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Ying Y, Liu X, Li X, Mei N, Ruan Z, Lu Y, Yin B. Distinct MRI characteristics of spinal cord diffuse midline glioma, H3 K27-altered in comparison to spinal cord glioma without H3 K27-alteration and demyelination disorder. Acta Radiol 2024; 65:284-293. [PMID: 38115811 DOI: 10.1177/02841851231215803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND An applicable magnetic resonance imaging (MRI) biomarker for diffuse midline glioma (DMG), H3 K27-altered of the spinal cord is important for non-invasive diagnosis. PURPOSE To evaluate the efficacy of conventional MRI (cMRI) in distinguishing between DMGs, H3 K27-altered, gliomas without H3 K27-alteration, and demyelinating lesions in the spinal cord. MATERIAL AND METHODS Between January 2017 and February 2023, patients with pathology-confirmed spinal cord gliomas (including ependymomas) with definite H3 K27 status and demyelinating diseases diagnosed by recognized criteria were recruited as the training set for this retrospective study. Morphologic parameter assessment was performed by two neuroradiologists on T1-weighted, T2-weighted, and contrast-enhanced T1-weighted imaging. Variables with high inter- and intra-observer agreement were included in univariable correlation analysis and multivariable logistic regression. The performance of the final model was verified by internal and external testing sets. RESULTS The training cohort included 21 patients with DMGs (13 men; mean age = 34.57 ± 13.489 years), 21 with wild-type gliomas (10 men; mean age = 46.76 ± 17.017 years), and 20 with demyelinating diseases (5 men; mean age = 49.50 ± 18.872 years). A significant difference was observed in MRI features, including cyst(s), hemorrhage, pial thickening with enhancement, and the maximum anteroposterior diameter of the spinal cord. The prediction model, integrating age, age2, and morphological characteristics, demonstrated good performance in the internal and external testing cohort (accuracy: 0.810 and 0.800, specificity: 0.810 and 0.720, sensitivity: 0.872 and 0.849, respectively). CONCLUSION Based on cMRI, we developed a model with good performance for differentiating among DMGs, H3 K27-altered, wild-type glioma, and demyelinating lesions in the spinal cord.
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Affiliation(s)
- Yinwei Ying
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Xiujuan Liu
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Xuanxuan Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Nan Mei
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Zhuoying Ruan
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Yiping Lu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Bo Yin
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
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de Paiva JLR, Sabino JV, Pereira FV, Okuda PA, Villarinho LDL, Queiroz LDS, França MC, Reis F. The Role of MRI in the Diagnosis of Spinal Cord Tumors. Semin Ultrasound CT MR 2023; 44:436-451. [PMID: 37555685 DOI: 10.1053/j.sult.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Spinal cord tumors are uncommon, and its multiple representatives not always have pathognomonic characteristics, which poses a challenge for both patients and caring physicians. The radiologist performs an important role in recognizing these tumors, as well as in differentiating between neoplastic and non-neoplastic processes, supporting clinical and surgical decision-making in patients with spinal cord injury. Magnetic Resonance Imaging (MRI) assessment, paired with a deep understanding of the various patterns of cord involvement allied to detailed clinical data can provide a diagnosis or significantly limit the differential diagnosis in most cases. In this article, we aim to review the most common and noteworthy intramedullary and extramedullary spinal tumors, as well as some other tumoral mimics, with an emphasis on their MRI morphologic characteristics.
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Affiliation(s)
- Jean L R de Paiva
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - João V Sabino
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Fernanda V Pereira
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Paulo A Okuda
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | | | | | - Marcondes C França
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Fabiano Reis
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil.
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McCullagh K, Zamora C, Castillo M. Troublemaking Lesions: Spinal Tumor Mimics. Neuroimaging Clin N Am 2023; 33:423-441. [PMID: 37356860 DOI: 10.1016/j.nic.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
There are various mass-like lesions that can mimic true neoplasms in the spine, including inflammatory, infectious, vascular, congenital, and degenerative etiologies. While some lesions have distinctive imaging features that suggest a correct diagnosis, others have overlapping characteristics that do not allow their differentiation based solely on their imaging findings. For entities with nonspecific imaging features, knowledge of the clinical and laboratory information is critical to provide an accurate diagnosis.
