(Left) Sagittal T1WI MR in a leukemia patient with leg weakness following intrathecal chemotherapy shows normal appearance of the conus and cauda equina.
(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 and cauda equina .
(Left) Axial T1WI C+ MR through the conus medullaris confirms smooth, thin, linear enhancement of the ventral conus pia and cauda equina .
(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 but not the dorsal cauda equina nerve roots .
TERMINOLOGY
Abbreviations
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Methotrexate (MTX), cytosine arabinoside (Ara-C)
Definitions
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Transient or permanent paraplegia
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Uncommon complication following intrathecal chemotherapy
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Initially described following intrathecal methotrexate (MTX) in pediatric acute lymphoblastic leukemia patients
Subsequently reported with other chemotherapy agents and in adults
IMAGING
General Features
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Best diagnostic clue
Smooth linear enhancement of conus pia and ventral cauda equina following intrathecal methotrexate chemotherapy
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Location
Ventral cauda equina and conus pia
MR Findings
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T1WI
Nearly always normal; ± mild diffuse cauda equina nerve root thickening
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T2WI
Nearly always normal; ± mild diffuse cauda equina nerve root thickening
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T1WI C+
Anterior lumbosacral nerve root, conus pial enhancement
Imaging Recommendations
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Best imaging tool
Multiplanar contrast-enhanced lumbar MR