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Imaging Appearance of Advanced Chronic Adhesive Arachnoiditis: A Retrospective Review. | LitMetric

Imaging Appearance of Advanced Chronic Adhesive Arachnoiditis: A Retrospective Review.

AJR Am J Roentgenol

1 Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

Published: September 2017

AI Article Synopsis

  • Chronic adhesive arachnoiditis (CAA) is a rare condition that can lead to serious clinical issues, and the article aims to enhance radiologists' understanding of its symptoms and imaging characteristics.* -
  • A review of 29 CAA cases revealed various underlying causes, including trauma and infections, with common imaging features like loculated cerebrospinal fluid collections, nerve root clumping, and spinal cord swelling.* -
  • The article emphasizes that recognizing CAA in imaging can help avoid unnecessary treatments and interventions, as its symptoms can resemble other neurological conditions.*

Article Abstract

Objective: Chronic adhesive arachnoiditis (CAA) is rare and has potentially devastating clinical consequences. The objective of this article is to review the clinical features of CAA and describe its appearance on imaging, to increase radiologists' awareness of this challenging diagnosis.

Materials And Methods: Twenty-nine cases of advanced CAA seen at our institution over 18 years (1995-2013) were retrospectively reviewed. Chart review was performed, with attention given to data on clinical presentation, suspected cause, and interventions performed. All patients underwent MRI, and seven patients also underwent CT myelography. Clinical and imaging features were evaluated and categorized.

Results: The 29 patients ranged in age from 23 to 96 years and included 11 women and 18 men. Suspected underlying causative factors included trauma (n = 10), prior surgery (n = 9), nontraumatic subarachnoid hemorrhage (n = 7), infection (n = 3), myelography with iophendylate used as contrast medium (n = 1), Guillain-Barré syndrome (n = 1), ankylosing spondylitis (n = 1), and unknown causes (n = 1). Imaging characteristics include loculated CSF collections (n = 23), nerve root clumping, enhancement, and displacement (n = 15), cord swelling with increased T2 signal (n = 12), arachnoid septations (n = 11), cord atrophy (n = 6), syrinx (n = 5), and intrathecal calcifications (n = 3). Ten patients underwent surgical procedures, and most had only brief clinical improvement.

Conclusion: CAA is a rare cause of devastating neurologic symptoms and chronic pain. The imaging features of CAA range from subtle to severe. Advanced arachnoiditis can present with spinal cord swelling and syrinx formation, which can mimic other disease processes. Inclusion of advanced CAA in the differential diagnosis can prevent unnecessary interventions.

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Source
http://dx.doi.org/10.2214/AJR.16.16704DOI Listing

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