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MRI of the cauda equina in CIDP: clinical correlations
G Midroni1, L N de Tilly, B Gray
1Department of Neurology, Neurophysiology - 9V, St. Michael's Hospital, 30 Bond Street, Toronto, Canada.
Abstract:
Isolated reports have documented enhancement and/or enlargement of spinal nerve roots on magnetic resonance imaging (MRI) in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). This work examines those findings in a consecutive series of 16 patients with CIDP, with blinded comparison to MRI in 13 disease controls, including five patients with Charcot-Marie-Tooth disease type 1A. MRI sequences consisted of T1 weighted sagittal and axial views, before and after administration of gadolinium. Blinded MRI interpretation was performed independently by two neuroradiologists. MRI results were correlated with data collected from chart review. Enhancement of the cauda equina was seen in 11 of 16 CIDP patients (69%), and in none of 13 control subjects. Nerve roots were enlarged, most significantly in the extraforaminal region, in three CIDP patients, and in one patient with Charcot-Marie-Tooth type 1A. MRI findings did not correlate with disease activity and severity, nor with any clinical or laboratory features in patients with CIDP.
Insights
Magnetic resonance imaging (MRI) shows cauda equina enhancement in most chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients, unlike controls. Enlarged nerve roots were also observed in some CIDP cases.
Area of Science:
- Neurology
- Radiology
- Neuroimmunology
Background:
- Isolated reports suggest spinal nerve root abnormalities on MRI in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).
- Previous findings require examination in a larger, consecutive patient series with blinded controls.
Purpose of the Study:
- To investigate the frequency and characteristics of spinal nerve root enhancement and enlargement on MRI in CIDP patients.
- To compare MRI findings in CIDP patients with those in disease controls, including Charcot-Marie-Tooth disease type 1A.
Main Methods:
- Consecutive series of 16 CIDP patients and 13 disease controls underwent MRI with T1-weighted sagittal and axial views, pre- and post-gadolinium.
- Two neuroradiologists independently performed blinded MRI interpretation.
- MRI results were correlated with clinical and laboratory data.
Main Results:
- Cauda equina enhancement was observed in 11 of 16 CIDP patients (69%) but in none of the 13 controls.
- Nerve root enlargement occurred in three CIDP patients and one patient with Charcot-Marie-Tooth disease type 1A.
- MRI findings did not correlate with disease activity, severity, or clinical/laboratory features.
Conclusions:
- Gadolinium-enhanced MRI reveals cauda equina abnormalities in a majority of CIDP patients.
- Spinal nerve root enlargement may occur in CIDP, though less frequently than enhancement.
- These MRI findings in CIDP do not appear to correlate with disease severity or activity.