Pancake-like gadolinium enhancement in the spinal cord: an image pattern that suggests spondylotic myelopathy

Realce pelo gadolínio “em panqueca” na medula espinhal: um padrão de imagem sugestivo de mielopatia espondilótica

A 55-year-old man without comorbidities presented with progressive paresthesia and weakness affecting the limbs. Cervical magnetic resonance imaging (MRI) demonstrated prominent spondylosis and myelopathy with pancake-like gadolinium enhancement (Figures 1 and 2).

Figure 1
Sagittal MRI reveals prominent cervical spondylosis associated with a fusiform longitudinally-extensive hyperintensity on T2-weighted image, below compression, due to spinal vasogenic edema (A), hypointensity on T1-weighted image (B), with a transverse pancake-like band of enhancement at the spinal cord just below the site of maximal stenosis (C3-C4) on T1-weighted post-gadolinium image (C).

Figure 2
The pancake-like sign on axial T2-weighted image (A) and axial T1-weighted post-gadolinium (B), showing a circumferential enhancement sparing spinal cord gray matter (B).

The pancake-like sign is related to a focal disruption of the blood-brain barrier and defined by a circumferential enhancement sparing spinal cord gray matter on axial images, located beneath the site of maximum stenosis, with a transverse band appearance on sagittal images, extending less than one vertebral segment. The recognition of these radiological findings contribute to the avoidance of unnecessary interventions^1,2,3.

References

• ¹
  Seidenwurm DJ. Myelopathy. Am J Neuroradiol. 2008;29(5):1032-4.
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  Flanagan EP, Krecke KN, Marsh RW, Giannini C, Keegan M, Weinshenker BG. Specific pattern of gadolinium enhancement in spondylotic myelopathy. Ann Neurol. 2014;76(1):54-65. https://doi.org/10.1002/ana.24184
  » https://doi.org/10.1002/ana.24184
• ³
  Flanagan EP, Marsh RW, Weinshenker BG. Teaching neuroimages: “pancake-like” gadolinium enhancement suggests compressive myelopathy due to spondylosis. Neurology. 2013;80(21):e229. https://doi.org/10.1212/WNL.0b013e318293e346
  » https://doi.org/10.1212/WNL.0b013e318293e346

Publication Dates

• Publication in this collection
  June 2018

History

• Received
  08 Jan 2018
• Reviewed
  03 Feb 2018
• Accepted
  06 Feb 2018