Neurological improvement associated with resolution of irradiation-induced myelopathy: serial magnetic resonance imaging and positron emission tomography findings

• Published in: Journal of neuroimaging Vol. 19; no. 3; p. 274
• Main Authors: Uchida, Kenzo, Nakajima, Hideaki, Takamura, Takaharu, Kobayashi, Shigeru, Tsuchida, Tatsuro, Okazawa, Hidehiko, Baba, Hisatoshi
• Format: Journal Article
• Language: English
• Published: United States 01.07.2009
• Subjects: Brown-Sequard Syndrome - diagnostic imaging; Brown-Sequard Syndrome - drug therapy; Central Nervous System Agents - therapeutic use; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Middle Aged; Mouth Neoplasms - radiotherapy; Positron-Emission Tomography; Radiation Injuries - diagnostic imaging; Radiation Injuries - drug therapy; Radiotherapy - adverse effects; Recovery of Function; Spinal Cord - diagnostic imaging; Spinal Cord - pathology; Spinal Cord - physiopathology; Steroids - therapeutic use
• ISSN: 1552-6569
• DOI: 10.1111/j.1552-6569.2008.00284.x

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.