Consultant Radiologist SGRH Lahore

Objective: Using histology as the gold standard, determine the diagnostic efficacy of MRI in the detection of intradural intramedullary spinal malignancies. 140 patients having a clinical suspicion of an intradural spinal tumour participated in this study. A 1.5-T Philips full body magnetic resonance equipment was used for the imaging. The cases underwent surgery, and histological findings were documented. Using histopathology as the gold standard, the results of magnetic resonance imaging and histopathology were compared. Results: On MRI, 26 patients (18.6%) of the 140 patients had an intramedullary tumour, making up 122 patients (87.2%) with an intradural spinal tumour.

Both 92.6% and 99.1% are high. For the evaluation of intradural spinal tumours, MRI is a highly accurate, non-invasive, secure, and practical imaging technique. It is useful for early identification, therapy planning, and directing surgical biopsies. Key words: magnetic resonance imaging, intramedullary tumours

Although spinal tumours are rare lesions, they can have a serious impact on morbidity through limb impairment. 1 With an incidence of 0.5 to 2.5 instances per 100,000 people, they make up 15% of all central nervous system malignancies. Identifying the site of cancerous growths and mass lesions in the placement of the spine in relation to the spinal cord and dura is crucial because specific lesions frequently develop there. Depending on where the mass lesions are, different diagnostic factors, treatments, and prognoses apply to these separate lesions. A needle biopsy, plain X-ray film, myelography, CT, and MRI are a few of the investigations. 3 The best imaging technique for analysing the majority of spinal malignancies is magnetic resonance imaging. It is highly helpful in the characterization of cancers since it makes it simple to classify tumours as extradural, intradural extramedullary, or intramedullary. A useful but invasive approach for evaluating spinal cord lesions is myelography.

7,8 The existence or absence of aberrant findings on plain film imaging, CT, or CT myelography cannot sufficiently rule out or confirm sketch out and describe an intradural tumour. A non-invasive method called magnetic resonance imaging has changed the diagnosis of intraspinal malignancies by enabling early detection and better anatomical localization. It is crucial for assessing spinal malignancies and is becoming increasingly important for staging and treatment.

The Diagnostic Radiology Department at Ganga Ram Hospital in Lahore conducted this investigation. Cross-sectional survey was used. the sample size The estimated sample size was 140 cases, with a 13% margin of error, a 95% confidence level, and the assumption that 50% of intradural spinal tumours would be expected, along with a sensitivity and specificity of 96.4% and 83.3% for magnetic resonance imaging in the diagnosis of intradural spinal tumours, respectively.

Study time: two year

Purposive sampling is non-probability.

Inclusion Requirements

1.10 to 70 years of age.

2.Both genders.

3.Patients who have been referred by a neurosurgeon with clinical suspicion of an intradural spinal tumour due to symptoms including neck discomfort, back pain, quadriplegia, or paraplegia. Exclusion Standards

4.Patients who should not undergo magnetic resonance imaging, such as those with pacemakers for the heart, artificial heart valves, cochlear implants, or coils or clips for brain aneurysms, as determined by their medical records.

5.Post-operative intradural spinal tumour patients whose medical records have been verified to rule out residual or recurring intradural spinal tumours.

6.Patients with other known primary malignant tumours, such as lung carcinoma, breast carcinoma, malignant melanoma, renal cell carcinoma, colorectal carcinoma, lymphoma, and medulloblastoma, who have been determined to be free of metastatic intradural cancer by the referring physician based on history and investigations and confirmed by medical records.

Neurosurgeons from outside Sir Ganga Ram Hospital, Lahore referred any patients who met the inclusion criteria and had clinical suspicion of an intradural spinal tumour. In order to prevent confounding factors, patients with spinal injuries and intradural malignancies that were metastatic, recurring, or residual were not included in the study. All of the study participants provided their informed consent for magnetic resonance imaging and histology. Age, gender, and address were all recorded for each patient as demographic characteristics. Then, magnetic resonance imaging was performed utilising a typical imaging coil on a 1.5-T Philips whole body MR system. The sagittal and axial projections of T2-weighted, unenhanced, and contrast-enhanced T1-weighted images were acquired.

Version 10 of SPSS was used to analyse every bit of data. Age, gender, the diagnosis from magnetic resonance imaging—whether an intradural spinal tumour was present or not—and the histological outcome were among the factors. The mean and standard deviation were calculated for quantitative data, such as age. Frequencies and percentages were determined for qualitative data, such as gender, magnetic resonance imaging diagnostic, such as the presence or absence of an intradural spinal tumour, and histological result. Using histology as the gold standard, a 2x2 table was utilised to calculate the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of magnetic resonance imaging for intradural spinal cancers.

RESULTS:Outcomes The results are detailed in tables (1-10). The Department of Diagnostic Radiology at Lahore General Hospital, Lahore, in partnership with the neurosurgery units there, conducted this study over a six-month period on 140 patients who had a clinical suspicion of an intradural spinal tumour.

Out of 140 patients, 25 had real positive results from the MRI, 112 had true negative results (the gold standard being histology), 2 had false positive results from the MRI, and 1 had false negative results. MRI had a 96.2% sensitivity rate, a 98.2% specificity rate, a 97.9% diagnostic accuracy rate, a 92.6% positive predictive value, and a 99.1% negative predictive value.

