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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticlePediatric Neuroimaging

Limited Dorsal Myeloschisis and Congenital Dermal Sinus: Comparison of Clinical and MR Imaging Features

S.M. Lee, J.-E. Cheon, Y.H. Choi, I.-O. Kim, W.S. Kim, H.-H. Cho, J.Y. Lee and K.-C. Wang
American Journal of Neuroradiology January 2017, 38 (1) 176-182; DOI: https://doi.org/10.3174/ajnr.A4958
S.M. Lee
aFrom the Departments of Radiology (S.M.L., J.-E.C., Y.H.C., I.-O.K., W.S.K., H.-H.C.)
dDepartment of Radiology (S.M.L.), Kyungpook National University Medical Center, Daegu, Korea
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  • ORCID record for S.M. Lee
J.-E. Cheon
aFrom the Departments of Radiology (S.M.L., J.-E.C., Y.H.C., I.-O.K., W.S.K., H.-H.C.)
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Y.H. Choi
aFrom the Departments of Radiology (S.M.L., J.-E.C., Y.H.C., I.-O.K., W.S.K., H.-H.C.)
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I.-O. Kim
aFrom the Departments of Radiology (S.M.L., J.-E.C., Y.H.C., I.-O.K., W.S.K., H.-H.C.)
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W.S. Kim
aFrom the Departments of Radiology (S.M.L., J.-E.C., Y.H.C., I.-O.K., W.S.K., H.-H.C.)
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H.-H. Cho
aFrom the Departments of Radiology (S.M.L., J.-E.C., Y.H.C., I.-O.K., W.S.K., H.-H.C.)
eDepartment of Radiology (H.-H.C.), Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.
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J.Y. Lee
bAnatomy (J.Y.L.)
cNeurosurgery, Division of Pediatric Neurosurgery (J.Y.L., K.-C.W.), Seoul National University College of Medicine, Seoul, Republic of Korea
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K.-C. Wang
cNeurosurgery, Division of Pediatric Neurosurgery (J.Y.L., K.-C.W.), Seoul National University College of Medicine, Seoul, Republic of Korea
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    Fig 1.

    LDM in a 4-month-old girl who presented with a midline skin lesion in the lumbar area. A, Photograph shows a crater covered with pearly pale epithelium (arrowheads) described as a cigarette-burn mark. Sagittal (B) and axial (C) T2-weighted MR images show that the intraspinal tract (arrows) displaying a distinct hypointense round structure separate from the filum terminale or nerve roots is completely traceable in its entire course (classified as “entirely visible” tract). The attachment site of the tract is the spinal cord just above the conus medullaris. A low-lying conus medullaris and dorsal tenting of the spinal cord at the tract-cord union are seen (open arrow). D, Photograph obtained during the operation shows a thick tract (asterisk) adhering to the dorsal aspect of the spinal cord.

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    Fig 2.

    LDM in an 11-month-old girl with an intradural lipoma. A, Photograph shows a pinpoint pit (arrowhead) in the midline area of the lumbosacral region. T1-weighted (B) and sagittal T2-weighted (C) MR images show an entirely visible intrathecal tract (arrow) traversing the center of an intradural dorsal lipoma (L) and a low-lying conus medullaris. The attachment site of the tract is the spinal cord is just above the conus medullaris. D, Sequential axial T2-weighted MR images show dorsal tenting of the spinal cord (open arrow) and tract with low signal intensity (arrows).

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    Fig 3.

    CDS in a 12-month-old girl who presented with fever and quadriplegia. Sagittal T2-weighted (A) and contrast-enhanced T1-weighted (B) MR images show ring-enhancing mass lesions nearly filling the entire intrathecal space (arrows), accompanied by spinal cord expansion and intramedullary thick enhancement (open arrows). There is no discernable tract in the intrathecal region on MR imaging (classified into “poorly visible”). These enhancing mass lesions (arrows) and intramedullary enhancement (open arrows) were infected epidermoid tumor and intramedullary abscess at the operation, respectively. C, Photograph obtained during the operation shows a yellowish material, representing infected epidermoid tumor.

