MRI in chronic progressive radiation myelopathy.
OBJECTIVE
Our goal was to assess medullary lesions in patients suffering from chronic progressive radiation myelopathy (CPRM) using MRI.


METHODS
In a group of 10 patients suffering from CPRM, MRI findings (11 examinations), radiation protocols, and patient prognoses were reviewed.


RESULTS
A cord enlargement was demonstrated in five cases, whereas four cases presented with medullary atrophy. As demonstrated by MRI, radiation-induced medullary lesions progressed toward cord atrophy in one patient. When MRI and/or comparison myelogram were performed within 8 months following the onset of the myelopathy, a cord enlargement was usually encountered. When the patient was evaluated > 8 months after the first neurological symptoms, a cord atrophy was always demonstrated. Medullary lesions extended beyond the boundaries of the radiation field in 67% of the cases. However, with the exception of one case, the main focus of the cord damage was included within an irradiated cord segment. An enlarged cord was often associated with a neurologic deterioration and a fatal outcome. In patients with cord atrophy, the neurologic deficit was often static and survival rates were better.


CONCLUSIONS
These results suggest a revision of classic criteria used for the diagnosis of CPRM. By demonstrating cord lesions, MRI helps to establish disease prognosis.
Melki
P S
PS
Service de Radiologie, Hôpital Necker, Paris, France.
Halimi
P
P
Wibault
P
P
Masnou
P
P
Doyon
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000473:pathology*; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology; D013118:Spinal Cord Diseases / Q000473:pathology*