Neurological improvement associated with resolution of irradiation-induced myelopathy: serial magnetic resonance imaging and positron emission tomography findings.
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.
Uchida
Kenzo
K
Department of Orthopaedics and Rehabilitation Medicine, Fukui University Faculty of Medical Sciences, Shimoaizuki 23, Matsuoka, Fukui 910-1193, Japan. kuchida@u-fukui.ac.jp
Nakajima
Hideaki
H
Takamura
Takaharu
T
Kobayashi
Shigeru
S
Tsuchida
Tatsuro
T
Okazawa
Hidehiko
H
Baba
Hisatoshi
H
D018437:Brown-Sequard Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002491:Central Nervous System Agents / Q000627:therapeutic use*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000532:radiotherapy; D049268:Positron-Emission Tomography; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011878:Radiotherapy / Q000009:adverse effects*; D020127:Recovery of Function; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D013256:Steroids / Q000627:therapeutic use*
D002491:Central Nervous System Agents; D013256:Steroids; D019788:Fluorodeoxyglucose F18