What is the role of MRI in the evaluation of conus medullaris and cauda equina syndrome?

Updated: Jun 14, 2018
  • Author: Segun Toyin Dawodu, JD, MD, MS, MBA, LLM, FAAPMR, FAANEM; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Answer

MRI with gadolinium contrast of the lumbosacral area is the diagnostic test of choice to define pathology in the areas of the conus medullaris and cauda equina (see the images below). It provides a more complete radiographic assessment of the spine than other tests; plain x-rays and CT scan may be normal. [85, 82] . Gadolinium contrast MRI also may be able to rule out abdominal aneurysm, which could be the source of emboli causing conus medullaris infarction. See the following images for representative MRIs.

Conus/epiconus infarction in the setting of sickle Conus/epiconus infarction in the setting of sickle cell crisis. Image courtesy of Matthew J. Baker, MD.
Conus/epiconus infarction in the setting of sickle Conus/epiconus infarction in the setting of sickle cell crisis in the same patient shown in the above image. Image courtesy of Matthew J. Baker, MD.
Conus/epiconus infarction in the setting of sickle Conus/epiconus infarction in the setting of sickle cell crisis in the same patient shown in the images above. Image courtesy of Matthew J. Baker, MD.

Schwannomas are visible using myelography, but MRI is the criterion standard. Schwannomas are isointense on T1 images, hyperintense on T2 images, and enhanced with gadolinium contrast. With infectious conditions, MRI can display the abnormal appearance of the nerve roots being forced to one side of the dural sac.


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