척수동정맥기형의 임상 양상과 영상 소견

김상흠 대한영상의학회 1997 대한영상의학회지 Vol.37 No.6

Purpose:To evaluate the findings of magnetic resonance (MR) imaging and selective spinal angiography of spinal cord arteriovenous malformations (SCAVMs) and to investigate the correlation of these findings with the development of clinical symptoms. Materials and Methods:In 16 patients diagnosed as suffering from SCAVMs, MR imaging and selective spinal angiograms were retrospectively analyzed and correlated with clinical symptoms. Clinical data were reviewed, especially concerning the mode of onset of clinical symptoms, and MR images of SCAVMs were evaluated with regard 개 the following parameters;spinal cord selling with T2 hyperintensity, cord atrophy, intramedullary hemorrhage, and contrast enhancement of the spinal cord. Selective spinal angiographic findings of SCAVMs were also evaluated in terms of the Imaging findings were also correlated with the development of clinical symptoms. Results:Neurologic deficits, either scute(n=4) or insidious(n=11), were noted in 15 patients. One case withput any neurologic deficits was found incidentally. MR showed spinal cord swelling(10/16), atrophy(2/16), intramedullary hemorrhage(0/16), and contrast enhancement of the cord (8/12);spinal angiograms showed the presence of associated aneury는 (6/16) and radicular venous drainage (8/16). SCAVMs were metameric(n=4), intramedullary(n=9), or fistular(n=3). Nine of 11 patients with insidious onset showed spinal cord swelling and no radicular venous drainage with prominent perimedullary venous dilatation. Aneurysms were present in all four patients with abrupt symptoms. Conclusion;Systematic evaluation of the findings of MR imaging and angiography provides detailed information on the type of AVM and status of the spinal cord parenchyma, and this can be correlated with clinical manifestations of SCAVM. In patients suffering from this condition, spinal cord dysfunction due to venous congestion appears to be the main cause of clinical symptoms.

흰쥐 척수 손상후 Parvalbumin과 Calbindin D-28K 함유신경세포에 관한 면역세포화학적 연구

김종중,정윤영,임유택,박상수,박영란,김현곤,문정석 조선대학교 부설 의학연구소 2002 The Medical Journal of Chosun University Vol.27 No.2

Background and Objectives: This study was done to compared the distribution of the two calcium-binding proteins immunoreactive neurons, parvalbumin immunoreactiv (PV-IR) and calbindin D-28K immunoreactive (CB-IR) neurons in the spinal cord after transection. Materials and Methods: Twenty rats were divided into 3 groups (control, complete spinal cord injury (SCI), and right and left spinal cord hemisection). SCI was produced by cutting the spinal cord use blades 11 with scalpel handles. Results: In this experiment, CB-IR neurons were mainly found in many pyramidal cells distributed in the brain stem and spinal cord of rats. PV-IR Neurons were demonstrated in all lamina of the gray matter of the spinal cord. These immunoreactive cells had the highest density in the layer I and II of dorsal horn and several nuclei of the ventral horn of the all the segments of the spinal cord. CB-IR neuropil labeling was strongly noted in all the segments of the spinal cord. In contrast PV-IR neurons were different in distribution, size and morphology in the spinal cord. The number of PV-IR neurons were greater than in the spinal cord compared with the CB-IR neurons. CB-IR and PV-IR somata were round, oval, spindle and polygonal in shape, and were unipolar, bipolar, multipolar and horizontal in types. The diameters of the somata of the PV-IR and CB-IR neurons were 40-50 ㎛, respectively. Also dendrites of PV-IR and CB-IR neurons were densely arrayed in network.

Age-related change of Iba-1 immunoreactivity in the adult and aged gerbil spinal cord

Kwon Young Lee,Joo Yeon Kang,Jung Im Yun,Jin Young Chung,In Koo Hwang,Moo Ho Won,Jung Hoon Choi 대한해부학회 2017 Anatomy & Cell Biology Vol.50 No.2

