve neoplasms in aged Sprague-Dawley rats.

Primary malignant neoplasms of the brain and spinal cord occurred in 20/718 male (2.8%) and in 13/717 female (1.8%) Crl:CD Br strain Sprague-Dawley rats. Of 33 neoplasms, 30 were found in brain while 3 were in the spinal cord. In males and females, the most common brain neoplasm was astrocytoma (13 males, 9 females). Other neoplasms, granular cell tumor (1 male), mixed glioma (2 males, 1 female), reticulosis (1 male, 2 females), and oligodendroglioma (2 males), were especially uncommon. Spinal cord neoplasms included 2 schwannomas (1 male, 1 female) and an astrocytoma (1 male). The overall brain neoplasm incidence was similar for males (2.8%) compared to data compiled for this strain, and there was a 2-fold increase for females (1.8% vs 0.9%) compared to available incidence data.

Aging↗
PubMed1992

Neoplasms of the spine.

Although the treatment of central nervous system neoplasms generally is unrewarding, some animals with spinal neoplasia may, for a variety of reasons, be successfully managed for extended periods of time. The veterinary profession has greater experience with spinal surgery than with intracranial surgery. As a result, surgeons are more willing to attempt and more successful at removing or debulking spinal neoplasms. Additionally, there are more affordable and accessible diagnostic procedures available to evaluate the spinal cord than there are to evaluate the brain. Finally, the majority of tumors that affect the spinal cord are extramedullary and are therefore amenable to attempts to remove them surgically.

Animals↗
PubMed1977

Computed tomography of intraspinal and paraspinal neoplasms.

Computed tomography (CT) has been used in the evaluation of 36 spinal neoplasms. Eleven of the 19 intraspinal and all of the 17 paraspinal tumors showed positive CT images. Computed tomography is of diagnostic value particularly in detecting calcified meningiomas, lipomas, and neurofibromas with bony changes. The size of the paraspinal tumors and the degree of bone destruction can be precisely demonstrated by CT.

Chordoma↗
PubMed1991

Neoplastic disease of the spine.

In summary, MR imaging has become the single most effective modality for the evaluation of spinal neoplasms by virtue of its ability to image the spinal cord directly and noninvasively. In this fashion, one can localize mass lesions relative to the spinal cord; in conjunction with the patient's clinical history, it is thus possible to provide a brief yet accurate differential diagnosis. Intravenous paramagnetic contrast enhancement also may prove extremely useful in further delineating such lesions. In addition, it has demonstrated a high sensitivity to primary and secondary tumors of the bony spine through its ability to detect subtle T1 signal changes in the vertebral marrow space.

Bone Cysts↗
PubMed1977

Treatment of experimental spinal cord compression caused by extradural neoplasms.

Epidural spinal cord compression was produced in rats by injection of Walker 256 carcinoma cell suspension anterior to the T-12 or T-13 vertebral body. The tumor grows through the intervertebral foramina to compress the spinal cord and produce paraplegia in 3 to 4 weeks. The effect of several treatments upon clinical signs was assessed. Dexamethasone caused a significant but transient improvement in neurological function. Radiation therapy likewise improved neurological function, and was more effective when given by a high-dose protracted course than when given either in a single dose or a low-dose protracted course. Laminectomy was not helpful in relieving neurological symptoms. Dimethyl sulfoxide did not relieve neurological symptoms. Cyclophosphamide was most effective in relieving neurological symptoms, and most of the animals that were treated with that drug when they were severely weak but still able to move their hind limbs recovered fully. Some animals that were totally paraplegic when treatment began recovered function after radiation therapy or cyclophosphamide treatment, but recovery was better if treatment was started when animals could still move their hind limbs. This animal model appears to be a useful way of studying the treatment of human spinal cord compression produced by epidural neoplasms.

Animals↗
PubMed1989

[Intradural spinal metastasis from visceral neoplasms. Apropos of 4 cases. Review of the literature].

Four patients were referred during the last year for treatment of an intradural metastasis. Primary sites were a bronchogenic carcinoma (one case), a prostatic carcinoma (one case) and in the two other cases the primary tumor was not found. In all cases Noot pain had lasted 1 to 5 months, despite CT examination during this painful period. Except in case n.4, diagnosis was not established until the onset of myelopathy. Surgical removal was complete in one case and subtotal in the three other cases, with complete postoperative relief of the pain in all cases and significative improvement of neurological status. The authors emphasize the importance of root pain as an early sign in these patients as well as the difficulty in establishing diagnosis. They discuss the different pathogenic mechanisms and the methods of treatment.

Aged↗
PubMed1992

Diagnostic role of gadolinium-DTPA in pediatric neuroradiology. A retrospective review of 655 cases.

