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Gadolinium-DTPA in the evaluation of intradural extramedullary spinal disease
1Memorial Sloan-Kettering Cancer Center, Dept. of Medical Imaging, Ave., New York, NY 10021.
Abstract:
Gadolinium-DTPA was used in MR imaging of the spine to determine the ability of a contrast agent to increase the detection and characterization of disease in the intradural extramedullary space. Although MR imaging, especially with recent technological improvements, has been shown to be at least competitive with, and often superior to, myelography and postmyelography CT in the study of intramedullary and extradural disease, its use in the assessment of intradural extramedullary disease has been questioned. We selected 12 patients with intradural extramedullary disease as demonstrated by positive CSF cytology and/or myelographic findings and performed MR examinations on them before and after administering gadolinium-DTPA (0.1 mmol/kg). Gadolinium-DTPA was extremely effective in depicting intradural extramedullary disease of the spine. Small nodules of 3 mm, virtually invisible on noncontrast MR scans, enhanced strongly and were easily detected. In addition, leptomeningeal spread of tumor along nerve roots was also visualized, sometimes more readily than by myelography and postmyelography CT. The remarkable sensitivity of gadolinium-DTPA to intradural extramedullary disease assures its role in future MR examinations of the spine.
Insights
Gadolinium-DTPA contrast agent significantly improves detection of spinal intradural extramedullary disease on MRI scans. This enhancement aids in visualizing small lesions and tumor spread, improving diagnostic accuracy.
Area of Science:
- Neuroradiology
- Medical Imaging
Background:
- Magnetic Resonance (MR) imaging is a key modality for spinal disease assessment.
- Its efficacy in evaluating intradural extramedullary disease has been debated compared to myelography and CT.
- Gadolinium-DTPA is a contrast agent used to enhance MR imaging.
Purpose of the Study:
- To evaluate the effectiveness of Gadolinium-DTPA in improving the detection and characterization of spinal intradural extramedullary disease using MR imaging.
Main Methods:
- MR examinations were performed on 12 patients with confirmed intradural extramedullary disease.
- Scans were conducted both before and after administration of Gadolinium-DTPA (0.1 mmol/kg).
Main Results:
- Gadolinium-DTPA significantly enhanced visualization of intradural extramedullary disease.
- Small nodules (3 mm), undetectable on non-contrast scans, were clearly depicted.
- Leptomeningeal tumor spread along nerve roots was visualized, often better than with myelography/CT.
Conclusions:
- Gadolinium-DTPA is highly effective in diagnosing spinal intradural extramedullary disease via MR imaging.
- The contrast agent's sensitivity confirms its valuable role in future spinal MR examinations.