European Radiology

, Volume 13, Issue 7, pp 1709–1721 | Cite as

Lumbosacral epidural lipomatosis: MRI grading

  • Daniel G. Borré
  • Guillermo E. Borré
  • Flavio Aude
  • Gladys N. Palmieri
Musculoskeletal

Abstract.

Lumbosacral epidural lipomatosis (LEL) is characterized by excessive deposition of epidural fat (EF). The purpose of our retrospective study was to quantify normal and pathologic amounts of EF in order to develop a reproducible MRI grading of LEL. In this study of 2528 patients (1095 men and 1433 women; age range 18–84 years, mean age 47.3 years) we performed a retrospective analysis of MRI exams. We obtained four linear measurements at the axial plane parallel and tangent to the superior end plate of S1 vertebral body: antero-posterior diameter of dural sac (A-Pd DuS), A-Pd of EF, located ventrally and dorsally to the DuS, and A-Pd of the spinal canal (Spi C). We calculated (a) DuS/EF index and (b) EF/Spi C index. We developed the following MRI grading of LEL: normal, grade 0: DuS/EF index ≥1.5, EF/Spi C index ≤40%; LEL grade I: DuS/EF index 1.49–1, EF/Spi C index 41–50% (mild EF overgrowth); LEL grade II: DuS/EF index 0.99–0.34, EF/Spi C index 51–74% (moderate EF overgrowth); LEL grade III: DuS/EF index ≤0.33, EF/Spi C index ≥75% (severe EF overgrowth). The MRI exams were evaluated independently by three readers. Intra- and interobserver reliabilities were obtained by calculating Kappa statistics. The MRI grading showed the following distribution: grade 0, 2003 patients (79.2%); LEL grade I, 308 patients (12.2%); LEL grade II, 165 patients (6.5%); and LEL grade III, 52 patients (2.1%). The kappa coefficients for intra- and interobserver agreement in a four-grade classification system were substantial to excellent: intraobserver, kappa range 0.79 [95% confidence interval (CI), 0.65–0.93] to 0.82 (95% CI, 0.70–0.95); interobserver, kappa range 0.76 (95% CI, 0.62–0.91) to 0.85 (95% CI, 0.73–0.97). In LEL grade I, there were no symptomatic cases due to fat hypertrophy. LEL grade II was symptomatic in only 24 cases (14.5%). In LEL grade III, all cases were symptomatic. A subgroup of 22 patients (42.3%) showed other substantial spinal pathologies (e.g., disk herniation). By means of simple reproducible measurements and indexes MRI grading enables a distinction between mild, moderate, and severe EF hypertrophy. Kappa statistics indicate that LEL can be reliably classified into a four-grade system by experienced observers.

Keywords.

