Spinal cord tumors: gadolinium-DTPA-enhanced MR imaging

Summary

To assess the utility of gadolinium-DTPA (Gd) and of MR imaging in the evaluation of spinal cord tumors, ten consecutive patients were prospectively evaluated. T1-proton density-, and T2-weighted images were obtained in sagittal or axial planes. T1-weighted images were obtained before and after intravenous administration. Five tumors were within the cervical spinal cord; 3 neoplasms were within the thoracic cord; 1 neoplasm extended from the cervical to the thoracic cord and 1 neoplasm extended from the cervical cord to the conus medullaris. Four tumors were ependymomas; 3 were astrocytomas; 1 was an hemangioblastoma, and 1 was a metastatic malignant peripheral nerve sheath tumor. The remaining patient died prior to spinal surgery and no autopsy was obtained. Of theprecontrast sequences, tumors were best evaluated using T1-weighted images. Abnormal findings included cord widening, presence of a tumor mass, intratumoral or other associated cyst(s), and hemorrhage. Nevertheless, T1-weighted images obtainedfollowing the administration of GD were superior relative to all other pre- and post-contrast sequences for defining tumor margins, characterizing cyst(s) and delineating tumor masses. Based primarily on their appearance on post-contrast T1-weighted images, tumor-associated cysts could be subcategorized into 3 types: intratumoral cysts (foundwithin the contrast-enhancing soft tissue mass); nonenhancing extratumoral cysts (found either rostral or caudal to the enhancing tumor mass); and enhancing extratumoral cysts (having an enhancing wall or containing an enhancing nodule). Our results indicate that T1-weighted MR images obtained both before and after administration of Gd are sufficient for characterizing the varying components of intramedullary spinal cord tumors. This information assists in treatment planning and follow-up of patients with these tumors.