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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(06): 424-425
DOI: 10.1590/0004-282X20180042
IMAGES IN NEUROLOGY

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
Gabriela Cezana Contarato
1   Universidade Federal do Espírito Santo, Vitória ES, Brasil;
,
Marcos Rosa Júnior
2   Universidade Federal do Espírito Santo, Departamento de Neurorradiologia, Vitória ES, Brasil.
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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]).

Zoom Image
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).
Zoom Image
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].


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Conflict of interest:

There is no conflict of interest to declare.

  • References

  • 1 Seidenwurm DJ. Myelopathy. Am J Neuroradiol. 2008;29(5):1032-4.
  • 2 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
  • 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

Address for correspondence

Marcos Rosa Júnior
Avenida Marechal Campos, 1468; Maruípe, 29043-900 Vitória ES
Brasil   

Publikationsverlauf

Eingereicht: 08. Januar 2018

Angenommen: 06. Februar 2018

Artikel online veröffentlicht:
25. August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Seidenwurm DJ. Myelopathy. Am J Neuroradiol. 2008;29(5):1032-4.
  • 2 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
  • 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

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Zoom Image
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).
Zoom Image
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).