Lumbar spine Lumbosacral epidural lipomatosis MRI 

References

  1. 1.
    Roy-Camille R, Mazel C, Husson J, Saillant G (1991) Symptomatic spinal epidural lipomatosis induced by long-term steroid treatment. Spine 16:1365–1371Google Scholar
  2. 2.
    Koch C, Doppman J, Watson J, Patronas N, Neiman L (1999) Spinal epidural lipomatosis in a patient with the ectopic corticotropin syndrome. N Engl J Med 341:1399–1400Google Scholar
  3. 3.
    Gero B, Chynn K (1989) Symptomatic spinal epidural lipomatosis without exogenous steroid intake. Report of a case with MRI. Neuroradiology 31:190–192Google Scholar
  4. 4.
    Fessler R, Johnson D, Brown F, Erickson R, Reid S, Kranzler L (1992) Epidural lipomatosis in steroid-treated patients. Spine 17:183–188Google Scholar
  5. 5.
    Kumar K, Nath R, Tchng S (1996) Symptomatic epidural lipomatosis secondary to obesity. J Neurosurg 85:348–350Google Scholar
  6. 6.
    Frank E (1998) Endoscopic suction decompression of idiopathic epidural lipomatosis. Surg Neurol 50:333–335Google Scholar
  7. 7.
    Haddad S, Hitchon P, Godersky J (1991) Idiopathic and glucocorticoid-induced spinal epidural lipomatosis. J Neurosurg 74:38–42Google Scholar
  8. 8.
    Borstlap A, Van Rooij W, Sluzewski M, Leyten A, Beute G (1995) Reversibility of lumbar epidural lipomatosis in obese patients after weight-reduction diet. Neuroradiology 37:670–673Google Scholar
  9. 9.
    Sato M, Yamashita K, Aoki Y, Hiroshima K (1995) Idiopathic spinal epidural lipomatosis. Case report and review of the literature. Clin Orthop 320:129–134Google Scholar
  10. 10.
    Soloniuk D, Pecoraro S, Munschauer F (1989) Myelopathy secondary to spinal epidural lipomatosis. A case report. Spine 14:119–122Google Scholar
  11. 11.
    Evison G, Windsor P, Duck F (1979) Myelographic features of the normal sacral sac. Br J Radiol 52:777–779Google Scholar
  12. 12.
    Hierholzer J, Benndorf G, Lehmann T, Schneider G, Podrabsky P, Sander B et al. (1996) Epidural lipomatosis: case report and literature review. Neuroradiology 38:343–348Google Scholar
  13. 13.
    Levy-Weil FE, Feldmann JL (2000) Epidural lipomatosis. Presse Med 29:469–475Google Scholar
  14. 14.
    Schönstöm N, Bolender N, Spengler D (1985) The pathomorphology of spinal stenosis as seen on CT scans of the lumbar spine. Spine 10:806–811Google Scholar
  15. 15.
    Beaujeux R, Dietemann J, Allal R, Wolfram-Gabel R (1995) Posterior epidural adipose tissue and the narrow lumbar canal: replacement tissue or cause of impingement? J Neuroradiol 22:63–70Google Scholar
  16. 16.
    Kuhn M, Youssef H, Swan T, Swenson L (1994) Lumbar epidural lipomatosis: the "Y" sign of thecal sac compression. Comput Med Imaging Graph 18:367–372Google Scholar
  17. 17.
    Baron RB (1989) Nutritional disorder. In: Schroeder SA, Krupp MA, Tierney LM et al. (eds) Current medical diagnosis and treatment. Appleton and Lange, East Norwalk, Connecticut, pp 834–839Google Scholar
  18. 18.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174Google Scholar
  19. 19.
    Wolfram-Gabel R, Beaujeux R, Fabre M (1996) Histologic characteristics of posterior lumbar epidural fatty tissue. J Neuroradiol 23:19–25Google Scholar
  20. 20.
    Robertson S, Vincent C, Traynelis M, Follet K, Menezes A (1997) Idiopathic spinal epidural lipomatosis. Neurosurgery 41:68–75Google Scholar
  21. 21.
    Daniel M, Doyon D, Bekkali F, Delvalle A, Francke J (1992) MRI of normal spinal epidural fat. J Radiol 73:695–698Google Scholar
  22. 22.
    Grayling M, Jardine D, McClintock A, Spar J, Witton G (2000) Symptomatic epidural lipomatosis following cyproterone acetate. Aust NZ J Surg 70:233–235Google Scholar
