Fig 8 - uploaded by Grace S Phillips
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Dermal sinus. a Sagittal T1-W MR image demonstrates a lowmidline dermal sinus (arrow) with a cutaneous marker. The conus is normal in position (arrowhead) and there are no associated lesions. b Sagittal T1-W image of a dermal sinus (arrow) within a subcutaneous lipoma. Also seen is low-lying conus (arrowhead) and fatty filum
Source publication
We present a pictorial review of MRI features of various closed spinal dysraphisms based on previously described clinicoradiological classification of spinal dysraphisms proposed. The defining imaging features of each dysraphism type are highlighted and a diagnostic algorithm for closed spinal dysraphisms is suggested.
Context in source publication
Context 1
... dermal sinus is an epithelium-lined tract extending inward from the skin surface, occurring most commonly in the lumbosacral region (Fig. 8). The sinus can commu- nicate with the subarachnoid space, potentially leading to CSF leak, meningitis or abscess. Intraspinal lipomas, dermoids or hamartomas sometimes coexist. The spinal cord conus might be abnormally low-lying in position. A high sacral dimple, (i.e. located above the natal cleft), with an upward coursing dermal ...
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Citations
... Females account for a notable proportion (55-70%) of neural tube abnormalities. Location, gender, race, and ethnicity are some of the variables that affect prevalence [9,10]. Prenatal screening and folic acid supplementation have contributed to a reduction in the frequency of neural tube abnormalities during the past 25 years [10]. ...
... Location, gender, race, and ethnicity are some of the variables that affect prevalence [9,10]. Prenatal screening and folic acid supplementation have contributed to a reduction in the frequency of neural tube abnormalities during the past 25 years [10]. The majority of instances of closed spinal dysraphism are asymptomatic at birth, but they may be suspected if there are high-risk cutaneous indicators or if the infant develops neurological problems later on [11]. ...
... Spinal dysraphism, with a reported incidence of about 1-3/1000 live (1) births , is a major healthcare concern in India, owing to lack of awareness and diagnostic facilities. However, last few decades have shown a considerable decline in the number of cases, thanks to improved antenatal care with better nutrition, supplementation of folic acid, prenatal screening using high-resolution ultrasound and (2) biochemical markers . ...
Background: Spine and spinal cord development is governed by intricate genetic mechanisms and any deviation from the normal embryological cascade during 2-6 gestational weeks causes imperfect fusion of midline mesenchymal, bony and neural structures causing spinal dysraphism. Imaging plays a pivotal role in their evaluation as many patients present with concurrent anomalies that need to be corrected simultaneously to avoid repeat surgeries. To demonstrate the spectrum of MRI ndings of spinal dysraphi Aim: Settings and design: sm. A cross sectional observational study was done in 36 pediatric patients with known or suspected spinal dysraphism on 3T MRI. MRI was Materials And Methods: performed using Siemens Skyra 3T MRI. In this study comprising of 36 patients, mean age Results: was 37.1months (3 years 1month) with minimum age of 4 days and maximum age of 18 years. Children of age less than 5 years were maximally affected. A female predominance was noted with male: female ratio of 0.9:1. Open spinal dysraphism (55.6%) was more common than closed dysraphism (44.4%). The most common dysraphism was myelomeningocele. Among open dysraphism, we also encountered 1 case each of hemimyelomeningocele and myelocele. Among closed defects, split cord malformation was most common (19.4%) as it was present with other dysraphic defects (called complex spina bida), followed by lipomyelocele (11.1%) and dermal sinus (11.1%). Among 7 cases of split cord malformation, type II (6 cases; 85.7%) was more common than type I (1 case; 14.3%). Other cases of closed dysraphism were lipomyelomeningocele, meningocele, terminal myelocystocele, intradural lipoma, lar lipoma and caudal regression syndrome. MRI is an excelle Conclusion: nt modality for dening the characteristic imaging features of each dysraphism to give a composite diagnosis.
... The filum terminale is a fibrous and viscoelastic band that connects the conus medullaris to the periosteum of the coccyx, and it is thought to fixate and stabilize the lower cord during abnormal cephalad and caudal traction, and also allow the conus to move during flexion and extension of the spine (20). The fatty filum terminale refers to a filum that is both >2 mm in diameter and contains a fat signal (21). The fat infiltration can cause stretching and tethering of the conus resulting in neurological symptoms. ...
Objective
This study aimed to explore the clinical features and outcomes of children with spinal cord injury (SCI) without fracture or dislocation.Methods
The clinical data of children with SCI without fracture or dislocation in this retrospective study were collected in Chongqing, China (January 2010 to December 2021). We collected patient demographics at admission including age, gender, cause, level, and severity of the injury in admission and complications. Reports from radiologic imaging were reviewed to identify spina bifida occulta (SBO). Neurological function was evaluated using the American Spinal Injury Association (ASIA) Impairment Scale (AIS) for an SCI.ResultsA total of 74 children with SCI (male, 27%; female, 73%; male-to-female ratio, 1:2.7; average age, 5.7 years) were included. The main cause of injury was backbend during the dance (34 patients, 45.9%, including 2 patients who hugged back falling backward), followed by traffic accidents (17 patients, 23%). Children with backbend-related SCI were older than other children (6.9 vs. 4.9 years old, P < 0.001). When reviewing all radiological images, it was found that 20 (27%) patients with SCI had SBO. The proportion of SCI with SBO caused by backbend was considerably higher than those caused by non-backbend (41.2 vs. 15%, P = 0.012). The AIS were 22 (29.7%), 4 (5.4%), 8 (10.8%), 31 (41.9%), and 9 (12.2%) in A, B, C, D, and E, respectively. The prognosis was poorer in the backbend during dancing than other causes of injury (p = 0.003).Conclusion
This study showed that backbend during the dance was the main cause of children's SCI without fracture or dislocation in Chongqing, China. The prognosis was poorer in those children than in other causes of injury. Meanwhile, we have established an association between SBO and SCI for children performing a backbend during the dance.
