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Age / Sex : 65 / F
Age / Sex : 65/F
Chief complaint : low back pain with radiating pain to both L/E (3 weeks
ago)
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of
this case.
* Send Application Answers to In Sook Lee, MD (lis@pusan.ac.kr)
Courtesy : Ja Young Choi, Seoul National University Hospital
Diagnosis: Intradural disc sequestration
Discussion
Findings: The T2-weighted
sagittal MRI showed an anterior intradural mass like lesion at the T12/L1 disc
level, which is located within the right sided central canal. The intradural
lesion has T2 central intermediate hyperintense, peripheral hyperintense and T1
isointense signal.
Differential Diagnosis: Intradural extramedullary tumor such as neurogenic tumor
Diagnosis:
Intradural disc sequestration
Discussion: Intradural disc herniations are most commonly
found in the lumbar area, and the incidence of this condition ranges from 0.04%
to 0.33% in lumbar herniated disc patients (1). The pathogenesis of intradural
disc herniation is unclear. However, several theories have been proposed (2).1.
There is adhesion formation between the dura and the posterior longitudinal
ligament secondary to chronic inflammation, with the resulting spontaneous perforation,
although not through propulsion of the disc material.2. There is a congenital
union between the dura mater and the common posterior vertebral ligament. 3.
There are secondary changes resulting from a previous surgery. It is generally
easy to differentiate lumbar disc herniation from other conditions with using
the current MRI techniques. Holtas et al. reported that the disc was directly connected
to the intradural mass, and a diagnosis of an intradural disc herniation can be
made from such a finding (3). Wasserstrom et al. reported on intradural lumbar
disc herniation with a ring enhancement pattern on a contrast MRI study (4).
The ring enhancement pattern on the contrast T1-weighted image was attributed
to the granulation tissue surrounding the lesion. The nonenhancing intradural
lesion was regarded as an unvascularized disc fragment rather than a tumor. Some
authors suggested that the enhancement is likely to depend on the age of the
intradural disc herniation. Almost all the intradural extramedullary tumors
were hyperintense on the T2-weighted scan (5).
References:
1.
Kataoka O, Nishibayasgu Y, Sho T. Intradural lumbar disc herniation. Report of
three cases with a review of the literature. Spine 1989;14:529-533
2.
D’Andrea G, Trillo G, Roperto R, Celli P, Orlando ER, Ferrante L. Intradural
lumbar disc herniations: the role of MRI in preoperative diagnosis and review
of the literature. Neurosurg Rev 2004;27:75-80
3.
Holtas S, Nordstrom CH, Larsson EM. MR Imaging of Intradural Disk Herniation. J Comput Assist
Tomogr 1987;11:353-356
4.
Wasserstrom R, Mamourian AC, Black JF, Lehman RA. Intradural lumbar disk
fragment with ring enhancement on MR. AJNR Am J Neuroradiol 1993;14:401-404
5.
Chung S, Lee S, Kim T, Jo B. Intradural Lumbar Disc Herniation with Intradural
Gas: Report of Three Cases1. J Korean Radiol Soc 2005;53:445-449
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