Figure 1125

Sagittal T1WI with contrast showing a large, lobulated, strongly hyperintense ependymoma. Courtesy Dr. J. Houten.

interpedicular distance, scalloping of the posterior vertebral bodies, and at times widened foraminae and eroded pedicles. CT discloses the enlarged spinal canal and might depict an isodense intradural mass that might enhance following contrast administration. On MRI, an isointense mass on T1WI that appears hyperintense to the cord on T2WI and intensely enhances following contrast administration can be seen (Figure 11-25).

Plain films in astrocytomas may be negative. Occasionally canal expansion may be noticed. On CT images cord thickening is noted, with possible mild enhancement following contrast administration. MRI will clearly demonstrate the dilated cord, which may appear on T1WI hypoin-tense or isointense to the cerebrospinal fluid. Occasionally hypointense cysts may be spotted on T1WI within the mass. The mass will appear hyperintense on T2WI and will further enhance following contrast administration. Occasionally cysts and syrinx may be observed in MRI studies.

Management

Microsurgery with tumor debulking may offer some hope for functional improvement. In patients with high-grade tumors, postoperative radiotherapy is indicated.

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Paget's disease (PD), also known as osteitis deformans, was initially described by Dr. James Paget in 1877 and bears his name. PD usually appears in the sixth through eighth decades, rarely under age 40, and is frequently incidentally discovered when patients take radiological tests for other reasons. The disease is commonly seen in Caucasian people of European descent and is more common in males. Up to 10% of Caucasians over 70 years old may be affected by PD. The disorder is rarely seen in people of Asian and African descent.

The etiology of Paget's disease (PD) is still unclear. Genetic factors and slow viruses have been implicated but there is still no conclusive evidence for either cause. Several studies have reported an increased level of interleukin-6, which induces osteoclast formation in PD. In the last two decades it has been observed that the incidence of PD and the severity of the illness in newly diagnosed patients are both decreasing.

PD is a chronic disorder characterized by increased osteoclast activity leading to bone resorption and, alongside it, increased osteo-blastic activity resulting in the production of disordered, irregular new bone. The disease activity level can be monitored by following the bone isoenzyme of alkaline phosphatase.

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