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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 slightly improved diagnosis of spinal disc disease in new cases. Enhancement may indicate epidural fibrosis, aiding future degenerative disc disease research.
Area of Science:
- Radiology
- Neurosurgery
- Orthopedics
Background:
- Degenerative disc disease is a common cause of spinal pain.
- Accurate diagnosis is crucial for effective treatment planning.
- Gadolinium-DTPA enhanced MRI is a diagnostic tool used in spinal imaging.
Purpose of the Study:
- To evaluate the effectiveness of gadolinium-DTPA enhanced MRI in increasing the conspicuity of extradural degenerative disease in previously unoperated patients.
- To assess the diagnostic accuracy of enhanced MRI compared to surgical findings and pathological correlations.
Main Methods:
- Prospective study of 30 patients with symptoms suggestive of disc disease.
- Gadolinium-DTPA enhanced Magnetic Resonance Imaging (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 (in six patients).
- In one patient, enhancement led to a change in diagnosis from degenerative disc disease to tumor.
- 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 as a marker of epidural fibrosis and healing may be valuable for studying the natural history and pathophysiology of degenerative disc disease.