Neurological improvement associated with resolution of irradiation-induced myelopathy: serial magnetic resonance imaging and positron emission tomography findings.

Abstract

We document serial magnetic resonance imaging (MRI) and [(18)F] 2-fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET) findings in the process of improvement from delayed radiation necrosis of the spinal cord. A 61-year-old woman underwent radiotherapy for an oral carcinoma. Forty-six months later she developed a left-sided Brown-Séquard syndrome, suggesting incomplete cervical cord transection below the cervico-thoracic junction. Two months after starting steroid therapy, she had gradual clinical improvement, which continues 8 years after the termination of radiotherapy. Neurological improvement was associated with gradual resolution of an extensive high-intensity area within the cervico-thoracic spinal cord on MRI. Initially, the FDG-PET showed linear and uniform increase in FDG uptake throughout the cervical spinal cord with standardized uptake value of 2.68 +/- 0.16 (mean +/- SD), but it returned to normal value (1.90 +/- 0.14) at final follow-up. Considering that the normalization of FDG uptake correlated with neurological recovery, the uniform- and diffuse-increased FDG uptake noted in the initial course of myelopathy could reflect the metabolic activity of the compromised spinal cord.

• Authors: Kenzo Uchida, Hideaki Nakajima, Takaharu Takamura, Shigeru Kobayashi, Tatsuro Tsuchida, Hidehiko Okazawa, Hisatoshi Baba
• Journal: Journal of neuroimaging : official journal of the American Society of Neuroimaging (J Neuroimaging) Vol. 19 Issue 3 Pg. 274-6 (Jul 2009) ISSN: 1552-6569 [Electronic] United States
• PMID: 18681929 (Publication Type: Case Reports, Journal Article)

Chemical References

• Central Nervous System Agents
• Steroids
• Fluorodeoxyglucose F18

Topics

• Brown-Sequard Syndrome (diagnostic imaging, drug therapy)
• Central Nervous System Agents (therapeutic use)
• Female
• Fluorodeoxyglucose F18
• Follow-Up Studies
• Humans
• Magnetic Resonance Imaging
• Middle Aged
• Mouth Neoplasms (radiotherapy)
• Positron-Emission Tomography
• Radiation Injuries (diagnostic imaging, drug therapy)
• Radiotherapy (adverse effects)
• Recovery of Function
• Spinal Cord (diagnostic imaging, pathology, physiopathology)
• Steroids (therapeutic use)