In the present study, we examined change of ionized calcium-binding adapter molecule 1 (Iba-1) in the adult and aged gerbil spinal cords. Significant change of morphological feature and neuronal cell loss were not observed in both adult and aged spinal cords of gerbil after NeuN immunohistochemistry and Fluoro-Jade B histofluoresce staining. Iba-1–immunoreactive microglia broadly distributed in the spinal cord. Most of Iba-1–immunoreactive microglia showed ramified forms in the adult gerbil cervical and lumbar spinal cords. However, morphological changes of Iba-1–immunoreactive microglia were observed in the cervical and lumbar regions of the aged gerbil spinal cord. These microglia were showed a hypertrophied body with shortened swollen processes which was characteristic of activated microglia. In addition, Iba-1 protein level significantly higher in aged cervical and lumbar spinal cords than those in the adult gerbil. The present study showed an increase of activated forms of Iba-1–immunoreactive microglia and its protein level without marked changes in morphological features and neuronal loss in the aged spinal cord compared to those in the adult gerbil spinal cord. This result suggests that the increase of Iba-1 expression in the aged spinal cord may be closely associated with age-related changes in aged gerbil spinal cord.

Acute Spinal-Cord Ischemia: Evolution of MRI Findings

Cornelis L. Alblas,Willem H. Bouvy,Geert J. Lycklama à Nijeholt,Jelis Boiten 대한신경과학회 2012 Journal of Clinical Neurology Vol.8 No.3

Background and Purpose Magnetic resonance (MR) findings in acute spinal-cord ischemia can be summarized as focal cord enlargement and hyperintensities on T2-weighted images and gadolinium enhancement, especially of the central gray matter. However, in analogy with acute brain ischemia, it is to be expected that the findings of MR imaging (MRI) may be normal in the first hours after symptom onset. We evaluated the clinical and MRI findings in a series of patients with acute spinal-cord ischemia, and tested the hypothesis that the development and course of MR abnormalities are predictable. Methods Five patients with acute spinal-cord ischemia were admitted to our hospital over a 2-year period. Repeated MRI (1.5 T) was performed in all patients. Clinical data were retrieved from the patients’ charts. Results Four women and one man with a median age of 52 years (range, 31-75 years) were admitted. Three patients had anterior spinal artery infarction and two patients had transverse infarctions. All patients underwent spinal MRI within 24 hours; the findings were normal in four of the five patients. After 1-2 days, T2-weighted MRI generally exhibited focal cord enlargement and hyperintensity in all patients, while spinal-cord enhancement appeared after 2-11 days. Conclusions Acute spinal-cord ischemia may have a typical course on MRI. MRI findings are usually normal in the acute phase, but spinal cord swelling and T2 abnormality are expected after several days, while gadolinium enhancement appears even later after symptom onset. The sensitivity and specificity of MRI can be increased by repeated MRI in patients suspected of acute spinal-cord ischemia.

Clinical Significance of Incidental Focal 18F-FDG Uptake in the Spinal Cord of Patients with Cancer

임채홍,현승협,문승환,조영석,최연성,이경한,김병태,최준영 대한핵의학회 2017 핵의학 분자영상 Vol.51 No.3

Purpose We investigated the incidence, location, and clinical significance of focal 18F-FDG uptake of the spinal cord in patients with cancer. Methods We reviewed the medical records of 22,937 consecutive adult patients with known or suspicious malignancy who underwent 18F-FDG PET/CT. PET/CT scans with incidental focal spinal cord uptake were selected and retrospectively reviewed to determine the presence, location, number, and maximum standardized uptake value (SUVmax) of any focal hypermetabolic lesions of the spinal cord. In subjects with focal spinal uptake, clinical characteristics and clinical follow-up results, including follow-up PET/CT, were reviewed. Results Incidental focal spinal cord uptake was observed in 69 of 22,937 adult patients (incidence = 0.3%; M:F = 31:38; age, 55.8 ± 14.7 years). Seventy-eight focal hypermetabolic lesions on spinal cord in the PET/CT scans of the 69 study subjects were analyzed. The most common sites of focal spinal cord uptake were the T12 vertebra (47/78; 60.3%) and L1 vertebra (20/78; 25.6%). Multifocal cord uptake was found in 8 of 69 patients (11.6%). The average SUVmax for cord uptake was 2.5 ± 0.5 (range, 1.4∼3.9). There was no clinical or imaging evidence of abnormalities in the spinal cord, both at the time of PET/CT and during clinical follow-up. Conclusions Although incidental focal 18F-FDG uptake of the spinal cord is rare in patients with cancer, it may be physiological or benign, but it should not be considered as malignant involvement. Common sites for the uptake were in the T12 and L1 spine levels.

