MR imaging of intramedullary and intradural-extramedullary spinal cysticercosis

The purpose of our study was to retrospectively review the MR imaging findings in a group of patients with clinically proven cysticercosis involving the spinal cord, the spinal subarachnoid space, or both. We retrospectively reviewed images of 16 patients with clinically diagnosed spinal cysticercosis to summarize the imaging characteristics. All patients underwent T1- and T2-weighted sagittal, axial, or both sagittal and axial MR imaging before i.v. administration of paramagnetic contrast media. Thirteen patients also underwent sagittal, axial, or both sagittal and axial T1-weighted MR imaging after i.v. gadolinium administration. In addition, all patients underwent cranial CT, MR imaging, or both to reveal possible evidence of cranial cysticercosis. MR imaging revealed isolated intradural-extramedullary involvement (n = 9), isolated intramedullary involvement (n = 3), combined intradural-extramedullary and intramedullary involvement (n = 3), and/or syringomyelia caused by infection and associated with chronic spinal arachnoiditis (n = 2). Evidence of intradural-extramedullary disease included cystic structures within the subarachnoid space or homogeneous sheetlike enhancement within the subarachnoid space over the surface of the spinal cord. Evidence of intramedullary disease included focal cystic lesions or syringomyelic cavitation of the spinal cord. All patients had evidence of simultaneous intracranial cysticercosis as shown on cranial CT, MR imaging, or both. In the absence of scolex visualization, cysticercotic involvement of the spinal cord or spinal subarachnoid space has a nonspecific appearance on MR imaging. On the basis of the findings in this group of patients, we believe that spinal cysticercosis is most often accompanied by intracranial disease.