Radiation myelitis

Case contributed by Dr Pankaj Saini

Presentation

Follow up case of breast carcinoma, with vertebral metastasis at D10 level who received high-dose of radiation therapy. Presented with complaints of pain in dorsal spine and inability to walk. Neurological examination revealed spastic paraparesis (grade: 4/5), sensory deficit below the D10 level.

Patient Data

Age: 32
Gender: Female
CT

Radiation myelitis: CT imaging

CT scan imaging shows hyperdense D10 vertebra with focal small hypodensity seen. D8, D9, D11 and D12 vertebrae show reduced attenuation. 

MRI

Radiation myelitis: MRI imaging

Vertebral bodies show hyperintense signal on T1 weighted images and intermediate signal intensity on T2 weighted fat saturation images, with D8 vertebral body showing intermediate signal on T1 and suppression of signal on T2 weighted fat saturation images.

Spinal cord shows intramedullary hyperintense signal on T2 weighted images, which is localized in the radiation field.

Case Discussion

Demyelination results from damage to white matter, which is an unavoidable incident due to the varied sensitivity of myelin and surrounding soft tissue.

It is reported that the dorsal segment of spinal cord can tolerate 200cGy per day up to 5000 cGy radiation.

This condition is very well demonstrated on MRI evaluation.

Authors:

  • Dr. Fazal T. Syed (MD Radiodiagnosis, consultant medical imaging - Artemis health institute)
  • Dr. Saini Pankaj (MD Radiodiagnosis, consultant medical imaging - Artemis health institute)
  • Dr. Mehta Sanjay (MD Radiodiagnosis, head of the department, medical imaging - Artemis health institute)
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Case information

rID: 35311
Case created: 31st Mar 2015
Last edited: 24th Apr 2017
Inclusion in quiz mode: Included

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