Spinal cord MRI using multi‐array coils and fast spin echo
Desmond P. KiddJ. W. ThorpeAlan J. ThompsonB. E. KendallI. F. MoseleyDavid MacManusW. I. McDonaldD. H. Miller
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We performed MRI of brain and spinal cord on 80 patients with multiple sclerosis (MS). Using multi-array coils and fast spin echo, 139 intrinsic lesions were identified in 59 patients (74%). Lesions were more common in the cervical than in the thoracic cord. Cross-sectional areas of the cord, measured from axial images at four levels, showed atrophy in 40%. Clinical disability correlated with cord atrophy but not with cord lesion load. These results show that the use of multi-array coils and fast spin echo allows rapid and sensitive detection of spinal cord lesions in MS and that the cord is involved in the majority of patients. A lack of association between cord lesions and disability may relate to limitations in MR resolution but also suggests that the mechanisms of disability in MS are complex and multifactorial.Amyotrophy
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Spinal cord lipid content was analyzed in 50 pigs that had experienced a simulated dive known to produce 20-80% incidence of neurologic decompression sickness (DCS). Using air and heliox as breathing mixtures, these animals underwent chamber dives ranging from 200-250 feet of seawater (fsw). These dives were designed to generate spinal cord DCS, which was detected by observing the animals for gross neurologic deficits. Using a standardized method, cylindrical samples of cord were cut from different spinal levels and analyzed for total lipid (TL) content, which produced two cervical, three thoracic, and two lumbar samples. All areas with gross hemorrhage were also sampled. The range of TL (mean) in milligrams per gram from the cervical, thoracic, and lumbar regions were 118-679 (319), 140-635 (366), and 109-658 (307), respectively. Although this implies that TL varies markedly between cords, values within each cord were fairly consistent (+/- 20% from cord mean). The difference in TL values between cord regions with and without hemorrhage was not significant (P > 0.1). This reveals that increased spinal cord TL levels, together with their presumed dissolved inert gas, do not play a major role in the location or incidence of spinal cord hemorrhages in pigs with clinical signs of spinal cord DCS.
Lumbar Spinal Cord
Spinal decompression
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We performed MRI of brain and spinal cord on 80 patients with multiple sclerosis (MS). Using multi-array coils and fast spin echo, 139 intrinsic lesions were identified in 59 patients (74%). Lesions were more common in the cervical than in the thoracic cord. Cross-sectional areas of the cord, measured from axial images at four levels, showed atrophy in 40%. Clinical disability correlated with cord atrophy but not with cord lesion load. These results show that the use of multi-array coils and fast spin echo allows rapid and sensitive detection of spinal cord lesions in MS and that the cord is involved in the majority of patients. A lack of association between cord lesions and disability may relate to limitations in MR resolution but also suggests that the mechanisms of disability in MS are complex and multifactorial.
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Pulsatile motion of the spinal cord was examined with phase imaging techniques. Sagittal images of the spinal cord were obtained at different times of the cardiac cycle in healthy volunteers, as well as in patients in whom the spinal cord either was tethered, was compressed, or contained an intramedullary lesion. Pulsatile velocity changes of the spinal cord, observed on the phase images, were most marked at the cervical-upper thoracic level. Cord motion was found to be significantly decreased in cases in which the cord was either tethered or compressed. Cord enlargement due to an intramedullary lesion generally did not lead to decreased cord motion. Imaging of pulsatile cord motion may be clinically useful in evaluating diseases restricting cord motion or changing the status of parenchymal compliance.
Pulsatile flow
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The root attachment lengths were consistently greater in the cranial cervical (C3), midthoracic (T7), caudal lumbar (L5) and cranial sacral (S1) cord segment levels than the corresponding caudal cervical, caudal thoracic, cranial lumbar and caudal sacral levels respectively. As to the root emergence length the greatest values were obtained bilaterally at C3, T1, L4 and S1 cord segment levels respectively. The interroot intervals were maximum at C3, T13, L1 and S1 cord levels in the respective regions. The longest cord segments were located at C2, T13, L3 and S1 levels; the shortest were at C8, T1, L6, and S4 cord levels. The greatest diameter and cross-sectional area were confined to the last cervical, first 2 thoracic, last lumbar and first sacral cord segment levels. The spinal cord segments C2, T13, L4 and S1 were most voluminous in the respective regions. The topography of cord segments and the level of termination of the spinal cord have been studied and recorded.
