Magnetic resonance imaging in the evaluation of spinal tumors

Article Abstract:

Magnetic resonance imaging (MRI) is capable of resolving small details within tissues. As the technique becomes more widely accessible, it is beginning to supplant computed tomography (CT) for many applications. In the imaging of the spinal cord, MRI is supplanting not only CT, but myelography (an X-ray technique) as well. The author discusses the application of magnetic resonance for the imaging of a variety of tumors of the spine. Spinal tumors may be considered in three distinct classes, based on their location. They may be located in the extradural space, that is, outside of the spinal cord proper. The tumors may be extramedullary, or within the dural covering of the spinal cord, but outside of the tissue of the spinal cord; or the tumors may be intramedullary, that is, within the spinal cord itself. Extradural tumors are usually delineated superbly by MRI, since the vertebrae and bone marrow represent very distinct tissues against which any lesion is clearly visualized. Many active lesions of the vertebrae that were suspected, but not visualized using bone scans, can be seen clearly using MRI. Tumors within the dural space, but outside the spinal cord, may be either primary tumors, such as a meningioma, or they may be metastatic tumors. In general, meningiomas and other primary tumors in this space may be visualized without the use of contrast-enhancing agents. However, secondary tumors within the extramedullary space may be difficult to detect without the use of contrast agents. It is within the spinal cord itself, that is, in the intramedullary space, that MRI shows its superiority to CT and myelography to greatest effect. Metastatic tumors are extremely rare in the spinal cord, and the majority are astrocytomas. These tumors are often invasive, particularly in adults, and the boundaries of astrocytomas are indistinct due to the invasive movement into adjacent tissue. The magnetic resonance image, however, resolves enough detail to demonstrate the enlargement of the cord by the developing tumor mass, even when the mass is not distinct. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnostic imaging

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Primary neoplasms of the central nervous system in children

Article Abstract:

Fifteen percent of all tumors in children occur within the cranial cavity. Often, these tumors cause only minor neurological symptoms, and an important challenge for pediatric neurologists is to make a determination of the extent and probable type of tumor as rapidly and accurately as nature permits. Modern techniques of diagnostic imaging are obviously helpful in determining the extent of an intracranial tumor, but they also help in evaluating the response to treatment and monitoring the patient for recurrent tumor. Furthermore, these same techniques monitor other changes which may be occurring during the recovery period, such as hydrocephalus or edema. The majority of intracranial tumors in children are gliomas, the greatest majority of which are low-grade astrocytomas. There is no single imaging method that is best for all possible intracranial tumors. Indeed, even traditional X-rays are still useful for the evaluation of calcified tissue, changes in the cranial sutures, or alterations in the vault or the sella turcica. Computed tomography (CT) is inferior to magnetic resonance imaging (MRI) in the examination of tumors in the temporal lobes and brain stem. Calcifications, which occur in about 29 percent of all pediatric brain tumors, are difficult to see on MRI, but are easily seen on CT. Magnetic resonance imaging is superior for the detection of tumors within the spinal cord, and also for the detection of the ''sugar coating'' of tumor cells that have settled out from the cerebrospinal fluid of the spinal cord. Computed tomography with myelography is still superior, however, for examining tumors within the cauda equina. All told, MRI seems to be the technique of choice, and it is still evolving. There is much that, at least at present, is not learned from MRI, and it is still useful to have information from the CT scan as well. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, CT imaging, CAT scans, Tumors in children, Pediatric tumors

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Right atrial extension of adrenocortical carcinoma: surgical management using hypothermia and cardiopulmonary bypass

Article Abstract:

Cancers of the adrenal cortex (center of the adrenal gland) have a poor prognosis because of their high rate of malignancy, the delays in making a diagnosis, and the lack of an adequate non- surgical form of therapy. Researchers employed applied hypothermia (low temperature) and cardiopulmonary bypass (placing the patient on a heart and lung life support system during surgery) during the surgical removal of a tumor that had extended from the adrenal gland to the right atrium (chamber) of the heart. Magnetic resonance (MR) imaging was used to demonstrate the extension of the tumor into the right atrium. This case is the first instance of adrenocortical carcinoma with right atrial extension successfully removed with the aid of hypothermia and cardiopulmonary bypass.

Surgery, Hypothermia, Cardiopulmonary bypass, Endocrine gland cancer

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