Forty-eight
Gd-DTPA-enhanced MR examinations of the spine were performed in 40 patients referred for MR because of clinically suspected spinal
tumor or for further evaluation of an expanded cord. The study group consisted of 32 patients with spinal
tumors (seven
ependymomas; seven
astrocytomas; four
hemangioblastomas; two
arteriovenous malformations; two unidentified intramedullary
neoplasms; four
meningiomas; and single cases of metastatic
breast carcinoma,
cavernous hemangioma with associated
hematomyelia,
neurinoma,
angiolipoma, drop
metastasis from
medulloblastoma, and epidermoid with
diastematomyelia). In the remaining eight patients, other diagnoses were established: thoracic
disk herniation (two patients), lumbosacral
meningocele (one),
syringomyelia secondary to
arachnoiditis (four), and expanded cord secondary to gliotic tissue (one). All but two diagnoses were proved histologically by biopsy, surgery, or autopsy; in the two patients with
arteriovenous malformations, the definitive diagnosis was made by spinal angiography. Contrast enhancement occurred in 30 of the 32 spinal
tumors, and
Gd-DTPA-enhanced T1-weighted images proved helpful in defining and outlining intra- and extramedullary
spinal neoplasms. All
ependymomas and
astrocytomas (including low-grade
astrocytomas) enhanced. In
meningiomas, an immediate and uniform contrast uptake was demonstrated. Additional advantages of
Gd-DTPA MR include the differentiation of solid
tumor components vs syrinx or
cyst or pseudotumoral areas of cord expansion, and the differentiation of residual or recurrent
tumor from
scar tissue in postoperative patients. Our results suggest that IV-injected
Gd-DTPA improves MR sensitivity and specificity in the evaluation of spinal lesions.