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Affiliation(s)
- Kassie McCullagh
- Division of Neuroradiology, Department of Radiology, The University of North Carolina, CB 7510 2000 Old Clinic, 101 Manning Drive, Chapel Hill, NC 27599, USA.
| | - Carlos Zamora
- Division of Neuroradiology, Department of Radiology, The University of North Carolina, CB 7510 2000 Old Clinic, 101 Manning Drive, Chapel Hill, NC 27599, USA
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, The University of North Carolina, CB 7510 2000 Old Clinic, 101 Manning Drive, Chapel Hill, NC 27599, USA
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Martins ES, Duque C, Rebelo O, Batista S. Primary intramedullary spinal-cord lymphoma (PISCL): a rare entity with a challenging diagnosis. BMJ Case Rep 2021; 14:14/5/e242548. [PMID: 34011646 DOI: 10.1136/bcr-2021-242548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Primary intramedullary spinal-cord lymphoma (PISCL) is a rare cause of myelopathy and constitutes only 1% of central nervous system lymphomas. Delay to diagnosis is common due to its rarity, its similarity to other causes of myelopathy and the difficulties in obtaining pathological diagnosis. We report a case of PISCL and discuss the challenges faced on diagnosis, namely the impact of corticosteroids on histological findings, the usefulness of MRI, positron-emission tomography/CT (PET/CT) and repeated lumbar punctures.
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Affiliation(s)
| | - Cristina Duque
- Neurology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Coimbra, Portugal
| | - Olinda Rebelo
- Neurology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Coimbra, Portugal
| | - Sónia Batista
- Neurology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Coimbra, Portugal
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Abstract
Multiple diverse pathologies result in the clinical presentation of myelopathy. The preferred way to image the spinal cord depends on clinical history, anatomic site of interest, and patient issues limiting certain imaging modalities. This radiology-focused article discusses pertinent physiological considerations, reviews basic and newer imaging techniques, and examines several distinct disease entities in order to highlight the key role of imaging in the work-up of myelopathy.
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Affiliation(s)
- Alice C Shea
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Anderson H Kuo
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Liangge Hsu
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
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Paoletti M, Muzic SI, Marchetti F, Farina LM, Bastianello S, Pichiecchio A. Differential imaging of atypical demyelinating lesions of the central nervous system. Radiol Med 2021; 126:827-842. [PMID: 33486703 DOI: 10.1007/s11547-021-01334-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/11/2021] [Indexed: 01/04/2023]
Abstract
The detection of atypical and sometimes aggressive or tumefactive demyelinating lesions of the central nervous system often poses difficulties in the differential diagnosis. The clinical presentation is generally aspecific, related to the location and similar to a number of different lesions, including neoplasms and other intracranial lesions with mass effect. CSF analysis may also be inconclusive, especially for lesions presenting as a single mass at onset. As a consequence, a brain biopsy is frequently performed for characterization. Advanced MRI imaging plays an important role in directing the diagnosis, reducing the rate of unnecessary biopsies and allowing a prompt start of therapy that is often crucial, especially in the case of infratentorial lesions. In this review, the main pattern of presentation of atypical inflammatory demyelinating diseases is discussed, with particular attention on the differential diagnosis and how to adequately define the correct etiology.
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Affiliation(s)
- Matteo Paoletti
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, PV, Italy.
| | | | | | - Lisa Maria Farina
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, PV, Italy
| | - Stefano Bastianello
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, PV, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Anna Pichiecchio
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, PV, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Kandemirli SG, Reddy A, Hitchon P, Saini J, Bathla G. Intramedullary tumours and tumour mimics. Clin Radiol 2020; 75:876.e17-876.e32. [PMID: 32591229 DOI: 10.1016/j.crad.2020.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/07/2020] [Indexed: 01/12/2023]
Abstract
Spinal cord lesions are traditionally classified as either extradural or intradural extramedullary or of intramedullary origin. Intramedullary spinal cord tumours are histopathologically similar to cranial tumours with a diverse range of pathologies. Astrocytomas and ependymomas account for approximately 80% of all intramedullary tumours, with other primary and secondary lesions accounting for the remaining 20%. Magnetic resonance imaging is the preferred imaging modality for diagnosing and characterising spinal cord lesions; however, accurate characterisation of tumour histology can be challenging, and is further confounded by intramedullary non-neoplastic lesions, such as demyelinating vascular, inflammatory, infectious, or traumatic lesions. This review illustrates the spectrum of intramedullary tumours and tumour mimics with emphasis on the imaging findings.
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Affiliation(s)
- S G Kandemirli
- University of Iowa Hospital and Clinics, Department of Radiology, Iowa city, IOWA, USA.
| | - A Reddy
- University of Iowa Hospital and Clinics, Department of Radiology, Iowa city, IOWA, USA
| | - P Hitchon
- University of Iowa Hospital and Clinics, Department of Neurosurgery, Iowa city, IOWA, USA
| | - J Saini
- Neuroimaging and Interventional Radiology, National Institute for Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - G Bathla
- University of Iowa Hospital and Clinics, Department of Radiology, Iowa city, IOWA, USA
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