Out of 140 patients in the current study, 25 patients had true positive results from the MRI, 112 patients had true negative results using histology as the gold standard, whereas 2 patients had false positive results and 1 patient had false negative data. The overall sensitivity, specificity, and diagnostic accuracy of MRI were 96.2%, 98.2%, and 97.9%, respectively. The positive predictive value and negative predictive value of MRI were 92.6% and 99.1%, respectively. These findings closely match those of other studies. MRI was found to have a sensitivity of 96.4%, specificity of 83.3%, positive predictive value of 87.1%, and a negative predictive value of 95.7% in a research by De Verdelhan et al. This study's reported 92% diagnostic accuracy study. In a concentrate by Pourissa et al18, the responsiveness of X-ray for finding of intradural spinal growths was accounted for to be 94%. This shows that X-ray has a high responsiveness, particularity and demonstrative exactness in the identification of intradural spinal cancers, hence, it is certainly the best imaging methodology for assessing intradural spinal growths.

Every one of the patients with intradural spinal growths in this study showed contrast (Gadolinium-DTPA) upgrade on post-contrast pictures. Parizel et al12 announced contrast improvement of all the intradural spinal growths in their review. This differentiation upgrade likewise upholds the perceptions of Dillon et al11, Chamberlain et al14 and Sze et al in that all of the intramedullary spinal growths in their examinations became improved after organization of gadolinium contrast material. Intramedullary cancers upgrade with contrast media due to breakdown of blood-string barrier.12 Intradural extramedullary growths improve due to the penetrability of open hole intersections between endothelial cells creating veins in this manner working with the development of Gd-DTPA from vascular to extracellular space.

For the assessment of intradural spinal tumours, MRI is a highly accurate, non-invasive, secure, and practical imaging technique. It is also helpful for directing surgical biopsies, reducing the need for unneeded intervention. It makes it simple to categorise tumours as intradural extramedullary or intramedullary, which is very helpful in tumour characterisation and is essential for early discovery, care planning, and determining the prognosis of patients.

1. Van Goethem JW, van den Hauwe L, Ozsarlak O, De Schepper AM, Parizel PM. Spinal tumors. Eur J Radiol2004;50:159-76.

2. Beall DP, Googe DJ, Emery RL, Thompson DB, Campbell SE, Ly JQ, et al. Extramedullary intradural spinal tumors: a pictorial review. CurrProbl Diagn Radiol2007;36:185-98.

3. Radek A, Zapalowicz K, Maciejczak A, Karbownik J, Radek M, Gasinski P, et al. Strategy in the diagnostics and therapy of tumours of the spine. OrtopTraumatolRehabil2003;5:530-3.

4. Khanna AJ, Shindle MK, Wasserman BA, Gokaslan ZL, Gonzales RA, Buchowski JM, et al. Use of magnetic resonance imaging in differentiating compartmental location of spinal tumors. Am J Orthop2005;34:472-6.

5. Struffert T, Grunwald I, Roth C, Reith W. Spinal intradural tumors. Radiologe2004;44:1211-27.

6. Abul-Kasim K, Thurnher MM, Mckeever P, Sundgren PC. Intradural spinal tumors: current classification and MRI features. Neuroradiology 2008;50:301-14.

7. Akbar A. Myelography in spinal disorders - experience of 1400 cases. J Pak Med Assoc 2004;54:604-9.

8. Rizwi SMR, Salahuddin T, Naseem A. Myelography & its diagnostic aspects. Pak Postgrad Med J 2003;14:48-50.

9. Bloomer CW, Ackerman A, Bhatia RG. Imaging for spine tumors and new applications. Top MagnReson Imaging 2006;17:69-87.

10. De Verdelhan O, Haegelen C, Carsin-Nicol B, Riffaud L, Amlashi SF, Brassier G, et al. MR imaging features of spinal scwannomas and meningiomas. J Neuroradiol2005;32:42-9.

11. Dillon WP, Norman D, Newton TH, Bolla K, Mark A. Intradural spinal cord lesions: Gd-DTPA-enhanced MR imaging. Radiology1989;170:229-37.

12. Parizel PM, Balériaux D, Rodesch G, Segebarth C, Lalmand B, Christophe C, et al. Gd-DTPA-enhanced MR imaging of spinal tumors. Am J Roentgenol1989;152:1087-96.

13. Sze G, KrolG, Zimmerman RD, Deck MD. Intramedullary disease of the spine: Diagnosis using gadolinium-DTPA enhanced MR imaging. Am J Roentgenol1988;151:1193-204.

14. Chamberlain MC, Sandy AD, PressGA. Spinal cord tumors: gadolinium-DTPA-enhanced MR imaging.Neuroradiology 1991;33:469-74.

15. Sze G, Bravo S, Krol G. Spinal lesions: quantitative and qualitative temporal evolution of gadopentetate dimeglumine enhancement in MR imaging. Radiology 1989;170:849-56.

16. Long DM. Vascular ultrastructure in human meningiomas and schwannomas. J Neurosurg1973;38:409-19.

17. Watabe T, Azuma T. T1 and T2 measurements of meningiomas and neuromas before and after Gd-DTPA.Am J Neuroradiol1989;10:463-70.

18. Pourissa M, Refahi S, Dehghan MH. Report and review of spinal cord tumors. Res J Biol Sci 2007;2:654-7.

Aasma Ashraf. The Detection of Intradural Intramedullary Spinal Tumors by MRI Has a High Diagnostic Accuracy. Insights of Clinical and Medical Images 2022.