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<meta name="DC.Title" content="Acute Myelopathy or Cauda Equina Syndrome in HIV-Positive Adults in a Tuberculosis Endemic Setting: MRI, Clinical, and Pathologic Findings" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3958" />
<meta name="DC.Date" content="2014-08-01" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Cape Town is the center of an HIV-tuberculosis coepidemic. This study's aim was to highlight the importance and to describe the MR imaging features of tuberculosis in acute myelopathy and cauda equina syndrome in HIV-positive adults. To accomplish this we retrospectively reviewed the MR imaging and clinico-pathologic findings of HIV-positive patients presenting to our hospital with recent onset paraplegia and sphincter dysfunction over a 4-year period, 2008–2011.

MATERIALS &amp; METHODS: MR imaging, CD4 count, and CSF analysis and pathology were correlated in 216 cases.

RESULTS: Fifty-eight percent (127) of subjects were female. The mean age was 37 years. The median CD4 count was 185 cells/μL. Twenty-five percent (54) of patients were on antiretroviral therapy. MR imaging showed spondylitis in 30% (65). The median CD4 count in these patients was significantly higher than in the remainder. Disk destruction was common and 10% had synchronous spondylitis elsewhere in the spinal column. Thirty percent (64) had features of myelitis/arachnoiditis. Twenty-five percent (55) had no MR imaging abnormality. In 123 (57%) of cases with a definitive etiology on CSF culture or biopsy, 84 (68%) were attributable to tuberculosis including all spondylitis cases and 40% of nonspondylitis cases. Twelve (10%) were due to nontuberculous infection and 12 (10%) had HIV-associated tumors including 2 rare Epstein-Barr–related tumors.

CONCLUSIONS: In our setting, acute onset myelopathy/cauda equina syndrome in HIV-positive patients is largely attributable to tuberculosis with nonspondylitic forms being more common than spondylitis and associated with a lower CD4 count.

TB
:   tuberculosis
ARV
:   antiretroviral
EB
:   Epstein-Barr virus" />
<meta name="DC.Contributor" content="S. Candy" />
<meta name="DC.Contributor" content="G. Chang" />
<meta name="DC.Contributor" content="S. Andronikou" />
<meta name="article:published_time" content="2014-08-01" />
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<meta name="citation_title" content="Acute Myelopathy or Cauda Equina Syndrome in HIV-Positive Adults in a Tuberculosis Endemic Setting: MRI, Clinical, and Pathologic Findings" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Cape Town is the center of an HIV-tuberculosis coepidemic. This study9s aim was to highlight the importance and to describe the MR imaging features of tuberculosis in acute myelopathy and cauda equina syndrome in HIV-positive adults. To accomplish this we retrospectively reviewed the MR imaging and clinico-pathologic findings of HIV-positive patients presenting to our hospital with recent onset paraplegia and sphincter dysfunction over a 4-year period, 2008–2011.&lt;/p&gt;&lt;h3&gt;MATERIALS &amp;amp; METHODS:&lt;/h3&gt;
&lt;p&gt;MR imaging, CD4 count, and CSF analysis and pathology were correlated in 216 cases.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Fifty-eight percent (127) of subjects were female. The mean age was 37 years. The median CD4 count was 185 cells/μL. Twenty-five percent (54) of patients were on antiretroviral therapy. MR imaging showed spondylitis in 30% (65). The median CD4 count in these patients was significantly higher than in the remainder. Disk destruction was common and 10% had synchronous spondylitis elsewhere in the spinal column. Thirty percent (64) had features of myelitis/arachnoiditis. Twenty-five percent (55) had no MR imaging abnormality. In 123 (57%) of cases with a definitive etiology on CSF culture or biopsy, 84 (68%) were attributable to tuberculosis including all spondylitis cases and 40% of nonspondylitis cases. Twelve (10%) were due to nontuberculous infection and 12 (10%) had HIV-associated tumors including 2 rare Epstein-Barr–related tumors.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;In our setting, acute onset myelopathy/cauda equina syndrome in HIV-positive patients is largely attributable to tuberculosis with nonspondylitic forms being more common than spondylitis and associated with a lower CD4 count.&lt;/p&gt;" />
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<meta name="twitter:title" content="Acute Myelopathy or Cauda Equina Syndrome in HIV-Positive Adults in a Tuberculosis Endemic Setting: MRI, Clinical, and Pathologic Findings" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Cape Town is the center of an HIV-tuberculosis coepidemic. This study's aim was to highlight the importance and to describe the MR imaging features of tuberculosis in acute myelopathy and cauda equina syndrome in HIV-positive adults. To accomplish this we retrospectively reviewed the MR imaging and clinico-pathologic findings of HIV-positive patients presenting to our hospital with recent onset paraplegia and sphincter dysfunction over a 4-year period, 2008–2011.

