Browsing by Subject "Spinal cord compression"

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    Spinal Cord Compression As the Initial Manifestation of Relapsed Acute Myeloid Leukemia: A Case Report and Literature Review of a Rare Presentation
    (Springer Nature, 2025-03-31) Gregg-Garcia, Raul; Sayar, Hamid; Medicine, School of Medicine
    Myeloid sarcoma (MS) is a solid mass of myeloid blasts outside the bone marrow (BM). Most cases occur in the setting of intramedullary acute myeloid leukemia (AML), but it can also present in the absence of overt BM disease, as a presentation of newly diagnosed or relapsed AML, or as a progression of myeloproliferative neoplasms or myelodysplastic syndromes. There are a few reports of spinal cord compression due to MS, and there is no consensus regarding its management. Here, we present a case of relapsed AML in the form of MS resulting in spinal cord compression and provide a comprehensive literature review of previously reported cases of MS causing cord compression. An 18-year-old male was diagnosed with AML with poor-risk cytogenetics in September 2023. He received induction chemotherapy (CTX) with 7+3, followed by consolidation with high-dose cytarabine, achieving remission. He was referred for BM transplant evaluation but opted against it. One year later, he presented with a four-month history of bilateral motor and sensory deficits along with bladder dysfunction. A magnetic resonance imaging (MRI) of the spine showed multilevel nerve root thickening and enhancement and multiple extramedullary masses. Spinal radiation therapy and corticosteroids were given; a biopsy was deferred due to high procedural risks. Given his prior history of AML, the findings were highly suspicious for MS. A complete blood count (CBC) and smear did not show circulating blasts, and a BM exam was inconclusive. Induction CTX with MEC regimen (mitoxantrone, etoposide, cytarabine) was started. A lumbar puncture with CSF flow cytometry confirmed central nervous system involvement with myeloid blasts, and a brain MRI revealed leptomeningeal disease. Intrathecal CTX was given. A spine MRI on day 15 post-induction showed partial improvement in spinal disease. The patient was discharged 30 days after receiving induction CTX, and he planned to continue his care at a local cancer institute in his home state.
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    Which MR Imaging Sequences Are Necessary in Determining the Need for Radiation Therapy for Cord Compression? A Prospective Study
    (American Society of Neuroradiology, 2007-01) Johnson, A.J.; Ying, J.; El Gammal, T.; Timmerman, R.D.; Kim, R.Y.; Littenberg, B.; Radiology and Imaging Sciences, School of Medicine
    Background and purpose: To determine which MR imaging sequences are necessary to assess for spinal metastases. Methods: Hypothetical MR imaging interpretations and management plans were made prospectively for consecutive adult cases acquired retrospectively. Standardized MR imaging protocols were independently interpreted by 2 neuroradiologists. MR imaging protocol types varied: 1) T1-weighted images only; 2) T1-weighted and T2-weighted images; 3) T1-weighted and postcontrast T1-weighted images; and 4) T1- and T2-weighted images and postcontrast T1-weighted images. Hypothetical management plans were created by 2 radiation oncologists. Logit model was used to investigate the effect of MR imaging protocol type on the probability of recommending radiation therapy (RT). Mixed effect models were used to investigate whether median spinal level or total number of spinal levels of planned RT was associated with MR imaging protocol type. Results: Thirty-one subjects were evaluated, each with multiple scan interpretations. Logit model showed that neither MR imaging protocol type nor neuroradiologist reader affected the probability that the oncologist would recommend RT (all P > .50). Mixed models showed that neither ML nor NL was affected by MR imaging protocol type or by neuroradiologist reader (all P > .12). Conclusion: Although MR imaging is known to be the most useful diagnostic test in suspected spinal cord compression, which particular MR images are necessary remain unclear. Compared with T1-weighted images alone, the additional use of T2-weighted and/or postcontrast T1-weighted sequences did not significantly affect the probability that RT would be recommended or the levels that would be chosen for RT in our study. Our data suggest that unenhanced T1-weighted images may be sufficient for evaluation of possible cord compression.