Clinical significance of intramedullary Gd-DTPA enhancement in cervical myelopathy.
METHODS
Prospective multicenter study.


OBJECTIVE
To clarify the significance of intramedullary Gd-DTPA enhancement in cervical myelopathy, the prevalence, morphologic features, clinical relevance and postoperative change were investigated.


METHODS
Four hospitals in Japan.


METHODS
A total of 683 patients with cervical myelopathy who underwent decompressive surgery were consecutively examined. T1, 2 and Gd-DTPA-enhanced MRI were taken before surgery. Fifty consecutive cases without intramedullary enhancement were allocated in the non-enhancement group. The following variables were investigated: prevalence of the enhancement, the morphologic feature, the relationship between the enhancement and T2 high-intensity areas, the change of the Japanese Orthopedic Association (JOA) score for cervical myelopathy and the change of the enhancement after surgery.


RESULTS
Intramedullary enhancement was observed in 50 cases (7.3%). The enhancements were observed between the most severely compressed disc and the cranial half of the lower vertebral body. On axial images, they were observed at the posterior or posterolateral periphery of the spinal cord. Enhancement areas were observed within T2 high-intensity areas and smaller than them. The preoperative JOA score was 9.8+/-2.8 points in the enhancement group and 9.8+/-3.3 points in the non-enhancement group (NS). The postoperative JOA score was 12.7+/-2.9 points in the enhancement group and 14.2+/-2.4 in the non-enhancement group (P=0.006). Intramedullary enhancement disappeared in 60% of the patients 1 year after surgery.


CONCLUSIONS
Intramedullary enhancement indicated not the severity of preoperative symptoms, but a sign of a worse prognosis.
Ozawa
H
H
Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan. ozw@mail.tains.tohoku.ac.jp
Sato
T
T
Hyodo
H
H
Ishii
Y
Y
Morozumi
N
N
Koizumi
Y
Y
Matsumoto
F
F
Kasama
F
F
Aizawa
T
T
Itoi
E
E
Kokubun
S
S
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000473:pathology; D003287:Contrast Media; D018450:Disease Progression; D019786:Gadolinium DTPA; D006801:Humans; D007223:Infant; D007403:Intervertebral Disc / Q000473:pathology; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013115:Spinal Canal / Q000473:pathology; D013116:Spinal Cord / Q000473:pathology* / Q000503:physiopathology; D013117:Spinal Cord Compression / Q000473:pathology* / Q000503:physiopathology / Q000534:rehabilitation; D013119:Spinal Cord Injuries / Q000473:pathology* / Q000503:physiopathology / Q000534:rehabilitation; D055009:Spondylosis / Q000150:complications / Q000473:pathology* / Q000503:physiopathology
D003287:Contrast Media; D019786:Gadolinium DTPA