Spinal Cord Subependymoma Surgery : A Multi-Institutional Experience

Yuh, Woon Tak,Chung, Chun Kee,Park, Sung-Hye,Kim, Ki-Jeong,Lee, Sun-Ho,Kim, Kyoung-Tae The Korean Neurosurgical Society 2018 Journal of Korean neurosurgical society Vol.61 No.2

Objective : A spinal cord subependymoma is an uncommon, indolent, benign spinal cord tumor. It is radiologically similar to a spinal cord ependymoma, but surgical findings and outcomes differ. Gross total resection of the tumor is not always feasible. The present study was done to determine the clinical, radiological and pathological characteristics of spinal cord subependymomas. Methods : We retrospectively reviewed the medical records of ten spinal cord subependymoma patients (M : F=4 : 6; median 38 years; range, 21-77) from four institutions. Results : The most common symptoms were sensory changes and/or pain in eight patients, followed by motor weakness in six. The median duration of symptoms was 9.5 months. Preoperative radiological diagnosis was ependymoma in seven and astrocytoma in three. The tumors were located eccentrically in six and were not enhanced in six. Gross total resection of the tumor was achieved in five patients, whereas subtotal or partial resection was inevitable in the other five patients due to a poor dissection plane. Adjuvant radiotherapy was performed in two patients. Neurological deterioration occurred in two patients; transient weakness in one after subtotal resection and permanent weakness after gross total resection in the other. Recurrence or regrowth of the tumor was not observed during the median 31.5 months follow-up period (range, 8-89). Conclusion : Spinal cord subependymoma should be considered when the tumor is located eccentrically and is not dissected easily from the spinal cord. Considering the rather indolent nature of spinal cord subependymomas, subtotal removal without the risk of neurological deficit is another option.

급성 척수손상시 세포사망의 특성

진동규,김영수,윤도흠,주진양,이경희,성제경 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.12

척수 국소 저온에 대한 실험적 연구

최용일,주정화,조순구,이기찬,정용구 대한신경외과학회 1983 Journal of Korean neurosurgical society Vol.12 No.2

A study of effect of local hypothermia upon the spinal cord was performed in cats. With a cuff, a cooler, to which was attached connecting tubes to a refrigerator, the experimental technique was deviced to cool the spinal cord locally at midthoracic level. Cold liquid, saline at a temperature of ±1.1℃, was circulated in closed system through the tubing into the cuff which was snugly rested on the dorsal surface of the spinal cord as a heat exchanger. The temperatures were measured with thermocouples at various sites in the spinal cord before, during, and after the cooling every two minutes upto twenty minutes. In the cord underneath he cuff, the mean precooling temperature of 35.4℃ in normal control group was lowered to 11.0℃ during the first two minutes of cooling. After this in initial rapid drop in temperature, there was a further gradual reduction of 4.5℃ upto 20 minutes cooling to be 6.5℃. The lowest mean temperatures recorded throughout cooling were 4.3℃ at dorsal surface and 6.9℃ at center of the cord. And the temperature lowering was nearly not noted beyond the cord 1㎝ apart from an edge of cuff in rostral and caudal directions. For comparison, the temperature in the cord that had not been unjured was also measured. The rate of cooling in the cord underneath the cuff seemed to be faster than that in the control group of animal in which the cord was not injured. Another design of this experiment was an evaluation of the protective effect of local hypothermia with respect to cord edema and injury associated cord hemorrhage. Immediately after intravenous administrations of fluorescin the spinal cords were contused with impaction injury. These injured cords were removed at different time interval after trauma, and spread or distribution of fluorescin in frozen sectioned specimens was observed under ultraviolet illumination with fluorescence microscope. In all cooling groups, pathological pictures were reduced in its degree and extent more than those in the control group, and that, earlier the colling after the injury to the cord, better the result was outcome. It would be well to say that local hypothermia might be within the margin of safety and beneficial in the management of spinal cord injury in this experiment.

Vascular Endothelial Growth Factor Enhances Axonal Outgrowth in Organotypic Spinal Cord Slices via Vascular Endothelial Growth Factor Receptor 1 and 2

