Idiopathic Hypertrophic Spinal Pachymeningitis: Report of Two Cases with Typical MR Imaging Findings
S. Paia,
C.T. Welshb,
S. Patela and
Z. Rumboldtc
a Department of Neurosurgery, Medical University of South Carolina, Charleston, SC
b Department of Pathology, Medical University of South Carolina, Charleston, SC
c Department of Radiology, Medical University of South Carolina, Charleston, SC
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Fig 1. A, Sagittal fast spin-echo (FSE) T2-weighted image of the cervical and upper thoracic spine shows a mass of very low signal intensity (arrows) within the spinal canal located adjacent to the posterior aspect of the T1 through T6 vertebral bodies. High signal intensity is present centrally within the spinal cord, indicative of cord edema. There is also thickening and hypointensity of the dura posterior to the spinal cord (arrowheads).
B, Axial FSE T2-weighted image at T5 level shows a hypointense mass (arrow) in the anterior aspect of the spinal canal that appears to be arising from the dura. The lesion is displacing the spinal cord posteriorly and completely effacing the intradural subarachnoid spaces.
C, Axial postcontrast T1-weighted image at a level similar to that of B reveals thick enhancement of the anterior epidural mass with central nonenhancing area (arrowheads).
D, Photomicrograph shows fibrosis with plump reactive fibroblasts. Chronic inflammatory infiltrate is consisting chiefly of plasma cells (arrows) with additional lymphocytes (arrowheads) and scattered histiocytes (macrophages) (hematoxylin and eosin, original magnification 40x).
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Fig 2. A, Sagittal fast spin-echo (FSE) T2-weighted image shows a hypointense mass (arrowheads) in the anterior aspect of the spinal canal that extends from C3 to T1 level.
B, Corresponding sagittal postcontrast T1-weighted image with fat suppression reveals attenuated enhancement of the mass, which is predominantly peripheral with central nonenhancing portions (arrowheads).
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