Gadolinium leakage into the surgical bed mimicking residual enhancement following spinal cord surgery. Case report.
Intramedullary spinal cord surgery can disrupt the blood-spinal cord barrier and cause intravascular contents to leak into the surgical cavity. Immediate postoperative Gd-enhanced magnetic resonance (MR) imaging can demonstrate leakage of contrast into the surgical bed and complicate the assessment of whether a residual enhancing tumor is present. The authors report a case in which the preoperative lesion was nonenhancing and not expected to enhance on postoperative imaging. A Gd-enhanced MR imaging study obtained less than 24 hours after surgery revealed that the intramedullary surgical cavity was filled with contrast material. Because of the time course and the lesion's preoperative appearance, this "enhancement" was known to be caused by the leakage of medium into the resection cavity rather than of pathological soft-tissue enhancement.
Walker
Matthew
M
Department of Radiology, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA. mwalker@radiology.northwestern.edu
Khawar
Saquib
S
Shaibani
Ali
A
Reddy
Sireen
S
Ganju
Aruna
A
Gupta
Manu
M
D003560:Cysts / Q000601:surgery; D019299:Decompression, Surgical / Q000009:adverse effects*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism*; D005682:Gadolinium / Q000493:pharmacokinetics*; D006801:Humans; D007049:Iatrogenic Disease; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata; D008875:Middle Aged; D013116:Spinal Cord / Q000378:metabolism* / Q000601:surgery*; D013118:Spinal Cord Diseases / Q000601:surgery
D005682:Gadolinium