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Pantopaque mimicking spinal lipoma: MR pitfall.
J Suojanen1, A M Wang, K R Winston
1Department of Radiology, Harvard Medical School, Boston, MA.
Journal of Computer Assisted Tomography
|March 1, 1988
Summary
A spinal MRI initially suggested a lipoma, but CT revealed a misdiagnosed intrathecal contrast collection. This collection was successfully removed, correcting the initial misinterpretation of spinal imaging findings.
Area of Science:
- Neuroradiology
- Spinal Imaging
- Diagnostic Radiology
Background:
- Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) are crucial for diagnosing spinal pathologies.
- Differentiating between extradural and intradural lesions is critical for appropriate patient management.
- Iophendylate (Pantopaque) was historically used as a contrast agent for myelography.
Observation:
- A patient presented with an intraspinal lesion in the lumbosacral region showing high signal intensity on T1-weighted MRI.
- T2-weighted MRI demonstrated a signal void, initially interpreted as an extradural spinal lipoma.
- CT imaging revealed an intrathecal collection of iophendylate (Pantopaque).
Findings:
- The initial MRI findings were misleading, mimicking an extradural spinal lipoma.
- CT successfully identified an intrathecal collection of iophendylate (Pantopaque).
- The apparent dural separation on T2-weighted MRI was attributed to artifact (chemical shift, CSF motion).
Implications:
- This case highlights the importance of multi-modal imaging in spinal diagnosis.
- Artifacts in MRI can lead to misinterpretation, necessitating correlation with other imaging modalities.
- Accurate identification of intrathecal contrast collections is vital for guiding treatment and preventing misdiagnosis.