... Contrary to the above facts, the perinatology literature has uniformly identified this entity with a good prognosis [1,17,[22][23][24]]. ...
... Early and accurate diagnosis is essential for the appropriate multidisciplinary counselling, prognostication and followup in the prenatal period [22]. The US is the initial imaging modality of prenatal evaluation of CSBs, given its wide availability and low cost [25]. ...
Purpose
Closed spina bifida (CSB) is rare in prenatal literature, and various lesions are grouped under this broad nosological entity CSB, leading to confusing and misleading prognostic conclusions.
Methods
This is a retrospective observational cohort study of prenatally detected CSB cases using two-dimensional ultrasound, complemented by three-dimensional ultrasonography and foetal MRI in indicated cases, from October 2014 to October 2021 in a tertiary-level single centre.
Results
The most common upper vertebral level of CSB was lumbar in 66.6% (10/15). The sub-classification of lesions based on prenatal ultrasound showed an agreement in 53% of the cases. Sixty percent had associated abnormalities identified postnatally, the most common being anorectal malformation seen in 33.3%. On postnatal follow-up, 46.6% had bowel incontinence and bladder dysfunction, and 33.3% developed lower limb deformities.
Conclusions
All CSBs do not have a uniformly favourable prognosis. The prognosis of CSB depends on the pathological type, the presence of associated abnormalities and the management.
... Variations in prevalence based on race, ethnicity, gender and region have also been reported [6]. The prevalence of neural tube defects (including anencephaly and spinal dysraphisms) has been on the decline during the last 25 years as a result of antenatal screening and folic acid supplementation [7]. Majority of the closed spinal dysraphic states are asymptomatic at birth. ...
... The neural placode is abnormal neural tissue located at either the terminal end of the open spinal cord or can be segmental, with the spinal cord extending further inferiorly (38). Herniation of the fluid-filled sac with neural elements points towards MMC, which is an open defect and is seldom referred for imaging (Fig. 7). ...
... In lipomyelocele (LMC), the lipoma is seen extending from the subcutaneous tissues, traversing the dural and vertebral defect entering the spinal canal attaching to and tethering the spinal cord (Fig. 9). The placode lipoma junction is present within the spinal canal or at the edge of the canal (38). The junction may be smooth or irregular with fatty projections extending into the central canal, leading to dilated central canal (9). ...
Magnetic resonance evaluation of spinal dysraphism can be confusing for inexperienced radiologists and a detailed, step-by-step evaluation of the normal and abnormal imaging findings can help garner the diagnosis. The purpose of this article is to review the existing literature and to provide a comprehensive, structured, template checklist-style format for reporting spinal dysraphism that can help inexperienced radiologists to systematically analyze and report all the significant and ancillary findings in cases of spinal dysraphism and efficiently communicate the findings to the treating physician/surgeon.
... Lipomyelomeningocele is also associated with enlargement of anterior cerebrospinal fluid (CSF) subarachnoid spaces. [34] ...
Spinal epidural space is a real anatomic space located outside the dura mater and within the spinal canal extending from foramen magnum to sacrum. Important contents of this space are epidural fat, spinal nerves, epidural veins and arteries. Due to close proximity of posterior epidural space to spinal cord and spinal nerves, the lesions present with symptoms of radiculopathy and/or myelopathy. In this pictorial essay, detailed anatomy of the posterior epidural space, pathologies affecting it along with imaging pearls to accurately diagnose them are discussed. Various pathologies affecting the posterior epidural space either arising from the space itself or occurring secondary to vertebral/intervertebral disc pathologies. Primary spinal bone tumors affecting the posterior epidural space have been excluded. The etiological spectrum affecting the posterior epidural space ranges from degenerative, infective, neoplastic - benign or malignant to miscellaneous pathologies. MRI is the modality of choice in evaluation of these lesions with CT scan mainly helpful in detecting calcification. Due to its excellent soft tissue contrast, Magnetic Resonance Imaging is extremely useful in assessing the pathologies of posterior epidural space, to know their entire extent, characterize them and along with clinical history and laboratory data, arrive at a specific diagnosis and guide the referring clinician. It is important to diagnose these lesions early so as to prevent permanent neurological complication.
Purpose
Closed spina bifida (CSB) is rare in prenatal literature and various lesions are grouped under this broad nosological entity CSB, leading to confusing and misleading prognostic conclusions.
Methods
This is a retrospective observational cohort study of prenatally detected CSB cases using two-dimensional ultrasound, complemented by three-dimensional ultrasonography and fetal MRI in indicated cases, from October 2014 to October 2021 in a tertiary level single centre.
Results
The most common upper vertebral level of CSB was lumbar in 66.6% (10/15). The sub-classification of lesions based on prenatal ultrasound showed an agreement in 53% of the cases. 60% had associated abnormalities identified postnatally, the most common being anorectal malformation seen in 33.3%. On postnatal follow-up, 46.6% had bowel incontinence and bladder dysfunction, 33.3% developed lower limb deformities.
Conclusions
All CSBs do not have a uniformly favourable prognosis. The prognosis of CSB depends on the pathological type, the presence of associated abnormalities and the management.
