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Spinal Cord Compression by Tophaceous Gout with Fluorodeoxyglucose–Positron-Emission Tomographic/MR Fusion Imaging

T. Popovicha, J.S. Carpentera, A.T. Raia, L.V. Carsonb, H.J. Williamsc and G.D. Maranoa

a Department of Radiology, West Virginia University School of Medicine, Morgantown, WV
b Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV
c Department of Pathology, West Virginia University School of Medicine, Morgantown, WV


Figure 1
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  		Fig 1. AP thoracic spine radiograph, demonstrating loss of left pedicles at multiple levels (arrows).


Figure 2
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  		Fig 2. A, T2-weighted sagittal image (TR/TE, 4550/110) shows predominantly hypointense mass lesions replacing the posterior elements of T4 through T7. B, T1-weighted sagittal image (516/12) demonstrates hypointensity of the same lesions. C, T1-weighted fat saturation images with gadolinium (816/12) with avid enhancement of the lesions.


Figure 3
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  		Fig 3. A, T1-weighted axial image (TR/TE, 617/10); B, T1-weighted axial image with 20 mL gadolinium (550/12) and C, T2-weighted axial image (6350/80) demonstrate extradural lesions with mass effect on the thecal sac resulting in spinal stenosis.


Figure 4
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  		Fig 4. T1-weighted fat-saturated postcontrast images with positron-emission tomographic fusion (TR/TE, 816/12 with 20 mL gadolinium, 17 mCi F-18 FDG) demonstrate extensive hypermetabolic activity localized to the posterior elements and paraspinal soft tissues, corresponding with CT and MR mass lesions.


Figure 5
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  		Fig 5. CT-guided percutaneous biopsy (124/552; 5.0-mm collimation, 512 x 512, 140 KV). A, Expansile lytic bone lesion with a soft tissue mass replacing the pedicles, lamina, and transverse processes of T6. B, Placement of the biopsy needle (Cook M-1 13 gauge; Cook, Bloomington, Ind) into the mass.


Figure 6
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  		Fig 6. Pathology (A) central fragment of eroded bone surrounded by gouty tophi which are rimmed by multinucleated giant cells and fibrous tissue (hematoxylin-eosin x10). B, Needle-shaped crystals exhibiting strong negative birefringence (bright yellow when aligned parallel with the compensating filter) characteristic of monosodium urate crystals (gout; polarized light, x50).





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X