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Radiation Myelopathy
KEY FACTS
Terminology
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Chronic progressive radiation myelitis
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Delayed radiation myelopathy
Imaging
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Spindle-shaped cord swelling with irregular, focal rind of enhancement (early)
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Focal cord atrophy (late)
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Clinical signs may reflect longer segment of damage than demonstrated on MR
Top Differential Diagnoses
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Transverse myelitis
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Multiple sclerosis
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Spinal cord infarct
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Astrocytoma
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Syrinx
Pathology
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Demyelination, lipid-laden microphages, swollen astrocytes, endothelial damage, necrosis, local Ca++ deposition, hyalinosis of intramedullary vessel walls
Clinical Issues
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Onset of progressive numbness and weakness ± sphincter dysfunction 1 month → several years after fractionated radiotherapy
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Relentless progression without significant improvement in most cases
Diagnostic Checklist
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Late focal atrophy at sites of previous enhancement
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Fatty marrow replacement in treatment field provides clue to etiology
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Pathologic cord changes not always visible on MR
Sagittal T2WI MR in a patient following radiation therapy demonstrates abnormal intramedullary T2 hyperintensity
, appearing as bright as the surrounding CSF. High-signal intensity in the vertebral bodies
reflects fatty marrow replacement, characteristic of postradiation changes.
, appearing as bright as the surrounding CSF. High-signal intensity in the vertebral bodies reflects fatty marrow replacement, characteristic of postradiation changes.
Sagittal T1WI C+ MR confirms abnormal spinal cord parenchymal enhancement in the area of greatest radiation myelopathic injury
. The fatty replacement of the vertebral marrow is well seen
.
. The fatty replacement of the vertebral marrow is well seen .
Axial T2* GRE MR obtained within the area of greatest cord expansion and cord injury confirms that the majority of abnormal signal
resides within spinal cord central gray matter.
resides within spinal cord central gray matter.
Sagittal T1WI C+ MR of radiation myelopathy shows spindle-shaped enhancement
in thoracic cord. Fatty marrow replacement
is also conspicuous in this patient following previous radiation therapy for vertebral metastases. A compression fracture
is also seen.
in thoracic cord. Fatty marrow replacement is also conspicuous in this patient following previous radiation therapy for vertebral metastases. A compression fracture is also seen.
TERMINOLOGY
Abbreviations
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Chronic progressive radiation myelitis (CPRM)
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Delayed radiation myelopathy (DRM)
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Radiation necrosis (RN)
Definitions
-
Damage of neural tissue in spinal cord following therapeutic radiation of intrinsic or adjacent neoplastic disease
IMAGING
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