Clinical experience with gadolinium contrast agents in spinal MR imaging

Gadolinium contrast agents represent one of the most important advances in MR imaging of spinal disease. Many abnormalities that affect the epidural, intradural extramedullary, and intramedullary compartments demonstrate contrast enhancement, the pattern of which often provides specific diagnostic information. This is particularly true of neoplastic diseases such as primary glioma and leptomeningeal tumor spread. Gadolinium contrast also finds vital application in differentiating herniated disc from epidural fibrosis in the failed-back surgery syndrome, as well as hypointense disc from enhancing tumor in select cases. Certain demyelinating and inflammatory processes also have predictable MR manifestations that facilitate accurate diagnosis.