[A case of chronic progressive radiation myelopathy--a diagnostic significance of gadolinium-DTPA enhancement MRI]

Abstract

A 65-year-old man had a biopsy diagnosis of right cervical squamous cell carcinoma. Post operative irradiation (4000 rads) was given to the bilateral cervical areas. Twenty five months after completion of irradiation, the patient developed muscle weakness in the right upper and lower extremities, and sensory disturbance below the C2 level in the left side, which was considered as Brown-Séquard syndrome. MRI of T1 weighted images (T1W1) showed mild swelling of the spinal cord from C1 to C6, while T2 weighted images (T2W1) revealed high intensity area at the same level. Gadolinium (Gd)-DTPA injection revealed ring enhancement in the right side of the spinal cord from C1 to C2 on sagittal and axial images. The neurological symptoms improved after the administration of corticosteroid. Two weeks after the therapy, a follow-up study revealed disappearance of cervical cord swelling on T1W1 and high intensity area was remarkably diminished on T2W1. Gd-DTPA enhancement, however, showed unremarkable change. Gd-DTPA enhancement was suggested to be a sensitive and valuable diagnostic method of CPRM.