Presentation
Follow up case of breast carcinoma, with vertebral metastasis at T10 level who received high-dose of radiation therapy. Presented with complaints of pain in thoracic spine and inability to walk. Neurological examination revealed spastic paraparesis (grade: 4/5), sensory deficit below the T10 level.
Patient Data
CT scan imaging shows hyperdense T10 vertebra with focal small hypodensity seen. T8, T9, T11, and T12 vertebrae show reduced attenuation.
Vertebral bodies show a hyperintense signal on T1 weighted images and intermediate signal intensity on T2 weighted fat saturation images, with the T8 vertebral body showing an intermediate signal on T1 and suppression of signal on T2 weighted fat saturation images.
The spinal cord shows an intramedullary hyperintense signal on T2 weighted images, which is localized in the radiation field.
Case Discussion
Demyelination results from damage to white matter, which is an unavoidable incident due to the varied sensitivity of myelin and surrounding soft tissue.
It is reported that the thoracic segment of the spinal cord can tolerate 200cGy per day up to 5000 cGy radiation.
This condition is very well demonstrated on MRI evaluation.
Authors:
Dr. Fazal T. Syed (MD Radiodiagnosis, consultant medical imaging - Artemis health institute)
Dr. Saini Pankaj (MD Radiodiagnosis, consultant medical imaging - Artemis health institute)
Dr. Mehta Sanjay (MD Radiodiagnosis, head of the department, medical imaging - Artemis health institute)
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