Tables

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    Table 1:

    Comparison of LDM and CDS: clinical data

    LDM (n = 12)CDS (n = 10)P Value
    Male/female2:106:4.074
    Age (mo) at admissiona11 ± 14.2 (0.5–47)12.9 ± 9 (0.25–34).207
    Clinical presentation
        Skin abnormalityb<.0001
            Skin-covered crater10 (83%)0
            Pit2 (17%)10 (100%)
        Infectionb06 (60%).003
        Neurologic deficitb2 (17%)4 (40%).348
    • ↵a Data are mean value, with ranges in parentheses.

    • ↵b Data are number of patients, with percentages in parentheses.

    • View popup
    Table 2:

    Visibility of tract: MRI and operative findingsa

    TractVisibilityLDM (n = 12)CDS (n = 10)P Value
    Subcutaneous12 (100%)10 (100%)–
    IntrathecalbEntirely visible10 (83%)1 (10%).003
    Partially visible2 (17%)4 (40%)
    Poorly visible0 (0%)4 (40%)
    • ↵a Data are number of patients, with percentages in parentheses.

    • ↵b Because the tract of 1 patient with CDS was revealed to end in the dura mater at the operation and there was no tract in the intrathecal area, only 9 CDS tracts were assessed with regard to visibility and attachment site in its intrathecal portion.

    • View popup
    Table 3:

    Attachment site of tract: MRI and operative findingsa

    TractAttachment SiteLDM (n = 12)CDS (n = 10)P Value
    MRIOPMRIOP
    IntrathecalbConus medullaris12 (100%)12 (100%)2 (20%)3 (30%).004
    Filum terminale/nerve root––2 (20%)2 (20%)
    Dermoid/epidermoid tumor–––4 (40%)
    Not availablec5 (50%)
    No extension into the spinal canal––1 (10%)1 (10%)
    • Note:—Op indicates operative findings.

    • ↵a Data are number of patients, with percentages in parentheses.

    • ↵b Because the tract of 1 patient with CDS was revealed to end in the dura mater at the operation and there was no tract in the intrathecal area, only 9 CDS tracts were assessed with regard to visibility and attachment site in its intrathecal portion.

    • ↵c The attachment sites of the tracts could not be evaluated on MRI.

    • View popup
    Table 4:

    Configuration of spinal cord: MRI and operative findingsa

    Spinal CordLDM (n = 12)CDS (n = 10)P Value
    Level of the conus medullarisNormal3 (25%)4 (40%).652
    Low-lying9 (75%)6 (60%)
    Shape of the spinal cordDorsal tenting10 (83%)1 (10%).001
    • ↵a Data are number of patients, with percentages in parentheses.

    • View popup
    Table 5:

    Intradural lesions: MRI and operative findingsa

    Associated Intradural LesionsMRIOPMRIOPP Value
    Dermoid-epidermoid0 (0%)0 (0%)5 (50%)6 (60%).003
    Lipoma2 (17%)2 (17%)2 (20%)2 (20%)1.000
    • Note:—OP indicates operative findings.

    • ↵a Data are number of patients, with percentages in parentheses.

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American Journal of Neuroradiology: 38 (1)
American Journal of Neuroradiology
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Limited Dorsal Myeloschisis and Congenital Dermal Sinus: Comparison of Clinical and MR Imaging Features
S.M. Lee, J.-E. Cheon, Y.H. Choi, I.-O. Kim, W.S. Kim, H.-H. Cho, J.Y. Lee, K.-C. Wang
American Journal of Neuroradiology Jan 2017, 38 (1) 176-182; DOI: 10.3174/ajnr.A4958
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S.M. Lee, J.-E. Cheon, Y.H. Choi, I.-O. Kim, W.S. Kim, H.-H. Cho, J.Y. Lee, K.-C. Wang
Limited Dorsal Myeloschisis and Congenital Dermal Sinus: Comparison of Clinical and MR Imaging Features
American Journal of Neuroradiology Jan 2017, 38 (1) 176-182; DOI: 10.3174/ajnr.A4958

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