Fig. 11
From: MRI characteristics of chemotherapy-related central neurotoxicity: a pictorial review
Methotrexate-induced myelopathy mimicking subacute combined degeneration of the spinal cord (SCID). A 54-year-old female with acute lymphocytic leukemia treated with intrathecal methotrexate (MTX) developed bilateral lower limb weakness and numbness approximately 2 weeks after commencing treatment. Axial (a) and sagittal (b) T2-weighted thoracic spine MRI demonstrates high signal lesions involving long segment along the dorsal column of the spinal cord (arrowheads, b). It resembles an “inverted V sign” or “kangaroo ears sign” on the axial image (red arrow, a) masquerading subacute combined degeneration of the cord. Axial (c) and sagittal (d) T2-weighted images at six-month follow-up MRI after cessation of intrathecal MTX treatment show improvement with significant reduction of the signal abnormality within the dorsal column of the spinal cord (red arrow in c and arrowheads in d)