Various MRI Findings of Toxocara canis Myelitis

Sun Young Park; Kyung Seok Park; Eugene Lee; Joon Woo Lee; Yun Jung Bae; Yusuhn Kang; Joong Mo Ahn; Heung Sik Kang

doi:10.3348/jksr.2020.81.1.135

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Park, Park, Lee, Lee, Bae, Kang, Ahn, and Kang: Various MRI Findings of Toxocara canis Myelitis

Original Article

J Korean Soc Radiol 2020;81(1):135-146.

Published online: 7 January 2020

DOI: https://doi.org/10.3348/jksr.2020.81.1.135

Various MRI Findings of Toxocara canis Myelitis

Sun Young Park¹

, Kyung Seok Park²

, Eugene Lee^1,^∗

, Joon Woo Lee¹

, Yun Jung Bae¹

, Yusuhn Kang¹

, Joong Mo Ahn¹

, Heung Sik Kang¹

¹Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea

²Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea

^∗ Corresponding author Eugene Lee, MD Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea. Tel 82-31-787-7619 Fax 82-31-787-4011 E-mail eugene801027@gmail.com

Received 5 March 201913 May 2019 Accepted 17 July 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To describe magnetic resonance imaging (MRI) findings in 10 cases of Toxocara canis myelitis and to analyze these findings to aid in the diagnosis of this condition.

Materials and Methods

From June 2015 to March 2018, we retrospectively analyzed the elec-tronic medical records and MR images of patients who were diagnosed withToxocara canis myelitis. The analysis of the MR images was based on a discussion between an experienced spinal radiologist and a radiology resident.

Results

This study classified MRI findings into the following two types. Type 1 was defined as central and diffuse T2 high signal intensity on the axial plane, which was observed in 50% of all cases. All lesions showed avid enhancement, mostly in the posterolateral or posterior region (4 cases, 80%). Type 2 was defined as wedge-shaped or focal T2 high signal intensity in the posterolateral or posterior region and corresponded to the remaining 50% of the cases. In this case, the extent of the lesion was relatively small and contrast enhancement was observed in only one case.

Conclusion

This study revealed that various imaging findings could be observed in cases of Toxocara canis myelitis, and the findings were classified into two types.

Index terms:

Index terms

Toxocara Canis, Myelitis, Magnetic Resonance Imaging, Spine

REFERENCES

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Fig. 1.

Typical MR imaging features (type 1) of Toxocara canis myelitis in a 31-year-old male. A, B. Sagittal T2-weighted image (A) shows diffuse signal change in the spinal cord at the T8–10 level (arrows). The signal change is observed in the central portion of the cord on an axial T2-weighted image (B). C, D. Contrast enhanced T1-weighted sagittal and axial images show nodular enhancement in the posterior region at the T9/10 level (arrows).

Fig. 2.

MR imaging features (type 2) of Toxocara canis myelitis in a 29-year-old male. A. Axial T2-weighted image shows a wedge-shaped hyperintense lesion (arrow) in the right posterolateral spinal cord at the C2–3 level. B. Sagittal T2-weighted image shows a short-segment patchy hyperintense lesion (arrow) on the posterior aspect of the spinal cord.

Fig. 3.

Atypical imaging features of Toxocara canis myelitis in a 47-year-old male. terior aspect of the spinal cord with focal patchy signal change and mild swelling at the T4/5 level. B. Axial T2-weighted image shows diffuse centrally located signal change in the spinal cord. C. Contrast enhanced T1-weighted axial image shows rim-like peripheral enhancement. A. Sagittal T2-weighted image shows cord signal change at the T3–4–5 level (arrows). The lesion shows thin pencil-like appearance on the anterior aspect of the spinal cord with focal patchy signal change and mild swelling at the T4/5 level. B. Axial T2-weighted image shows diffuse centrally located signal change in the spinal cord. C. Contrast enhanced T1-weighted axial image shows rim-like peripheral enhancement.

Fig. 4.

Non-enhancing Toxocara canis myelitis in a 61-year-old female. A. Axial T2-weighted image shows focal hyperintense lesion on the left posterolateral aspect at the cervico-medullary junction. B. Contrast enhanced T1-weighted axial image on brain MRI shows no contrast enhancement.

Table 1.