MATERIALS &amp; METHODS: MR imaging, CD4 count, and CSF analysis and pathology were correlated in 216 cases.

RESULTS: Fifty-eight percent (127) of subjects were female. The mean age was 37 years. The median CD4 count was 185 cells/μL. Twenty-five percent (54) of patients were on antiretroviral therapy. MR imaging showed spondylitis in 30% (65). The median CD4 count in these patients was significantly higher than in the remainder. Disk destruction was common and 10% had synchronous spondylitis elsewhere in the spinal column. Thirty percent (64) had features of myelitis/arachnoiditis. Twenty-five percent (55) had no MR imaging abnormality. In 123 (57%) of cases with a definitive etiology on CSF culture or biopsy, 84 (68%) were attributable to tuberculosis including all spondylitis cases and 40% of nonspondylitis cases. Twelve (10%) were due to nontuberculous infection and 12 (10%) had HIV-associated tumors including 2 rare Epstein-Barr–related tumors.

CONCLUSIONS: In our setting, acute onset myelopathy/cauda equina syndrome in HIV-positive patients is largely attributable to tuberculosis with nonspondylitic forms being more common than spondylitis and associated with a lower CD4 count.

TB
:   tuberculosis
ARV
:   antiretroviral
EB
:   Epstein-Barr virus" />
<meta name="og-title" property="og:title" content="Acute Myelopathy or Cauda Equina Syndrome in HIV-Positive Adults in a Tuberculosis Endemic Setting: MRI, Clinical, and Pathologic Findings" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/35/8/1634" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Cape Town is the center of an HIV-tuberculosis coepidemic. This study's aim was to highlight the importance and to describe the MR imaging features of tuberculosis in acute myelopathy and cauda equina syndrome in HIV-positive adults. To accomplish this we retrospectively reviewed the MR imaging and clinico-pathologic findings of HIV-positive patients presenting to our hospital with recent onset paraplegia and sphincter dysfunction over a 4-year period, 2008–2011.

MATERIALS &amp; METHODS: MR imaging, CD4 count, and CSF analysis and pathology were correlated in 216 cases.

RESULTS: Fifty-eight percent (127) of subjects were female. The mean age was 37 years. The median CD4 count was 185 cells/μL. Twenty-five percent (54) of patients were on antiretroviral therapy. MR imaging showed spondylitis in 30% (65). The median CD4 count in these patients was significantly higher than in the remainder. Disk destruction was common and 10% had synchronous spondylitis elsewhere in the spinal column. Thirty percent (64) had features of myelitis/arachnoiditis. Twenty-five percent (55) had no MR imaging abnormality. In 123 (57%) of cases with a definitive etiology on CSF culture or biopsy, 84 (68%) were attributable to tuberculosis including all spondylitis cases and 40% of nonspondylitis cases. Twelve (10%) were due to nontuberculous infection and 12 (10%) had HIV-associated tumors including 2 rare Epstein-Barr–related tumors.

