Development of intraspinal ectopic endometrial tissue in connection with tethered cord syndrome.

We herein report a rare case of intraspinal ectopic endometrial tissue associated with tethered cord syndrome. The patient underwent MR imaging of the lumbar spine and CT spinal angiography. Asymptomatic dysraphism was also detected, including spinal bifida, low-lying conus medullaris, spinal meningocele and a lumbosacral lipoma. Venous reflux obstruction was also suggested. The patient underwent L2-S1 laminectomy and microdecompression of the lesion. The histological and immunohistochemical features were characteristic of ectopic endometrial tissue. Since the surgery, no neurological signs have been noted, either during or outside the patient's menstrual periods. The two-month follow-up MRI scans showed a regression of the lesion.

Clinical application and diagnostic value of noninvasive spinal angiography in spinal vascular malformations.

OBJECTIVE: The purpose of this study was to explore the value of computed tomographic (CT) spinal angiography with 256-slice CT and fast dynamic contrast-enhanced 3-dimensional magnetic resonance angiography (MRA) at 3.0 T in the diagnosis of spinal vascular malformations. METHODS: Seventeen patients who presented with suspected spinal vascular diseases by initial magnetic resonance and clinical findings all underwent CT spinal angiography. Among these, 10 patients underwent MRA, 15 patients underwent digital subtraction angiography (DSA) within 3 to 5 days, and 8 patients finally underwent surgical treatment. RESULTS: Computed tomographic angiography examination clearly showed the abnormal vascular lesions in 16 of the 17 patients, including 7 patients with the diagnosis of spinal dural arteriovenous fistula, 7 patients with perimedullary arteriovenous fistula, and 2 patients with spinal arteriovenous malformations. The results were consistent with the diagnosis of DSA or surgery. One patient was poorly diagnosed. The fistulas could be seen in 12 patients; feeding arteries were correctly displayed in 12 patients. The fistulas and feeding arteries were accurately shown in 7 of 10 patients by MRA; DSA results were also negative in the other 3 patients. CONCLUSIONS: Spinal angiography with 256-slice CT and contrast-enhanced MRA at 3.0 T can clearly show the extent of spinal vascular malformations, feeding arteries, and fistulas. They are safe, noninvasive, as well as rapid and can shorten the time of DSA diagnosis and treatment.

Correlation study of 3T-MR-DTI measurements and clinical symptoms of cervical spondylotic myelopathy.

OBJECTIVE: To discuss the correlation between diffusion tensor imaging (DTI) measurements, diffusion tensor tractography and the clinical symptoms of cervical spondylotic myelopathy. METHODS: Based on the Japanese Orthopedics Association (JOA) score, 104 cervical spondylotic myelopathy cases were first divided into four groups: mild, moderate, severe and serious groups. According to lesion signal characteristics, all cases were again divided into three groups: A(N/N): normal signal in both T1WI and T2WI; B (N/H): normal signal in T1WI but high signal in T2WI; and C (L/H): low signal in T1WI and high signal in T2WI. The apparent diffusion coefficient (ADC), fractional anisotropy (FA), λ1, λ2, and λ3 were measured and diffusion tensor tractography was performed in the seriously compressed section of the spinal cord. RESULTS: The FA values were positively correlated with JOA scores (r=0.883, P<0.05), and significantly different among four JOA groups (P<0.05). The ADC, λ2, and λ3 were significantly different among the moderate, severe and serious groups as well as among the A, B, and C groups (P<0.05). Declining FA values were found associated with increasing fiber bundle damage. CONCLUSIONS: The FA values and the change patterns of fiber bundle were more sensitive than T2WI for spinal cord lesion, and were positively correlated with clinical symptoms.