  23. 23.
    Willén J, Danielson B, Gaulitz A, Niklason T, Schönström N, Hansson T (1997) Dynamic effects on the lumbar spinal canal. Spine 22:2968–2976Google Scholar
  24. 24.
    Sandberg D, Lavyne M (1999) Symptomatic spinal epidural lipomatosis after local epidural corticosteroid injections: case report. Neurosurgery 45:162–165Google Scholar
  25. 25.
    Papadopoulos S (1999) Comments (on Sandberg D et al. "Symptomatic spinal epidural lipomatosis after local epidural corticosteroid injections. Case report"). Neurosurgery 45:165Google Scholar
  26. 26.
    Qasho R, Ramundo O, Maraglino C, Lunardi P, Ricci G (1997) Epidural lipomatosis with lumbar radiculopathy in one obese patient. Case report and review of literature. Neurosurg Rev 20:206–209Google Scholar
  27. 27.
    Randall B, Muraki A, Osborn R, Brown F (1986) Epidural lipomatosis with lumbar radiculopathy: CT appearance. J Comput Assist Tomogr 10:1039–1041Google Scholar
  28. 28.
    Van Rooij W, Bortslap A, Canta L, Tijssen C (1994) Lumbar epidural lipomatosis causing neurogenic claudication in two obese patients. Clin Neurol Neurosurg 96:181–184Google Scholar
  29. 29.
    Dihlmann S, Mayer H (1995) Lumbar epidural lipomatosis. Z Rheumatol 54:417–423Google Scholar
  30. 30.
    Bednar D, Esses S, Kucharczyk W (1990) Symptomatic lumbar epidural lipomatosis in a normal male. A unique case report. Spine 15:52–53Google Scholar
  31. 31.
    Lipson S, Naheedy M, Kaplan M, Bienfang D (1980) Spinal stenosis caused by epidural lipomatosis in Cushing's syndrome. N Engl J Med 320:36Google Scholar
  32. 32.
    Pouchot J, Si-Hassen C, Damade R, Bayeux M, Mathieu A, Vinceneux P (1995) Cauda equina compression by epidural lipomatosis in obesity. Effectiveness of weight reduction. J Rheumatol 22:1771–1775Google Scholar
  33. 33.
    Archer C, Smith K (1982) Extradural lipomatosis simulating an acute herniated nucleus pulposus. J Neurosurg 57:559–562Google Scholar
  34. 34.
    McCullen G, Spurling G, Webster J (1999) Epidural lipomatosis complicating lumbar steroid injections. J Spinal Disord 12:526–529Google Scholar
  35. 35.
    Peeters F, Koster P (1991) Epidural lipomatosis simulating spinal canal stenosis or herniated nucleous pulposus. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 154:342–343Google Scholar
  36. 36.
    Pennisi A, Meisle W, Dina T (1985) Lymphomatous meningitis and steroid-induced epidural lipomatosis: CT evaluation. J Comput Assist Tomogr 9:595–598Google Scholar
  37. 37.
    Beges C, Rousselin B, Chevrot A, Godefroy D, Vallee C, Berenbaumn F et al. (1994) Epidural lipomatosis. Interest of MRI in weight-reduction treated case. Spine 15:251–254Google Scholar
  38. 38.
    Benamou PH, Hilliquin P, Chemla N, Chevrot A, Cormier C, Menkes C (1996) Epidural lipomatosis not induced by corticosteroid therapy. Three cases including one in a patient with primary Cushing's disease (review of the literature). Rev Rhum Engl Ed 63:207–212Google Scholar
  39. 39.
    Berenbaum F, Revel M, Deshays C, Rousselin B, Amor B (1992) Lumbar-radicular pain caused by epidural lipomatosis in an obese patient: recovery after hypocaloric diet. Rev Rhum Mal Ostéoartic 59:225–227Google Scholar
  40. 40.
    Blanckaert F, Cotten A, Maury F (1995) Epidural lipomatosis. Is it pathogenic? Comments on two case reports. Rachis 7:109–113Google Scholar
  41. 41.
    Flores A, Sonntag V, Dickman C (1995) Idiopathic spinal epidural lipomatosis: report of two cases and review of the literature. BNIQ 11:22–25Google Scholar
