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Citation:
Lodhi T, Sharma R, Lim L, Pancake sign. Reference article, Radiopaedia.org (Accessed on 17 May 2024) https://doi.org/10.53347/rID-172688
The pancake sign represents flat, tranverse gadolinium enhancement at the midpoint of a hyperintense, spindle-shaped T2 signal and is seen on sagittal and axial MR imaging 1. The axial corollary is formed by circumferential enhancement with sparing the spinal gray matter 2. Of note, the enhancement spans less than one vertebral body and is localised immediately below the point of maximal stenosis.
Although frequently described as a pattern seen in spondylotic myelopathy, the pancake sign may also be seen in pathologies involving focal disruption of the blood-brain barrier 2.
While clinical myelopathy may help to make the diagnosis of spondylotic myelopathy, spinal cord enhancement may be due to other aetiologies including 1,3,4 :
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1. Flanagan E, Krecke K, Marsh R, Giannini C, Keegan B, Weinshenker B. Specific Pattern of Gadolinium Enhancement in Spondylotic Myelopathy. Ann Neurol. 2014;76(1):54-65. doi:10.1002/ana.24184 - Pubmed
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2. Contarato G & Rosa Júnior M. Pancake-Like Gadolinium Enhancement in the Spinal Cord: An Image Pattern That Suggests Spondylotic Myelopathy. Arq Neuro-Psiquiatr. 2018;76(6):424-5. doi:10.1590/0004-282x20180042
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3. Pessini Ferreira L, Auger C, Kortazar Zubizarreta I et al. MRI Findings in Cervical Spondylotic Myelopathy with Gadolinium Enhancement: Review of Seven Cases. BJR|case Reports. 2021;7(2):20200133. doi:10.1259/bjrcr.20200133 - Pubmed
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4. Mohajeri Moghaddam S & Bhatt A. Location, Length, and Enhancement: Systematic Approach to Differentiating Intramedullary Spinal Cord Lesions. Insights Imaging. 2018;9(4):511-26. doi:10.1007/s13244-018-0608-3 - Pubmed
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