CONCLUSIONS: In our setting, acute onset myelopathy/cauda equina syndrome in HIV-positive patients is largely attributable to tuberculosis with nonspondylitic forms being more common than spondylitis and associated with a lower CD4 count.

TB
:   tuberculosis
ARV
:   antiretroviral
EB
:   Epstein-Barr virus" />
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<div id="hw-article-author-popups-top-node-13597--62008661165" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">S. Candy </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (S.C., G.C.), Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BCandy%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Candy%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.%2BCandy%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">G. Chang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (S.C., G.C.), Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BChang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chang%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AG.%2BChang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">S. Andronikou </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (S.A.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BAndronikou%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Andronikou%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.%2BAndronikou%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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        <h2 class="pane-title">Article Figures &amp; Data</h2>
    
  
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    <div class="elements-frag-data highwire-markup" id="fig-data"><div id="fig-data-figures" class="group frag-figure"><div class="fig-data-title-jump clearfix"><h3 class="fig-data-group-title">Figures</h3><div class="fig-data-jump-links"><ul class="fig-data-jump-links-list links inline"><li class="table first last"><a href="#fig-data-tables" class="fig-data-jump-link fig-data-jump-link-table link-icon"><span class="icon-caret-down"></span> <span class="title">Tables</span></a></li></ul></div></div><div class="item-list"><ul class="fig-data-list clearfix" id="fragments-fig"><li class="first"><div class="element-fig-data clearfix figure-caption"><div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="fig-expansion " id="F1"><span class="highwire-journal-article-marker-start"></span><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F1.large.jpg?width=800&amp;height=600&amp;carousel=1" title="Summary of causation of myelopathy. Abbreviations: CC indicates cryptococcus; Zoster, Varicella zoster; MA, Mycobacterium avium; EC, enterococcus; and MEAS, measles; CMV, cytomegalovirus." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-49916000" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;&lt;div xmlns=&quot;http://www.w3.org/1999/xhtml&quot;&gt;Summary of causation of myelopathy. Abbreviations: CC indicates &lt;em&gt;cryptococcus&lt;/em&gt;; Zoster, Varicella zoster; MA, &lt;em&gt;Mycobacterium avium&lt;/em&gt;; EC, &lt;em&gt;enterococcus;&lt;/em&gt; and MEAS, measles; CMV, cytomegalovirus.&lt;/div&gt;&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Fig 1." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F1.medium.gif" width="440" height="258"/><noscript><img class="highwire-fragment fragment-image" alt="Fig 1." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F1.medium.gif" width="440" height="258"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F1.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Fig 1." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F1.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/42618" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="fig-label">Fig 1.</span> <p id="p-30">Summary of causation of myelopathy. Abbreviations: CC indicates <em>cryptococcus</em>; Zoster, Varicella zoster; MA, <em>Mycobacterium avium</em>; EC, <em>enterococcus;</em> and MEAS, measles; CMV, cytomegalovirus.</p><div class="sb-div caption-clear"></div></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div></div></li><li><div class="element-fig-data clearfix figure-caption"><div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="fig-expansion " id="F2"><span class="highwire-journal-article-marker-start"></span><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F2.large.jpg?width=800&amp;height=600&amp;carousel=1" title="Tuberculous spondylo-diskitis. A, Sagittal T2-weighted MR imaging demonstrates caseous destruction of the L2&#x2013;3 disk with epidural collection causing compression of the conus. B, Coronal FISP demonstrates large psoas abscesses communicating with the L2&#x2013;3 disk. A thick walled collection displaces the right kidney superiorly." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-49916000" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;&lt;div xmlns=&quot;http://www.w3.org/1999/xhtml&quot;&gt;Tuberculous spondylo-diskitis. &lt;em&gt;A&lt;/em&gt;, Sagittal T2-weighted MR imaging demonstrates caseous destruction of the L2&#x2013;3 disk with epidural collection causing compression of the conus. &lt;em&gt;B&lt;/em&gt;, Coronal FISP demonstrates large psoas abscesses communicating with the L2&#x2013;3 disk. A thick walled collection displaces the right kidney superiorly.&lt;/div&gt;&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Fig 2." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F2.medium.gif" width="440" height="237"/><noscript><img class="highwire-fragment fragment-image" alt="Fig 2." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F2.medium.gif" width="440" height="237"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F2.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Fig 2." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F2.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/42625" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="fig-label">Fig 2.</span> <p id="p-39">Tuberculous spondylo-diskitis. <em>A</em>, Sagittal T2-weighted MR imaging demonstrates caseous destruction of the L2–3 disk with epidural collection causing compression of the conus. <em>B</em>, Coronal FISP demonstrates large psoas abscesses communicating with the L2–3 disk. A thick walled collection displaces the right kidney superiorly.</p><div class="sb-div caption-clear"></div></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div></div></li><li><div class="element-fig-data clearfix figure-caption"><div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="fig-expansion " id="F3"><span class="highwire-journal-article-marker-start"></span><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F3.large.jpg?width=800&amp;height=600&amp;carousel=1" title="Nonspondylitic spinal tuberculosis. A, T1 sagittal pregadolinium image with increased signal of the CSF. B, T2 sagittal shows root thickening. C and D, T1 sagittal postgadolinium demonstrates circumferential cord and root enhancement. E, T2 sagittal shows loculated CSF with extensive cord signal abnormality." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-49916000" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;&lt;div xmlns=&quot;http://www.w3.org/1999/xhtml&quot;&gt;Nonspondylitic spinal tuberculosis. &lt;em&gt;A&lt;/em&gt;, T1 sagittal pregadolinium image with increased signal of the CSF. &lt;em&gt;B&lt;/em&gt;, T2 sagittal shows root thickening. &lt;em&gt;C&lt;/em&gt; and &lt;em&gt;D&lt;/em&gt;, T1 sagittal postgadolinium demonstrates circumferential cord and root enhancement. &lt;em&gt;E&lt;/em&gt;, T2 sagittal shows loculated CSF with extensive cord signal abnormality.&lt;/div&gt;&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Fig 3." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F3.medium.gif" width="440" height="271"/><noscript><img class="highwire-fragment fragment-image" alt="Fig 3." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F3.medium.gif" width="440" height="271"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F3.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Fig 3." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F3.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/42524" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="fig-label">Fig 3.</span> <p id="p-43">Nonspondylitic spinal tuberculosis. <em>A</em>, T1 sagittal pregadolinium image with increased signal of the CSF. <em>B</em>, T2 sagittal shows root thickening. <em>C</em> and <em>D</em>, T1 sagittal postgadolinium demonstrates circumferential cord and root enhancement. <em>E</em>, T2 sagittal shows loculated CSF with extensive cord signal abnormality.</p><div class="sb-div caption-clear"></div></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div></div></li><li><div class="element-fig-data clearfix figure-caption"><div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="fig-expansion " id="F4"><span class="highwire-journal-article-marker-start"></span><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F4.large.jpg?width=800&amp;height=600&amp;carousel=1" title="Burkitt lymphoma. A, Coronal FISP showing nonfluid-containing right L2/3 paraspinal and right pelvic masses infiltrating the right iliac bone and multiple low-signal lesions in both renal cortices. B, Sagittal T1 shows diffusely low marrow signal with isointense epidural masses posterior to the bodies of L5, S1, and S2." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-49916000" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;&lt;div xmlns=&quot;http://www.w3.org/1999/xhtml&quot;&gt;Burkitt lymphoma. &lt;em&gt;A&lt;/em&gt;, Coronal FISP showing nonfluid-containing right L2/3 paraspinal and right pelvic masses infiltrating the right iliac bone and multiple low-signal lesions in both renal cortices. &lt;em&gt;B&lt;/em&gt;, Sagittal T1 shows diffusely low marrow signal with isointense epidural masses posterior to the bodies of L5, S1, and S2.&lt;/div&gt;&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Fig 4." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F4.medium.gif" width="440" height="220"/><noscript><img class="highwire-fragment fragment-image" alt="Fig 4." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F4.medium.gif" width="440" height="220"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F4.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Fig 4." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F4.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/42539" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="fig-label">Fig 4.</span> <p id="p-78">Burkitt lymphoma. <em>A</em>, Coronal FISP showing nonfluid-containing right L2/3 paraspinal and right pelvic masses infiltrating the right iliac bone and multiple low-signal lesions in both renal cortices. <em>B</em>, Sagittal T1 shows diffusely low marrow signal with isointense epidural masses posterior to the bodies of L5, S1, and S2.</p><div class="sb-div caption-clear"></div></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div></div></li><li><div class="element-fig-data clearfix figure-caption"><div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="fig-expansion " id="F5"><span class="highwire-journal-article-marker-start"></span><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F5.large.jpg?width=800&amp;height=600&amp;carousel=1" title="Plasmablastic lymphoma. A, Axial T2-weighted MR imaging shows a large destructive lobulated mass in the left hemithorax infiltrating the thoracic spinal canal via the neural foramen. B, T2-weighted sagittal MR imaging showing posterior epidural cord compression." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-49916000" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;&lt;div xmlns=&quot;http://www.w3.org/1999/xhtml&quot;&gt;Plasmablastic lymphoma. &lt;em&gt;A&lt;/em&gt;, Axial T2-weighted MR imaging shows a large destructive lobulated mass in the left hemithorax infiltrating the thoracic spinal canal via the neural foramen. &lt;em&gt;B&lt;/em&gt;, T2-weighted sagittal MR imaging showing posterior epidural cord compression.&lt;/div&gt;&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Fig 5." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F5.medium.gif" width="381" height="440"/><noscript><img class="highwire-fragment fragment-image" alt="Fig 5." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F5.medium.gif" width="381" height="440"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F5.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Fig 5." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F5.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/42600" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="fig-label">Fig 5.</span> <p id="p-79">Plasmablastic lymphoma. <em>A</em>, Axial T2-weighted MR imaging shows a large destructive lobulated mass in the left hemithorax infiltrating the thoracic spinal canal via the neural foramen. <em>B</em>, T2-weighted sagittal MR imaging showing posterior epidural cord compression.</p><div class="sb-div caption-clear"></div></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div></div></li><li class="last"><div class="element-fig-data clearfix figure-caption"><div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="fig-expansion " id="F6"><span class="highwire-journal-article-marker-start"></span><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F6.large.jpg?width=800&amp;height=600&amp;carousel=1" title="EB-associated myopericytoma. A, Sagittal T2-weighted MR imaging shows predominantly low-signal epidural mass causing significant cord compression at T6/7 with abnormal marrow in the adjacent vertebral body. B, Coronal FISP demonstrates improved conspicuity of marrow signal abnormality. C, Axial T2-weighted image shows tumor displacing and compressing the cord." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-49916000" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;&lt;div xmlns=&quot;http://www.w3.org/1999/xhtml&quot;&gt;EB-associated myopericytoma. &lt;em&gt;A&lt;/em&gt;, Sagittal T2-weighted MR imaging shows predominantly low-signal epidural mass causing significant cord compression at T6/7 with abnormal marrow in the adjacent vertebral body. &lt;em&gt;B&lt;/em&gt;, Coronal FISP demonstrates improved conspicuity of marrow signal abnormality. &lt;em&gt;C&lt;/em&gt;, Axial T2-weighted image shows tumor displacing and compressing the cord.&lt;/div&gt;&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Fig 6." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F6.medium.gif" width="440" height="411"/><noscript><img class="highwire-fragment fragment-image" alt="Fig 6." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F6.medium.gif" width="440" height="411"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F6.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Fig 6." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/35/8/1634/F6.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/42658" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="fig-label">Fig 6.</span> <p id="p-82">EB-associated myopericytoma. <em>A</em>, Sagittal T2-weighted MR imaging shows predominantly low-signal epidural mass causing significant cord compression at T6/7 with abnormal marrow in the adjacent vertebral body. <em>B</em>, Coronal FISP demonstrates improved conspicuity of marrow signal abnormality. <em>C</em>, Axial T2-weighted image shows tumor displacing and compressing the cord.</p><div class="sb-div caption-clear"></div></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div></div></li></ul></div></div><div id="fig-data-tables" class="group frag-table"><div class="fig-data-title-jump clearfix"><h3 class="fig-data-group-title">Tables</h3><div class="fig-data-jump-links"><ul class="fig-data-jump-links-list links inline"><li class="figure first last"><a href="#fig-data-figures" class="fig-data-jump-link fig-data-jump-link-figure link-icon"><span class="icon-caret-up"></span> <span class="title">Figures</span></a></li></ul></div></div><div class="item-list"><ul class="fig-data-list clearfix" id="fragments-table"><li class="first"><div class="element-fig-data clearfix table-caption"><div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="table-expansion " id="T1"><span class="highwire-journal-article-marker-start"></span><div class="table-caption"><ul class="inline table-expansion-links"><li class="view-popup first last"><a href="/highwire/markup/42639/expansion?width=1000&amp;height=500&amp;iframe=true&amp;postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed" class="colorbox colorbox-load table-expand-popup" rel="gallery-fragment-tables-2011091519" data-icon-position="" data-hide-link-title="0">View popup</a></li></ul><span class="table-label">Table 1:</span> <p id="p-24">MRI-based pathologic categories in 216 patients with HIV and acute onset myelopathy/cauda equina</p><div class="sb-div caption-clear"></div></div><table frame="hsides" id="table-1" alt="Table 1:"><thead valign="bottom" id="thead-1" class="table-vbottom"><tr id="tr-1"><th align="center" rowspan="1" colspan="1" id="th-1" class="table-center table-bborder">MRI Normal</th><th align="center" colspan="10" rowspan="1" id="th-2" class="table-center table-bborder">MRI Abnormal</th></tr><tr id="tr-2"><th align="center" rowspan="1" colspan="1" id="th-3" class="table-center table-bborder">Normal Group</th><th align="center" rowspan="1" colspan="1" id="th-4" class="table-center table-bborder">Spondylitis Group</th><th align="center" colspan="9" rowspan="1" id="th-5" class="table-center table-bborder">Nonspondylitis Groups</th></tr><tr id="tr-3"><th rowspan="2" colspan="1" id="th-6"></th><th align="center" rowspan="2" colspan="1" id="th-7" class="table-center">Spondylitis</th><th align="center" rowspan="2" colspan="1" id="th-8" class="table-center">Arachnoiditis-Myelitis Intramedullary Tuberculomas</th><th align="center" colspan="2" rowspan="1" id="th-9" class="table-center table-bborder">Neoplasm Nonbone</th><th align="center" colspan="3" rowspan="1" id="th-10" class="table-center table-bborder">Neoplasm