  42. 42.
    Kurt E, Bakker-Niezen SH (1995) Neurogenic claudication by epidural lipomatosis: a case report and review of the literature. Clin Neurol Neurosurg 97:354–357Google Scholar
  43. 43.
    Millwater C, Jacovson I, Howard G (1992) Idiopathic epidural lipomatosis as a cause of pain and neurological symptoms attributed initially to radiation damage. Clin Oncol (R Coll Radiol) 4:333–334Google Scholar
  44. 44.
    Romero C, Buzzi A, Lambre H, Martínez A, Meli F, Redondo W, Salas E (1997) Radicular compression caused by lumbosacral epidural lipomatosis. Rev Argent Radiol 61:173–180Google Scholar
  45. 45.
    Stambough J, Cheeks M, Keiper G (1989) Nonglucocortoid-induced lumbar epidural lipomatosis. A case report and review of literature. J Spinal Disord 2:201–207Google Scholar
  46. 46.
    Sundram S (1990) CT of epidural lipomatosis: a case report. Radiogr Today 56:26–28Google Scholar
  47. 47.
    Vázquez L, Ellis A, Saint-Genez D, Patino J, Nogués M (1988) Epidural lipomatosis after renal transplantation: complete recovery without surgery. Transplantation 46:773–774Google Scholar
  48. 48.
    Zampella E, Duvall E, Sekar B, Langford K, Epstein A, Kirklin J, Morawetz R (1987) Symptomatic spinal epidural lipomatosis as a complication of steroid immunosuppression in cardiac transplant patients. Report of two cases. J Neurosurg 67:760–766Google Scholar
  49. 49.
    Chapman P, Martuza R, Poletti C, Karchmer A (1981) Symptomatic spinal epidural lipomatosis associated with Cushing's syndrome. Neurosurgery 8:724–727Google Scholar
  50. 50.
    Zentner J, Buchbender K, Vahlensieck M (1995) Spinal epidural lipomatosis as a complication of prolonged corticosteroid therapy. J Neurosurg Sci 39:81–85Google Scholar
  51. 51.
    Quint D, Boulos R, Sanders W, Mehta B, Patel S, Tiel R (1988) Epidural lipomatosis. Radiology 169:485–490Google Scholar
  52. 52.
    Lemaire M, Maldague P, Noel P (1998) Corticosteroid-induced epidural lipomatosis. Efficacy of medical treatment. Ann Med Interne (Paris) 149:459–463Google Scholar
  53. 53.
    Badami J, Hinck V (1982) Symptomatic deposition of epidural fat in a morbidly obese woman. Am J Neuroradiol 3:664–665Google Scholar
  54. 54.
    Toshniwal P, Glick R (1987) Spinal epidural lipomatosis: report of a case secondary to hypothyroidism and review for the literature. J Neurol 234:172–176Google Scholar
  55. 55.
    Lisai P Coria C, Crissantu L, Meloni G, Conti M, Achene A (2001) Cauda equina syndrome secondary to idiopathic spinal epidural lipomatosis. Spine 26:307–309Google Scholar
  56. 56.
    Stern J, Quint D, Sweasey T, Hoff J (1994) Spinal epidural lipomatosis: two new idiopathic cases and a review of the literature. J Spinal Disord 7:343–349Google Scholar
  57. 57.
    McCormick P (1997) Comments (on Robertson S et al. "Idiopathic spinal epidural lipomatosis"). Neurosurgery 41:74Google Scholar
  58. 58.
    Cooper P (1997) Comments (on Robertson S et al. "Idiopathic spinal epidural lipomatosis"). Neurosurgery 41:74Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Daniel G. Borré
    • 1
    • 2
    • 3
  • Guillermo E. Borré
    • 1
    • 2
  • Flavio Aude
    • 2
  • Gladys N. Palmieri
    • 1
  1. 1.Department of MRI, RM-Hastings, Clínica Monte Grande, Monte Grande, Buenos Aires, ArgentinaArgentina
  2. 2.Department of MRI, Oncologic Center of Excellence, Gonnet, Buenos Aires, ArgentinaArgentina
  3. 3.Sociedad Argentina de Radiología, Arenales 1985 P.B., Ciudad Autónoma de Buenos Aires C1124AAC, ArgentinaArgentina

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