Korean J Radiol.  2011 Apr;12(2):241-246. 10.3348/kjr.2011.12.2.241.

Sequential Magnetic Resonance Imaging Finding of Intramedullary Spinal Cord Abscess including Diffusion Weighted Image: a Case Report

• Roh JE
• Lee SY
• Cha SH
• Cho BS
• Jeon MH
• Kang MH

• KMID: 1088570
• DOI: http://doi.org/10.3348/kjr.2011.12.2.241

Abstract

Intramedullary spinal cord abscess (ISCA) is a rare infection of the central nervous system. We describe the magnetic resonance imaging (MRI) findings, including the diffusion-weighted imaging (DWI) findings, of ISCA in a 78-year-old man. The initial conventional MRI of the thoracic spine demonstrated a subtle enhancing nodule accompanied by significant edema. On the follow-up MRI after seven days, the nodule appeared as a ring-enhancing nodule. The non-enhancing central portion of the nodule appeared hyperintense on DWI with a decreased apparent diffusion coefficient (ADC) value on the ADC map. We performed myelotomy and surgical drainage, and thick, yellowish pus was drained.

Keyword

Intramedullary spinal cord abscess; Magnetic resonance imaging; Diffusion-weighted imaging

MeSH Terms

Abscess/complications/*diagnosis/surgery
Aged
Anti-Bacterial Agents/therapeutic use
Diagnosis, Differential
Diffusion Magnetic Resonance Imaging
Drainage
Humans
Magnetic Resonance Imaging/*methods
Male
Paraplegia/etiology
Spinal Cord Diseases/complications/*diagnosis/surgery
Thoracic Vertebrae

Figure

• 

  Fig. 1 Intramedullary spinal cord abscess in 78-year-old man. A-C. Initial MRI of thoracic spine shows focal hyperintense nodular lesion involving gray matter at level of T9 (arrows) and diffuse intramedullary high signal intensity extending from T7 to T11 on sagittal (A) and axial (B) T2-weighted images. Axial fat-saturated T1-weighted image with gadolinium (C) at level of T9 shows focal spotty intramedullary enhancement (arrow in C). D-H. Follow-up MRI of thoracic spine that was performed 10 days after initial presentation shows more prominent focal hyperintense lesion at T9 level and increased extent of intramedullary hypersignal intensity, and this all suggested edema from T5 to T11 on sagittal (D) and axial (F) T2-weighted images. Fat-saturated sagittal T1-weighted image after gadolinium injection (E) shows intramedullary ring-enhancing lesion at T9 level. Precontrast (G) and postcontrast (H) axial T1-weighted MRI at T9 level show striking intramedullary enhancement. I. Sagittal diffusion-weighted imaging shows intramedullary hyperintensity at T9 level (arrow). J. Sagittal apparent diffusion coefficient map shows restricted apparent diffusion coefficient map at T9 level (arrow). K. Apparent diffusion coefficient map with region of interest shows each apparent diffusion coefficient value in abscess cavity, surrounding edema and normal spinal cord. Apparent diffusion coefficient within region of interest measured 0.610 × 10-3 mm2/s in abscess cavity (arrow), 1.306 × 10-3 mm2/s in surrounding edema (open arrow) and 1.112 × 10-3 mm2/s in normal-appearing spinal cord (not shown). L. Intraoperative photograph shows yellowish pus after myelotomy at T8-9 level. M-O. Follow-up MRI of thoracic spine performed two weeks after surgical treatment shows markedly improved intramedullary signal change and spinal cord swelling on sagittal (M) T2-weighted images and at-saturated postcontrast sagittal (N) and axial (O) T1-weighted images. But there was residual increased intramedullary signal intensity and contrast enhancement (arrows) at T9-10 level. Postoperative epidural fluid collection (open arrows) and ill-defined enhancement at posterior paraspinal area from T8 to T10 level were also noted.

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