Spinal Cord Schistosomiasis: MR Imaging Appearance with Surgical and Pathologic Correlation
Sahar Saleema,
Adel I. Belala and
Nasser M. El-Ghandourb
a Department of Radiodiagnosis, Faculty of Medicine, Cairo University, Cairo, Egypt
b Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
View larger version (102K):
[in a new window]
|
FIG 1. Localization of spinal cord schistosomiasis. MR imaging of dorso-lumbar spine of case 3.
A, Sagittal T1-weighted SE (TR/TE 530/20 ms) image shows moderate expansion of the distal cord and conus medullaris (arrow). The lesion is isointense to the cord.
B, Sagittal T2-weighted SE (TR/TE 5800/95 ms) image. The lesion has heterogeneous hyperintense signal intensity (arrow).
C, Coronal T1-weighted SE MR images (TR/TE 520/20 ms) shows the expanded distal cord and conus medullaris (arrow).
D, Postcontrast coronal image, in which the lesion is well delineated by contrast enhancement (arrow). Note the associated linear enhancement of cauda equina nerve roots (arrowhead).
| |
View larger version (84K):
[in a new window]
|
FIG 2. Diffuse nodular enhancement form in spinal cord schistosomiasis.
A, Postcontrast sagittal T1-weighted SE MR image (TR/TE 520/20 ms) of case 5, showing multiple small intramedullary enhancing nodules diffusely involving the distal thoracic cord and conus medullaris (arrows).
B, High-power photomicrograph stained with H & E (x250) of the patient, showing multiple granulomas. Schistosoma ova are seen in the midst of the granulomas surrounded by chronic inflammatory cells (arrows). Arrowheads point to the lateral spines, characteristic of S mansoni ova. The surrounding neural tissues are edematous and infiltrated by chronic inflammatory cells.
| |
View larger version (98K):
[in a new window]
|
FIG 3. Masslike nodular enhancement form in spinal cord schistosomiasis. MR imaging of dorso-lumbar spine of case 6.
A, Sagittal T1-weighted SE (TR/TE: 530/20 ms) image showing mild expansion of the distal cord and conus medullaris by a poorly defined iso- to hypointense lesion (arrow).
B, Sagittal T2-weighted SE (TR/TE 5800/95 ms) image showing a hypointense lesion (arrow) surrounded by extensive perilesional hyperintense edema (arrowheads).
C, Postcontrast sagittal T1-weighted SE MR images (TR/TE: 520/20 ms). The lesion shows a solitary enhancing nodule (arrow).
D, Postcontrast axial image (TR/TE: 520/20 ms) documenting the intramedullary location of the enhancing spinal lesion (arrow).
| |
View larger version (62K):
[in a new window]
|
FIG 4. Peripheral enhancement form of spinal cord schistosomiasis. MR imaging of dorso-lumbar spine and histopathologic slide of case 2.
A, Postcontrast sagittal image (TR/TE 520/20 ms) shows peripheral and intramedullary enhancing lesions on the anterior surface of the distal spinal cord (arrow).
B, Postcontrast axial image (TR/TE 520/20 ms), clearly showing the peripheral (meningeal) enhancement on the anterior surface of the cord (arrow).
C, Postcontrast axial image, which is inferior to that shown in B, shows a small peripheral enhancing lesion on the anterior cord surface (arrow) in association with an underlying intramedullary cord enhancement (arrowhead).
D, High-power photomicrograph stained with H & E (x250) showing infiltration of the resected neural tissues by chronic inflammatory cells (arrow) surrounding multiple schistosoma ova. One of the ova shows the terminal spine characteristic of S hematobium (arrowhead).
| |
View larger version (111K):
[in a new window]
|
FIG 5. Radicular enhancement form in spinal cord schistosomiasis. Postcontrast T1-weighted images (TR/TE 520/20 ms) of case 1.
A, Sagittal image shows linear enhancement of cauda equina nerve roots (arrow). Note the associated diffuse nodular intramedullary and peripheral enhancement of the distal cord and conus medullaris (arrowhead).
B, Axial image documenting the thickened enhancing cauda equina nerves (arrow).
| |
