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FIG 2. Patient 2.
A, Midline sagittal T2-weighted image (4000/102eff /2) shows central T2 prolongation within the lower cervical spinal cord parenchyma (arrows).
B, Parasagittal T2-weighted image (4000/102eff /2) shows a large paracentral disk/osteophyte complex at the C3–C4 level (arrow).
C, Contrast-enhanced sagittal T1-weighted image (650/15/2) with fat saturation shows intense meningeal enhancement along the surface of the spinal cord. The patient was treated aggressively with broad-spectrum antibiotics and a decompressive laminectomy at C6 for a parasagittal epidural abscess (not shown).
D, Sagittal T1-weighted image (600/11/3) obtained 16 months later shows marked enlargement of the cervical spinal cord below the C3–C4 level. The parenchyma is hyperintense compared with CSF, and no evidence is detected of frank cavitation.
E, Sagittal T2-weighted image (4000/102/2) confirms the marked enlargement of the cervical cord below the C3–C4 level as well as extensive and confluent T2 prolongation within the central cord parenchyma. The cord surface is slightly irregular at C3–C4, suggesting possible adhesions.
F, Contrast-enhanced sagittal T1-weighted image (650/11/2) shows no abnormal enhancement of the cord parenchyma. Faint linear increased signal dorsal to the cord (arrows) likely represents residual thickening and fibrosis of the dura/epidural space related to the previous intense inflammatory episode.
G, Cervical CT myelogram was obtained several days later, via a lumbar approach. Axial image at the C7–T1 level shows normal-appearing spinal cord surrounded by dense intrathecal contrast.
H, Axial image from the CT myelogram at the C5–C6 level shows marked cord enlargement and minimal intrathecal contrast along the right lateral cord.
I, Axial image from the CT myelogram at the C3–C4 level shows a narrow spinal canal, a left lateral calcified disk/osteophyte complex, and a lack of contrast around the spinal cord.
J, Delayed CT scan obtained 6 hours after the initial study shows subtle increased density of the peripheral parenchyma at the C3–C4 level consistent with penetration of contrast medium. The central cord (arrow) stands out in subtle contrast to the more dense peripheral white matter.
K, Postoperative sagittal T2-weighted image (4000/102eff /2) obtained after C3 to C7 laminectomy, lysis of subdural adhesions, and sectioning of the dentate ligaments at C3 and C4 shows a marked decrease in cord caliber. Parenchymal T2 prolongation persists, as does irregularity consistent with persistent adhesions/obstruction at the C3–C4 level. Because the patient was symptomatically improved, it was elected to monitor her with serial imaging studies rather than to reoperate.
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