Demographics and Clinical Findings of 10 Patients withToxocara canis Myelitis

Patient	Age (years)	Sex	Symptom	Duration	Exposure to Pets	Ingestion Hx	Spine MR F/U Period	Treatment	Disease Course
1	30	M	Both L/Ex paresthesia, weakness erectile dysfunction	1 YA	Dogs	Uncooked cow or cattle omasum^∗	7 mon A	Albendazole,	Partial recovery but improved
2	58	M	Progressing both L/Ex paresthesia	a 1 MA	No	Uncooked cow or cattle liver and meat	A N/A	Albendazole, steroids	Complete recovery
3	29	M	Left U/Ex paresthesia	1 MA	No	cattle liver and meat N/A	A 12 mon	steroids Albendazole, steroids	Complete recovery
4	42	M	Left L/Ex paresthesia, erectile and urinary dysfunction	1 YA	No	Uncooked cow or cattle meat	A 6 mon	Albendazole, steroids	Persistent
5	65	M	Both L/Ex paresthesia	1 YA	N/A	N/A	A 16 mon	Albendazole, steroids	Persistent
6	62	M	Both L/Ex paresthesia, weakness	2 WA	Cats	N/A	A N/A	Albendazole, steroids	Partial recovery but improved
7	61	F	Headache	5 MA	Dogs	N/A	N/A S	Steroids	Complete recovery
8	55	M	Both L/Ex paresthesia	5 YA	Dogs	N/A	A N/A	Albendazole, steroids	Partial recovery but improved
9	48	M	Both L/Ex paresthesia, erectile dysfunction	3 WA	No	N/A	3 mon S	Steroids	Partial recovery but improved
10	47	M	erectile dysfunction Progressing both L/Ex paresthesia	1 MA	N/A	N/A	N/A	Steroids	Partial recovery but improved

^∗ The third stomach of a ruminant.

F/U = follow up, Hx = history, L/Ex = lower extremity, MA = month ago, mon = months, N/A = not available, U/Ex = upper extremity, WA = week ago, YA = year ago

Table 2.

Blood and CSF Characteristics of the 10 Patients

Patient	Blood				CSF			Serum
Patient	WBC (× 10³/μL)	E (%)	IgE	ELISA, IgG, 1st	WBC (/mm³)	Protein (mg/dL)	Glucose (mg/dL)	BST (mg/dL)
1	7.92	2.5	N/A	1.587 (0.904)	1	104.2	65	103
2	4.66	2.1		1.331 (0.966)	0	43.2	65	109
3	8.5	2.9	1137.0	1.959 (0.944)	2	40.4	70	107
4	9.1	1.5		1.783 (0.926)	6	76.6	59	110
5	9.73	1.5		1.104 (1.077)	0	82.6	62	159
6	4.36	3.2		1.131 (1.013)	9	76.8	80	126
7	8.2	0.1		1.142 (1.055)	2	55.8	110	207
8	9.54	4.5		1.665 (0.985)	0	137.6	57	125
9	8.4	19.1		2.641 (1.009)	2	82	65	93
10	7.6	2.2		1.306 (0.956)	0	122.9	72	126

Normal range: serum WBC (4.0–10.0 × 10³/µL), E (1–5%), ELISA, IgG antibody (cut off value), CSF WBC (0–5/mm³), protein (15–45 mg/dL), glucose (> 50–60% plasma level), BST (70–110 mg/dL).

BST = blood sugar test, CSF = cerebrospinal fluid, E = eosinophil, ELISA = enzyme-linked immunosorbent assay, Ig = immunoglobulin, N/A = not available, WBC = white blood cell

Table 3.

MRI Findings in 10 Patients

Patient	Level	Extent (VC)	Skipped Lesion	Cord Swelling	Cyst or Syringomyelia	T1SI	Axial T2SI	Sagittal T2SI	CE Pattern/ Location	Sequale
1	T8–10	3	(−)	(−)	(−)	Iso	Diffuse, central	Diffuse	Nodular/ posterior	Normalized
2	C6–7	1	(−)	(−)	(−)	Iso	Posterolateral, wedge shape	Patchy	Nodular/ posterolateral	N/A
3	C2–3 T12–L1	1	(−)	(−)	(−)	Iso	Posterolateral, wedge shape	Patchy	N/A Nodular/	Normalized
4	T12–L1 (conus medullaris)	1	(−)	(−)	(−)	Iso	Diffuse, central	Patchy	Nodular/ posterolateral	Normalized
5	T3–4	1	(−)	(−)	(−)	Iso	Posterolateral, wedge shape	Patchy	No Nodular/	N/A
6	T1–3	3	(−)	(+)	(−)	Iso	Diffuse, central	Diffuse	Nodular/ posterolateral	N/A
7	Cervicomedullary junction	1	(−)	(−)	(−)	Iso	Posterolateral, focal	Focal	No	N/A
8	T6–7	1	(−)	(−)	(−)	Iso	Posterior, focal	Focal	No	N/A
9	T7–9	3	(−)	(+)	(−)	Iso	Diffuse, central	Diffuse	Nodular/lateral	No change of anterolateral enhancement
10	T2/3–5	3	(−)	(+)	(−)	Iso	Diffuse, central	Diffuse	Peripheral, patchy/central	N/A

CE = contrast-enhancement, Iso = isointensity, N/A = not available, T1SI = T1-weighted signal intensity, T2SI = T2-weighted signal intensity, VC = vertebral column

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