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Secondary tethering of the spinal cord in people with myelomeningocele (MMC) is almost universal but there is a relatively low incidence of the secondary tethered cord syndrome (S‐TCS). In view of this, we wish to explore the notion that cord pulsation, as demonstrated by ultrasound of the spinal cord, can become an independent measure for increased tension of the spinal cord in patients with MMC. One‐hundred and six patients with MMC underwent ultrasonographic examination of their back, a thorough physical examination, and a careful review of their clinical history. Of these patients, 53 had MRI of their back. Cord pulsation was graded and the statistical relation between pulsation and various clinical and MRI findings was analysed. Age and arm span were not correlated with grades of cord pulsation. The absence of cord pulsation correlated with the presence of symptoms but this relation may be explained by MRI findings of certain structural cord malformations and not by tethering per se. Assuming that cord pulsation is a reliable marker for the tension within the spinal cord, the results of our study suggest that overstretching of the cord is not the main cause for the development of the S‐TCS.
Cord blood
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We report a case of HTLV-I associated myelopathy (HAM) with a spinal cord MRI showing abnormal multifocal and patchy lesions. A 50-year-old woman suffering from progressive paraparesis was admitted to our hospital. HTLV-I antibodies in the serum and CSF were positive, and a diagnosis of HAM was made. Her T2 weighted spinal cord MRI showed scattered areas of high signal intensity from the cervical to the thoracic cord. The lesions were enhanced with gadolinium-DTPA on T1 weighted imaging. Atrophy of the thoracic cord has been reported in many patients with HAM. In rare cases, T2 weighed thoracic cord MRI showed diffuse high signal intensity. The pattern of high signal intensity in our case, however, was multifocal and patchy, thus differing from the findings of previous reports. And we believe this is the first such report. This case suggests that the MRI of HAM patient may show multifocal and scattered lesions in the spinal cord.
Spinal Cord Diseases
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The authors report their findings by electron microscopy after microsurgical subpial spinal cord transection in dogs. After cord transection, conspicuous myelin microcysts are formed in a background of otherwise intact cord tisue at a distance of 1 to 2 mm from the cut end of the cord, both proximal and distal to the transection, Seen through the electron microscope, the microcysts iss a myelin sac distended by fluid under pressure, containing a swollen axon filled with excessive axoplasmic organelles; that is, a terminal club. Later the microcysts and terminal clubs rupture. The large spaces within the microcysts are opened to heretofore small extracellular spaces and the spinal cord tissues are destroyed. Thus, microcysts are precursors of large cavitites seen at the ends of transcreted cord stumps. The formation of microcysts and their subsequent rupture, which leads to cord cavitation, is interpreted as an inherent response of cord tissue to injury, and the result of an abortive attempt at cord regeneration.
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Summary The anatomy of the spinal cord segments was studied and recorded for the impala. The root attachment lengths were greatest at C 3 , T 10 and L 3 cord segment levels in the respective regions. As to the root emergence length the greatest lengths were observed at C7, T ]0> L5 and S 1 cord segment levels respectively. The interroot interval was longest at C 2 , T 8 and L 1 segments respectively. The longest cord segments were C2, T13, L 2 and S 2 segments. The widest cord segments of their respective regions were C 7 , T 1 , L5 and S 1 cord segments. As to segment volume C3, T 13 , L 2 and S 1 were the most voluminous cord segments in the respective cord regions. Statistical analysis revealed a high correlation among all of the study parameters suggesting a high degree of multicolinearity. Gross anatomical relationships concerning the location of the spinal cord segments with respect to the vertebrae were studied. The cord segments C], T s –T 4 and Li–L 3 were within their vertebral limits. In the impala the spinal cord terminated at the midlevel of S 4 vertebra.
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