MRI of spinal cord radiation necrosis simulating recurrent cervical cord astrocytoma and syringomyelia.
BACKGROUND
Although primary intramedullary tumors of the spinal cord with syrinx formation are well documented, there have been no reports of extensive syrinx formation or cystic degeneration associated with radiation necrosis.


METHODS
We report a case of radiation necrosis and syrinx formation in a 49-year-old woman with a 5-year history of astrocytoma grade II of the cervical cord, who progressed to quadriparesis following surgery and radiation therapy. Magnetic resonance imaging (MRI) of the cervical and thoracic spine demonstrated enlargement of upper cervical cord (C1-C6) with diffuse increased signal enhancing mass by gadolinium, as well as appearance of syrinx from T4-T10.


RESULTS
Autopsy findings indeed revealed a small, residual, infiltrating glioma in the upper cervical areas, but the diffuse parenchymal abnormality seen on MRI as prolonged T2 characteristics on double-echo spin-echo sequence was revealed to be radiation necrosis.


CONCLUSIONS
What appeared to be a cystic cavity or syrinx at the thoracic level was also diagnosed as radiation necrosis with cyst formation on histologic examination.
Phuphanich
S
S
Neuro-Oncology Program, H. Lee Moffitt Cancer Center, University of South Florida College of Medicine, Tampa, USA.
Jacobs
M
M
Murtagh
F R
FR
Gonzalvo
A
A
D000328:Adult; D001254:Astrocytoma / Q000175:diagnosis / Q000532:radiotherapy*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011832:Radiation Injuries / Q000175:diagnosis* / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects*; D013116:Spinal Cord / Q000473:pathology / Q000528:radiation effects*; D013120:Spinal Cord Neoplasms / Q000175:diagnosis / Q000532:radiotherapy*; D013595:Syringomyelia / Q000175:diagnosis* / Q000209:etiology