Bone</th><th align="center" colspan="3" rowspan="1" id="th-11" class="table-center table-bborder">Other</th></tr><tr id="tr-4"><th align="center" rowspan="1" colspan="1" id="th-12" class="table-center">HIV Associated</th><th align="center" rowspan="1" colspan="1" id="th-13" class="table-center">Lymphoma</th><th align="center" rowspan="1" colspan="1" id="th-14" class="table-center">Lymphoma</th><th align="center" rowspan="1" colspan="1" id="th-15" class="table-center">Plasmacytoma</th><th align="center" rowspan="1" colspan="1" id="th-16" class="table-center">Mets</th><th align="center" rowspan="1" colspan="1" id="th-17" class="table-center">Disk</th><th align="center" rowspan="1" colspan="1" id="th-18" class="table-center">Syrinx</th><th align="center" rowspan="1" colspan="1" id="th-19" class="table-center">?</th></tr></thead><tbody valign="top" id="tbody-1" class="table-vtop"><tr id="tr-5"><td align="left" rowspan="1" colspan="1" id="td-1" class="table-left">55</td><td align="center" rowspan="1" colspan="1" id="td-2" class="table-center">65</td><td align="center" rowspan="1" colspan="1" id="td-3" class="table-center">64</td><td align="center" rowspan="1" colspan="1" id="td-4" class="table-center">2</td><td align="center" colspan="2" rowspan="1" id="td-5" class="table-center">10</td><td align="center" rowspan="1" colspan="1" id="td-6" class="table-center">3</td><td align="center" rowspan="1" colspan="1" id="td-7" class="table-center">4</td><td align="center" rowspan="1" colspan="1" id="td-8" class="table-center">8</td><td align="center" rowspan="1" colspan="1" id="td-9" class="table-center">2</td><td align="center" rowspan="1" colspan="1" id="td-10" class="table-center">3</td></tr></tbody></table><div class="table-foot"><ul class="table-footnotes"><li class="fn-abbr" id="fn-1"><p id="p-25"><strong>Note:</strong>—? indicates no final diagnosis.</p></li></ul></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div></div></li><li><div class="element-fig-data clearfix table-caption"><div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="table-expansion " id="T2"><span class="highwire-journal-article-marker-start"></span><div class="table-caption"><ul class="inline table-expansion-links"><li class="view-popup first last"><a href="/highwire/markup/42631/expansion?width=1000&amp;height=500&amp;iframe=true&amp;postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed" class="colorbox colorbox-load table-expand-popup" rel="gallery-fragment-tables-2011091519" data-icon-position="" data-hide-link-title="0">View popup</a></li></ul><span class="table-label">Table 2:</span> <p id="p-33"><em>Mycobacterium tuberculosis</em> as a cause of myelopathy/cauda equina syndrome in subset of patients with a confirmed aetiology on laboratory testing</p><div class="sb-div caption-clear"></div></div><table frame="hsides" id="table-2" alt="Table 2:"><thead valign="bottom" id="thead-2" class="table-vbottom"><tr id="tr-6"><th rowspan="1" colspan="1" id="th-20"></th><th align="center" rowspan="1" colspan="1" id="th-21" class="table-center">MRI Spondylitis</th><th align="center" rowspan="1" colspan="1" id="th-22" class="table-center">MRI Nonspondylitis</th><th align="center" rowspan="1" colspan="1" id="th-23" class="table-center">Total</th></tr></thead><tbody valign="top" id="tbody-2" class="table-vtop"><tr id="tr-7"><td align="left" rowspan="1" colspan="1" id="td-11" class="table-left">TB</td><td rowspan="1" colspan="1" id="td-12"></td><td rowspan="1" colspan="1" id="td-13"></td><td rowspan="1" colspan="1" id="td-14"></td></tr><tr id="tr-8"><td align="left" rowspan="1" colspan="1" id="td-15" class="table-left">    Yes</td><td align="char" char="." rowspan="1" colspan="1" id="td-16" class="table-char">57</td><td align="char" char="." rowspan="1" colspan="1" id="td-17" class="table-char">26</td><td align="char" char="." rowspan="1" colspan="1" id="td-18" class="table-char">83</td></tr><tr id="tr-9"><td align="left" rowspan="1" colspan="1" id="td-19" class="table-left">    No</td><td align="char" char="." rowspan="1" colspan="1" id="td-20" class="table-char">0</td><td align="char" char="." rowspan="1" colspan="1" id="td-21" class="table-char">40</td><td align="char" char="." rowspan="1" colspan="1" id="td-22" class="table-char">40</td></tr><tr id="tr-10"><td align="left" rowspan="1" colspan="1" id="td-23" class="table-left">Total</td><td align="char" char="." rowspan="1" colspan="1" id="td-24" class="table-char">57</td><td align="char" char="." rowspan="1" colspan="1" id="td-25" class="table-char">66</td><td