Division of Neuroradiology, Russell H. Morgan Department of Radiology (M.K., I.I.), Johns Hopkins University School of Medicine, Baltimore, Maryland.
From the Brain Cancer Program (P.A., J.B., S.T.).
AJNR Am J Neuroradiol. 2018 Aug;39(8):1576-1581. doi: 10.3174/ajnr.A5671. Epub 2018 May 17.
Myelitis is a rare complication of radiation exposure to the spinal cord and is often a diagnosis of exclusion. A retrospective review of clinical records and serial imaging was performed to identify subjects with documented myelitis and a history of prior radiation. Eleven patients fulfilled the inclusion criteria. All patients had longitudinally extensive cord involvement with homogeneous precontrast T1 hyperintense signal in the adjacent vertebrae, corresponding to the radiation field. T2 signal abnormalities involving the central two-thirds of the cord were seen in 6/11 patients (55%). The degree of cord expansion and contrast enhancement was variable but was seen in 6 (54%) and 5 (45%) patients, respectively. On follow-up, 2 patients developed cord atrophy, while complete resolution was noted in 1. Clinical improvement was noted in 5 patients, with symptom progression in 2 patients. Our results suggest that radiation myelitis is neither universally progressive nor permanent, and some radiographic and clinical improvement may occur.
脊髓炎是脊髓辐射暴露的罕见并发症，通常是排除性诊断。我们对临床记录和连续影像学进行回顾性分析，以确定有记录的脊髓炎和既往放疗史的患者。符合纳入标准的患者共 11 名。所有患者均有脊髓纵向广泛受累，相邻椎体呈均匀的对比前 T1 高信号，与放疗野相对应。6/11 例（55%）患者的 T2 信号异常累及脊髓的中央 2/3 。脊髓扩张和强化程度不同，但分别在 6 例（54%）和 5 例（45%）患者中观察到。随访时，2 例患者出现脊髓萎缩，1 例完全缓解。我们的结果表明，放射性脊髓炎并非普遍进展或永久性的，一些影像学和临床改善可能发生。
