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Embryologic Basis Of Imaging Findings In Spinal Cord Malformations: A Pictorial Review 2014

Category General Spine Aswin Krishnamoorthy, MD Sanjay Prabhu, MBBS, FRCR Purpose LEARNING OBJECTIVE: List 3 specific events in the embryologic development of the spinal cord, and how they each impact the imaging appearance of spinal cord malformations. Materials & Methods Knowledge of several key stages in the embryology of the spinal cord provides valuable insight when analyzing spinal cord malformations. The traditional approach to spinal cord malformations classifies these lesions into phenotypic patterns, for example, based on the presence of an externally visible placode and whether there is a subcutaneous low back mass. This algorithm is extremely useful to arrive at a set of differential considerations for a given phenotype. An understanding of the embryogenesis of spinal cord malformations complements the traditional approach by providing a framework for navigating the resultant distorted anatomy. Results A pictorial summary of the current understanding of the key stages of gastrulation, primary neurulation, and secondary neurulation is provided, along with genetic underpinnings of some spinal cord malformations. Conclusion Since embryologically distinct events can result in very similar phenotypes in spinal cord malformations, knowledge of both the phenotype-based algorithm and the embryogenesis is complementary in developing a radiologic approach to these entities. References Au, KS et al. Epidemiologic and genetic aspects of spina bifida and other neural tube defects. Dev Disabil Res Rev 2010. 16(1) 6-15. Copp, AJ et al. Neural tube defects: recent advances, unsolved questions and controversies. Lancet Neurol 2013. 12(8) 799-810. Moore KL and TVN Persaud. The developing human: clinically oriented embryology. Philadelphia, PA: Saunders 7th ed 2003. Rossi, A et al. Current classification and imaging of congenital spinal abnormalities. Semin Roentgenol 2006. 41(4) 250-73. Rufener, S et al. Imaging of congenital spine and spinal cord malformations. Neuroimaging Clin N Am 2011. 21 659-76. Schwartz ES and Barkovich AJ. Congenital anomalies of the spine. In Barkovich AJ and Raybaud C (eds). Pediatric Neuroimaging. Philadelphia, PA: Lippincott Williams & Wilkins 5th ed 2012. Tortori-Donati, P et al. Spinal dyraphism: a review of neuroradiological features with embryological correlations and proposal for a new classification. Neuroradiology 2000. 42(7) 471-91. Yamaguchi Y and Miura M. How to form and close the brain: insight into the mechanism of cranial neural tube closure in mammals. Cell Mol Life Sci 2013. 70(17) 3171-86.