Anterior Lumbar Radiculopathy


(Left) Sagittal T1WI MR in a leukemia patient with leg weakness following intrathecal chemotherapy shows normal appearance of the conus and cauda equina.



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(Right) Sagittal T1WI C+ MR in a leukemia patient with leg weakness following intrathecal chemotherapy reveals abnormal smooth, thin, linear enhancement of the ventral conus pia image and cauda equina image.

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(Left) Axial T1WI C+ MR through the conus medullaris confirms smooth, thin, linear enhancement of the ventral conus pia and cauda equina image.


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(Right) At the level of the cauda equina, axial T1WI C+ MR demonstrates characteristic smooth thin linear enhancement of the ventral cauda equina nerve roots image but not the dorsal cauda equina nerve roots image.


TERMINOLOGY


Abbreviations




• Methotrexate (MTX), cytosine arabinoside (Ara-C)


Definitions




• Transient or permanent paraplegia

• Uncommon complication following intrathecal chemotherapy

• Initially described following intrathecal methotrexate (MTX) in pediatric acute lymphoblastic leukemia patients
image Subsequently reported with other chemotherapy agents and in adults


IMAGING


General Features




• Best diagnostic clue
image Smooth linear enhancement of conus pia and ventral cauda equina following intrathecal methotrexate chemotherapy

• Location
image Ventral cauda equina and conus pia


MR Findings




• T1WI
image Nearly always normal; ± mild diffuse cauda equina nerve root thickening

• T2WI
image Nearly always normal; ± mild diffuse cauda equina nerve root thickening

• T1WI C+
image Anterior lumbosacral nerve root, conus pial enhancement


Imaging Recommendations




• Best imaging tool
image Multiplanar contrast-enhanced lumbar MR

Oct 5, 2016 | Posted by in NEUROLOGICAL IMAGING | Comments Off on Anterior Lumbar Radiculopathy

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