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Assessment of extradural degenerative disease with Gd-DTPA-enhanced MR imaging: correlation with surgical and
J S Ross1, M T Modic, T J Masaryk
1Department of Radiology, University Hospitals of Cleveland/Case Western Reserve University, OH 44106.
Abstract:
To test whether gadolinium-DTPA-enhanced MR would increase the conspicuity of extradural degenerative disease in the previously unoperated patient, we prospectively studied a group of 30 patients with symptoms suggestive of disk disease. Surgical findings and pathologic correlations were used as an objective measure of accuracy. Gadolinium-DTPA increased the confidence of diagnosis at one of eight operated cervical levels (six patients) and changed the diagnosis from extradural degenerative disease to tumor in one patient. The mechanism of enhancement of the epidural space and peridiskal region appears to be related to accumulation of contrast material within the epidural venous plexus, as well as to epidural fibrosis associated with disk disruption and herniation. While the immediate clinical utility of gadolinium-DTPA for morphologic analysis seems limited to difficult cervical spine cases, the presence of enhancement as a marker of epidural fibrosis and attempted healing may prove to be of great importance in studying the natural history and basic pathophysiology of degenerative disk disease.
Insights
Gadolinium-DTPA enhanced MRI showed limited diagnostic improvement for extradural degenerative disease in most patients. However, it may help identify epidural fibrosis and aid in difficult cervical spine cases.
Area of Science:
- Radiology
- Neurosurgery
- Orthopedics
Background:
- Extradural degenerative disease diagnosis can be challenging.
- Magnetic Resonance Imaging (MRI) is a key diagnostic tool.
- Gadolinium-DTPA contrast enhancement is used to improve MRI visualization.
Purpose of the Study:
- To evaluate if gadolinium-DTPA enhanced MRI improves the conspicuity of extradural degenerative disease in previously unoperated patients.
- To assess the diagnostic accuracy of gadolinium-DTPA enhanced MRI compared to surgical and pathological findings.
Main Methods:
- Prospective study of 30 patients with symptoms suggestive of disk disease.
- Gadolinium-DTPA enhanced MRI was performed.
- Surgical findings and pathological correlations served as the gold standard for accuracy assessment.
Main Results:
- Gadolinium-DTPA enhanced MRI increased diagnostic confidence at one of eight operated cervical levels (six patients).
- The contrast agent changed the diagnosis from degenerative disease to tumor in one patient.
- Enhancement mechanism involves contrast accumulation in the epidural venous plexus and epidural fibrosis.
Conclusions:
- Immediate clinical utility of gadolinium-DTPA for morphologic analysis is limited, primarily to complex cervical spine cases.
- Enhancement may serve as a marker for epidural fibrosis and healing.
- Further research on its role in understanding the natural history of degenerative disk disease is warranted.