align="char" char="." rowspan="1" colspan="1" id="td-26" class="table-char">123</td></tr></tbody></table><div class="table-foot"></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div></div></li><li class="last"><div class="element-fig-data clearfix table-caption"><div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="table-expansion " id="T3"><span class="highwire-journal-article-marker-start"></span><div class="table-caption"><ul class="inline table-expansion-links"><li class="view-popup first last"><a href="/highwire/markup/42612/expansion?width=1000&amp;height=500&amp;iframe=true&amp;postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed" class="colorbox colorbox-load table-expand-popup" rel="gallery-fragment-tables-2011091519" data-icon-position="" data-hide-link-title="0">View popup</a></li></ul><span class="table-label">Table 3:</span> <p id="p-35">Comparison of myelitis group and normal MRI groups with regard to CSF parameters using Mann-Whitney <em>U</em> test</p><div class="sb-div caption-clear"></div></div><table frame="hsides" id="table-3" alt="Table 3:"><thead valign="bottom" id="thead-3" class="table-vbottom"><tr id="tr-11"><th align="center" rowspan="1" colspan="1" id="th-24" class="table-center">MRI Group</th><th align="center" rowspan="1" colspan="1" id="th-25" class="table-center">Lymphocyte Count Median (per mm<sup>3</sup>) and Range</th><th align="center" rowspan="1" colspan="1" id="th-26" class="table-center">Polymorphonuclear Median (per mm<sup>3</sup>) and Range</th><th align="center" rowspan="1" colspan="1" id="th-27" class="table-center">Protein Median (g/l) Normal 0.15–0.45 and Range</th></tr></thead><tbody valign="top" id="tbody-3" class="table-vtop"><tr id="tr-12"><td align="left" rowspan="1" colspan="1" id="td-27" class="table-left">Myelitis</td><td align="char" char="(" rowspan="1" colspan="1" id="td-28" class="table-char">38.5 (0–265)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-29" class="table-char">0 (0–300)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-30" class="table-char">2 (0.14–2)</td></tr><tr id="tr-13"><td align="left" rowspan="1" colspan="1" id="td-31" class="table-left">Normal</td><td align="char" char="(" rowspan="1" colspan="1" id="td-32" class="table-char">1 (0–160)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-33" class="table-char">0 (0–5)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-34" class="table-char">0.49 (0.11–2.6)</td></tr><tr id="tr-14"><td align="left" rowspan="1" colspan="1" id="td-35" class="table-left"><em>P</em> value</td><td align="center" rowspan="1" colspan="1" id="td-36" class="table-center">.0053<sup><a id="xref-fn-2-1" class="xref-table-fn" href="#fn-2"><sup>a</sup></a></sup></td><td align="center" rowspan="1" colspan="1" id="td-37" class="table-center">.2082</td><td align="center" rowspan="1" colspan="1" id="td-38" class="table-center">.0017<sup><a id="xref-fn-2-2" class="xref-table-fn" href="#fn-2"><sup>a</sup></a></sup></td></tr></tbody></table><div class="table-foot"><ul class="table-footnotes"><li class="fn-other" id="fn-2"><p id="p-36"><a class="rev-xref" href="#xref-fn-2-1">↵</a><span class="fn-label">a</span> Indicates significance.</p></li></ul></div><span class="highwire-journal-article-marker-end"></span></div><span 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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 35</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 8 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Aug 2014 </div></div>
      
      
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Candy</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Chang</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Andronikou</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2014, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">35 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1634-1641; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3958 </span></div>
  
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Candy</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Chang</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Andronikou</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2014, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">35 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1634-1641; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3958 </span></div>
  
  
  
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