박환우,전효진,장미숙 한국조직공학과 재생의학회 2016 조직공학과 재생의학 Vol.13 No.5

Enhancing adult nerve regeneration is a potential therapeutic strategy for treating spinal cord injury. Vascular endothelial growth factor (VEGF) is a major contributor to angiogenesis, which can reduce the spinal cord injury by inhibiting the inflammation and improve recovery after spinal cord injury. We have previously demonstrated that exogenous VEGF has neurotrophic effects on injured spinal nerves in organotypic spinal cord slice cultures. However, the mechanisms underlying the neurite growth by exogenous VEGF remain to be explored in spinal cord. In this study, we found out that exogenous VEGF mediated axonal outgrowth through VEGF receptor 1 (VEGFR1) and VEGFR2, both of which were expressed on organotypic spinal cord slices. Although VEGFR1 and VEGFR2 were constitutively expressed in some cells of control spinal cord slices, VEGF treatment upregulated expression of VEGFR1 and VEGFR2. Both VEGFR1 and VEGFR2 were expressed in neuronal cells as well as glial cells of organotypic spinal cord slices. We also observed that VEGF-induced axonal outgrowth was attenuated by a specific mitogen-activated protein kinase (MAPK) inhibitor PD98059 and a specific phosphoinositide 3-kinase (PI3K) inhibitor wortmannin. Thus, these findings suggest that these MAPK and PI3K pathways have important roles in regulating VEGF-induced axonal outgrowth in the postnatal spinal cord.

척수경색의 확산강조자기공명영상

김윤정,서정진,임남열,정태웅,김윤현,박진균,정광우,강형근 대한자기공명의과학회 2002 Investigative Magnetic Resonance Imaging Vol.6 No.2

목적: 척수경색의 진단에서 현성확산계수 값의 측정을 포함한 확산강조자기공명영상의 유용성을 평가하고자하였다. 대상 및 방법: 척수 경색으로 진단받은 6명의 환자를 대상으로 후향적으로 분석하였다. 경색증상 발현 후 평균 5.4일이 지난 후에 1.5 T 초전도체 자기공명영상 기기를 이용하여 자기공명영상을 얻었다. 확산강조자기공명영상은 고식적인 b값($1000s/\textrm{mm}^2$)으로 하여 multi-shot echo planar imaging 기법을 이용하여 영상을 획득하였으며 개인용 컴퓨터로 옮겨져 현성확산계수 지도를 얻어 정상부위와 병변부위의 현성확산계수 값을 측정하였다. 자기공명영상에서 병변의 위치와 T1 과 T2 강조영상, 그리고 확산강조자기공명영상에서 나타나는 각각의 신호강도를 알아 보았고, 병변부위와 정상부위에서 측정한 현성확산계수 값을 비교하였다. 결과: T1강조영상에서 6예 중 4예에서 등신호강도를, 2예에서 저신호 강도를 보였고, T2강조 영상에서 6예 모두 고신호강도를 보였다. 또한 확산강조자기공명영상에서 6예 모두 고신호강도를 보였다. 현성확산계수 지도는 6예 전예에서 성공적으로 얻을 수 있었다. 현성확산계수 지도에서 6예 모두 정상과 뚜렷한 차이를 보이는 색조변화를 보였으며, 6예 모두 병변부위의 현성확산계수 값은 정상 부위의 현성확산계수의 값보다 더 낮았으며 통계적으로 유의하였다 (p<0.05 ). 결론: 척수경색 환자에서 척수병변의 확산강조자기공명영상과 현성확산계수 값의 측정이 가능하였다. 따라서 확산강조자기공명영상은 척수경색의 조기진단과 국재화(localization)에 유용하리라 보여진다. Purpose : To evaluate the usefulness of diffusion-weighted imaging(DWI) and quantitative apparent diffusion coefficient (ADC) maps in the patients with spinal cord infarction. Materials and methods : We studied 6 patients presented symptoms with spinal cord infarction, retrospectively (3 men and 3 women). We obtained multi-shot echo planar-based, DWI using 1.5T MR scanner at 5.4 mean days after the onset of ischemic symptoms. In six patients, signal intensity was acquired at conventional b value $1000s/\textrm{mm}^2$). The ADC value for the normal spinal cord and for infarcted lesions was measured from the trace ADC maps by using regions of interest positioned over the spinal cord. We analyzed signal intensity of lesion on MRI and DWI, and compared with ADC values in infarcted lesions and normal site. Results : T1-weighted MR image showed isosignal intensity in four of six patients and low signal intensity in two of six. T2-weighted MR image demonstrated high signal intensity in all of six. All DWI were considered to be diagnostic. All of six depicted a bright signal intensity on DWI. ADC values of infarcted lesion were measured lower than that of normal spinal cord on ADC map. The differences in ADC values between infarcted and normal spinal cord were significantly different (p<0.05). Conclusion : It is possible to obtain DWI and ADC map of the spinal cord and DWI may be useful in the early diagnosis and localization of lesion site in patients with spinal cord infarction.