Neurological Improvement Associated with Resolution of Irradiation-Induced Myelopathy: Serial Magnetic Resonance Imaging and Positron Emission Tomography Findings

Authors: Uchida, Kenzo; Nakajima, Hideaki; Takamura, Takaharu; Kobayashi, Shigeru; Tsuchida, Tatsuro; Okazawa, Hidehiko; Baba, Hisatoshi

Source: Journal of Neuroimaging, Volume 19, Number 3, July 2009 , pp. 274-276(3)

Publisher: Wiley-Blackwell

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Abstract:

We document serial magnetic resonance imaging (MRI) and [¹⁸F] 2-fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET) findings in the process of improvement from delayed radiation necrosis of the spinal cord. A 61-year-old woman underwent radiotherapy for an oral carcinoma. Forty-six months later she developed a left-sided Brown-Séquard syndrome, suggesting incomplete cervical cord transection below the cervico-thoracic junction. Two months after starting steroid therapy, she had gradual clinical improvement, which continues 8 years after the termination of radiotherapy. Neurological improvement was associated with gradual resolution of an extensive high-intensity area within the cervico-thoracic spinal cord on MRI. Initially, the FDG-PET showed linear and uniform increase in FDG uptake throughout the cervical spinal cord with standardized uptake value of 2.68 ± 0.16 (mean ± SD), but it returned to normal value (1.90 ± 0.14) at final follow-up. Considering that the normalization of FDG uptake correlated with neurological recovery, the uniform- and diffuse-increased FDG uptake noted in the initial course of myelopathy could reflect the metabolic activity of the compromised spinal cord.

J Neuroimaging 2009;19:274-276.

Keywords: Radiation myelopathy; spinal cord; magnetic resonance imaging; fluoro-deoxyglucose-positron emission tomography

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1552-6569.2008.00284.x

Affiliations: 1: From the Department of Orthopaedics and Rehabilitation Medicine (KU, HN, TT, SK, HB); Radiology (TT); and Biomedical Imaging Research Center, Fukui University Faculty of Medical Sciences, Shimoaizuki 23, Matsuoka, Fukui 910-1193, Japan (HO).[Correction added after online publication 10-June-2009: Received and revised dates have been corrected.]

Publication date: 2009-07-01

Neurological Improvement Associated with Resolution of Irradiation-Induced Myelopathy: Serial Magnetic Resonance Imaging and Positron Emission Tomography Findings

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