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Intraspinal Paragonimiasis in Children: MRI Findings and Suggestions for Pathogenesis.
AJNR Am J Neuroradiol. 2019 12; 40(12):2166-2171.AA

Abstract

BACKGROUND AND PURPOSE

Intraspinal paragonimiasis is a rare entity for which imaging findings have seldom been described. The present study investigated the MR imaging features of spinal paragonimiasis, thus providing diagnostic imaging evidence and exploring the possible pathogenesis of intraspinal paragonimiasis.

MATERIALS AND METHODS

The clinical and imaging findings of spinal paragonimiasis in 6 children were analyzed retrospectively. Spinal MR imaging was performed in all patients, 5 of whom also underwent enhanced MR imaging. The diagnosis was confirmed by enzyme-linked immunosorbent assay in all cases and postoperative pathology in 4 cases.

RESULTS

All cases manifested as fusiform-shaped or beanlike masses in the extradural space in the thoracic spine. The extradural masses were connected with pleural lesions through the intervertebral foramen. The plain MR imaging scan showed mixed signals with predominant isointensity on T1WI and hyperintensity on T2WI, among which 5 (5/6) masses presented as patchy hemorrhage with hyperintensity on T1WI. On enhanced scans, all masses (5/5) showed heterogeneous marked enhancement, with thickening and enhancement in the adjacent spinal meninges (5/5). Various degrees of spinal cord compression and edema were found in 5 cases (5/6).

CONCLUSIONS

MR imaging is sensitive for detecting and characterizing spinal paragonimiasis. The MR imaging features of intraspinal granulomas included localization to the extradural space and thoracic segment, connections between intraspinal lesions and pleural lesions through the intervertebral foramen, and hemorrhagic foci within the mass. These findings support an intraspinal mode of paragonimiasis pathogenesis: The Paragonimus larvae migrate from the chest into the extradural space through the intervertebral foramen.

Authors+Show Affiliations

From the Departments of Radiology (Y.Q., J.C., L.T., S.J., L.W., X.H.).From the Departments of Radiology (Y.Q., J.C., L.T., S.J., L.W., X.H.) cai_jinhua@126.com.Neurosurgery (W.J.), Children's Hospital of Chongqing Medical University, Chongqing, China.Outpatient Surgery (X.C.).From the Departments of Radiology (Y.Q., J.C., L.T., S.J., L.W., X.H.).From the Departments of Radiology (Y.Q., J.C., L.T., S.J., L.W., X.H.).From the Departments of Radiology (Y.Q., J.C., L.T., S.J., L.W., X.H.).From the Departments of Radiology (Y.Q., J.C., L.T., S.J., L.W., X.H.).

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31727748

Citation

Qin, Y, et al. "Intraspinal Paragonimiasis in Children: MRI Findings and Suggestions for Pathogenesis." AJNR. American Journal of Neuroradiology, vol. 40, no. 12, 2019, pp. 2166-2171.
Qin Y, Cai J, Ji W, et al. Intraspinal Paragonimiasis in Children: MRI Findings and Suggestions for Pathogenesis. AJNR Am J Neuroradiol. 2019;40(12):2166-2171.
Qin, Y., Cai, J., Ji, W., Chen, X., Tian, L., Jun, S., Wang, L., & He, X. (2019). Intraspinal Paragonimiasis in Children: MRI Findings and Suggestions for Pathogenesis. AJNR. American Journal of Neuroradiology, 40(12), 2166-2171. https://doi.org/10.3174/ajnr.A6296
Qin Y, et al. Intraspinal Paragonimiasis in Children: MRI Findings and Suggestions for Pathogenesis. AJNR Am J Neuroradiol. 2019;40(12):2166-2171. PubMed PMID: 31727748.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraspinal Paragonimiasis in Children: MRI Findings and Suggestions for Pathogenesis. AU - Qin,Y, AU - Cai,J, AU - Ji,W, AU - Chen,X, AU - Tian,L, AU - Jun,S, AU - Wang,L, AU - He,X, Y1 - 2019/11/14/ PY - 2019/06/08/received PY - 2019/09/03/accepted PY - 2020/12/01/pmc-release PY - 2019/11/16/pubmed PY - 2020/7/14/medline PY - 2019/11/16/entrez SP - 2166 EP - 2171 JF - AJNR. American journal of neuroradiology JO - AJNR Am J Neuroradiol VL - 40 IS - 12 N2 - BACKGROUND AND PURPOSE: Intraspinal paragonimiasis is a rare entity for which imaging findings have seldom been described. The present study investigated the MR imaging features of spinal paragonimiasis, thus providing diagnostic imaging evidence and exploring the possible pathogenesis of intraspinal paragonimiasis. MATERIALS AND METHODS: The clinical and imaging findings of spinal paragonimiasis in 6 children were analyzed retrospectively. Spinal MR imaging was performed in all patients, 5 of whom also underwent enhanced MR imaging. The diagnosis was confirmed by enzyme-linked immunosorbent assay in all cases and postoperative pathology in 4 cases. RESULTS: All cases manifested as fusiform-shaped or beanlike masses in the extradural space in the thoracic spine. The extradural masses were connected with pleural lesions through the intervertebral foramen. The plain MR imaging scan showed mixed signals with predominant isointensity on T1WI and hyperintensity on T2WI, among which 5 (5/6) masses presented as patchy hemorrhage with hyperintensity on T1WI. On enhanced scans, all masses (5/5) showed heterogeneous marked enhancement, with thickening and enhancement in the adjacent spinal meninges (5/5). Various degrees of spinal cord compression and edema were found in 5 cases (5/6). CONCLUSIONS: MR imaging is sensitive for detecting and characterizing spinal paragonimiasis. The MR imaging features of intraspinal granulomas included localization to the extradural space and thoracic segment, connections between intraspinal lesions and pleural lesions through the intervertebral foramen, and hemorrhagic foci within the mass. These findings support an intraspinal mode of paragonimiasis pathogenesis: The Paragonimus larvae migrate from the chest into the extradural space through the intervertebral foramen. SN - 1936-959X UR - https://www.unboundmedicine.com/medline/citation/31727748/Intraspinal_Paragonimiasis_in_Children:_MRI_Findings_and_Suggestions_for_Pathogenesis L2 - http://www.ajnr.org/cgi/pmidlookup?view=long&pmid=31727748 DB - PRIME DP - Unbound Medicine ER -