We retrospectively reviewed the findings in 655 consecutive young patients who underwent contrast-enhanced MR examinations (1.5T) of the head or spine. Their ages ranged from 4 months to 20 years (mean 10 years). There was a 1.7% incidence of minor adverse reactions to gadolinium (Gd)-DTPA, none of which required treatment; no serious adverse reactions were encountered. Based on the radiologic diagnosis the patients were divided into three groups: (1) normal, (2) CNS neoplasm, (3) abnormal but not neoplasm. There were 178 patients thought to have CNS neoplasms and of these 156 (88%) enhanced. Of 124 histologically confirmed neoplasms 115 (93%) showed enhancement after Gd-DTPA. Eight children had histologically confirmed spinal neoplasms; 5 of 6 neurofibromas and 2 ependymomas enhanced. In the 216 patients with abnormalities thought not to be neoplastic, the enhancement rate was 11%; most of the enhancing lesions were vascular malformations. There were very few examples of inflammatory disease, acute trauma or stroke among our patients.

Adolescent↗
PubMed1987

Gliomas presenting outside the central nervous system.

Tumours outside the central nervous system rarely prove to be intracranial glioma metastases. The mechanism of glioma metastasis has been thought to be related to dissemination of tumour cells either at the time of surgery or later through the surgical defect. However, 8 cases have been recorded to date in which metastases have occurred in the absence of surgery. This report details the clinical findings in 2 such patients. One presented with a pharyngeal mass that was found to be a metastasis from an anatomically remote parietal lobe astrocytoma. The other patient presented with a C8 nerve root tumour which was external to the dura. Biopsy revealed an astrocytoma that had metastasized from the roof of the lateral ventricle. Possible mechanisms of pathogenesis are discussed, including that of neural spread.

Astrocytoma↗
PubMed1992

Role of MR imaging in the management of spinal infections.

Infection of the spine is a major category of spinal disease that is difficult to differentiate clinically from degenerative disease, noninfective inflammatory lesions, and spinal neoplasm. The infection can affect the vertebrae, intervertebral disks, paraspinal soft tissues, the epidural space, the meninges, and/or the spinal cord. Specific causative organisms include bacteria (pyogenic, granulomatous), fungi, parasites (Echinococcus, Schistosoma), and viruses. Early diagnosis and prompt treatment are essential to prevent permanent neurologic deficit and/or spinal deformity. Imaging plays an important role in the overall evaluation of these lesions, and the ideal technique is expected to provide information that will help characterize and delineate the disease process, guide biopsy and/or drainage procedures, suggest method of treatment (medical vs surgical), and assess response to therapy. The aim of this article is to review the advantages and limitations of MR imaging in the management of spinal infections.

Adult↗
PubMed1989

Magnetic resonance imaging of the spine.

Magnetic resonance (MR) imaging offers the advantages of multiplanar capabilities, physiologic as well as anatomic imaging, and some tissue specificity. Since mid-1985, we have performed more than 2,800 MR examinations of the spine, and gadolinium has been used as a contrast agent in many MR studies since its release by the Food and Drug Administration last year. Although MR imaging has been promoted as the procedure of choice for all clinical indications, on the basis of our experience myelography still plays an important role in the imaging of many spinal disorders, including disk disease. Some pathologic conditions such as intraspinal vascular malformations and leptomeningeal metastatic lesions are best imaged by myelography. MR studies have been most useful in evaluating intraspinal neoplasms, spinal cord parenchymal lesions, infections, congenital abnormalities, and "postoperative failed back syndromes."

Humans↗
PubMed1991

Echinococcal infestation of the spine in North America.

Taenia echinococcal infestation, a parasitic disease rarely seen in the United States, occurred in a 62-year-old man. Bone is involved in about 1% of all cases, and of these cases, the spine is involved in about 50%. Preoperative identification is difficult because of lack of characteristic radiographic features. Successful management is also problematic because of the difficulty of preoperative diagnosis, the invasive nature of the bony involvement, and the variable anaphylactic reaction to the cyst fluid antigen. The diagnosis must be entertained in the differential diagnosis of benign spinal neoplasms especially when dealing with patients from endemic areas.

Echinococcosis↗
PubMed1975

Generalized melanosis complicating disseminated malignant melanoma in pregnancy: a case report.

A case of generalized melanosis complicating disseminated malignant melanoma in pregnancy is described. Four features of this case, unique in combination, are discussed. First, generalized melanosis is a rare complication in macrophages of skin and other areas. Secondly, extensive bone lesions in the absence of roentgenographic changes are an uncommon occurrence. Thirdly, pregnancy probably has little effect on the course of melanoma, as illustrated by this case and a review of the literature. Finally, placental metastases may be more common than generally thought, yet may have little significance to the fetus.

Adult↗
PubMed1975

Incidence and sites of bone lesions detected by 99mTc-polyphosphate scans in patients with tumors.

The value of bone scanning with 99mTc-polyphosphate was assessed in 186 patients with various types of tumors. The sensitivity of this technique was greater than that of metastatic roentgenographic series and the reported results of 85-Sr-bone scans, in the detection of osseous involvement by tumors. Three cases with normal bone scans and abnormal roentgenographic studies illustrated the necessity and complementary value of comparing bone scan findings with radiographic studies. Patients with carcinoma of the breast, lung, or prostate displayed characteristic patterns of bone involvement by their tumors. The importance of clinical information, including bone symptoms, antecedent bone disease, and serum calcium and alkaline phosphatase, was stressed in the detection and interpretation of bone scan abnormalities.

Alkaline Phosphatase↗