Imaging the Spinal Cord & Intradural Disease
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1 Department of Radiology University of California San Diego Imaging the Spinal Cord & Intradural Disease John R. Hesselink, M.D.
2 Spinal Cord Diseases Tumors Syringohydromyelia Trauma Ischemia / Infarction Vascular malformations Inflammatory / Degenerative
3 Spinal Cord Tumors Ependymoma Astrocytoma Oligodendroglioma Hemangioblastoma Teratoma, epidermoid, dermoid, lipoma Metastases
4 Spinal Cord Tumors Imaging Features Expansion of the cord Heterogeneous T2 signal Cysts & necrosis Variable enhancement
5 History: 58 y/o man with neck pain & paresthesias in fingertips 642
6 Dx: Ependymoma {Page 2}
7 History: 43 y/o male with bilateral arm paresthesias & weakness 673
8 Dx: Pilocytic astrocytoma {Page 2}
9 480 History: 19 y/o male with progressive leg weakness for 2 years
10 {Page 2} Dx: Pylocytic astrocytoma
11 CD Hemangioblastoma
12 History: 55 y/o woman with pain & tingling in the extremities Dx: Hemangioblastoma 754
13 Dorsal Dermal Sinus with Dermoid Tumor LB 19-20
14 History: 69 y/o man with progressive weakness in his arms & legs 458
15 Dx: Lung CA {Page 2}
16 History: 40 y.o. man with pain & paresthesias in both arms & shoulders 136
17 {Page 2} Dx: NF 2 with intramedullary neurofibroma
18 Chiari I with syrinx CB-7
19 History: 22 y/o male with brain stem dysfunction Dx: Chiari I malformation with syringohydromyelia 339
20 C1 History: 45 y.o. male with a progressive myelopathy C5 C6 101
21 T5 {Page 2} T6 T9
22 History: 31 y/o woman with severe back pain 556
23 Dx: Pilocytic astrocytoma {Page 2}
24 223 History: 56 y/o man with C6 quadriplegia following an MVA 5 years ago
25 A {Page 2} B A B C C Dx: Old cord contusion with a post-traumatic syrinx and cord atrophy
26 Spinal Cord Cysts Evidence for Benign Syrinx Fluid isointense to CSF Smooth, well-defined internal margins Thinned adjacent parenchyma Cord atrophy No contrast enhancement Presence of Chiari malformation
27 Spinal Cord Masses Non-Tumorous Lesions Cord contusion Multiple sclerosis Vascular malformation Parasitic disease Abscess Sarcoidosis
28 History: 18 y/o male became tetraplegic while surfing in Puerto Vallarta 278
29 {Page 2} C3 C4
30 Dx: Fractures C3 & C4; Posterior ligamentous injury; Cord contusion Tetraplegia {Page 3}
31 History: 44 y.o. man fell off a roof onto his head
32 History: 35 woman with MS T2 FSE PD STIR T1 FSE
33 {Page 2} T2 FSE Dx: MS - MERGE MERGE
34 History: 27 y/o woman with muscular dystrophy & new left sided numbness Dx: Transverse myelitis (ADEM) - Bronchitis 3 weeks ago 577
35 History: 23 y/o female with leg weakness & sensory changes 593
36 {Page 2}
37 Dx: Neuromyelitis optica Devic s disease {Page 3} 2 years later
38 History: 95 y/o woman with acute bilateral upper extremity weakness Dx: Acute cord infarction
39 Intramedullary AV Malformation LH 9-12
40 History: 36 y/o man with a chronic C6-8 radiculopathy 620
41 Dx: Spinal dural AVM {Page 2}
42 TC Tuberculoma of the Spinal Cord
43 Schistosomiasis T1W T1W+GD Courtesy of Bassem Georgy, San Diego, California
44 Intradural Extramedullary Tumors Schwannoma / Neurofibroma Meningioma Metastatic disease
45 Primary Intraspinal Tumors Schwannoma Meningioma 25% 35% 20% 10% 2% 3% 5% Other Chordoma Vascular Glioma Sarcoma
46 Schwannoma CD 29-31
47 History: 42 y/o woman with anterior chest pain & lower extremity weakness 608
48 Dx: Schwannoma {Page 2}
49 Nerve Sheath Tumors Originate from Schwann cells Associated with Neurofibromatosis Foraminal enlargement Intradural/extradural components Long T1, long T2 Bright enhancement
50 History: 23 y/o male with cauda equina syndrome 501
51 Dx: Schwannoma {Page 2}
52 Neurofibromatosis Type 1 CD-15
53 Dx: NF 1 {Page 4}
54 History: 54 male with leg weakness & a T3 sensory level Dx: Meningioma 743 h1079
55 Spinal Meningioma Arise from meninges - intradural Middle-aged females 80% in thoracic region MR signal similar to cord Intense enhancement
56 218 History: 43 y/o male with back & bilateral leg pain
57 Dx: Intradural Paraganglioma {Page 2}
58 553 CV History: 43 y/o man with back pain for several months
59 Dx: Hemangioblastoma {Page 2}
60 History: 35 y/o female with pain & weakness in both legs DWI Dx: Arachnoid cyst
61 History: 22 y/o female with flank pain & progressive leg weakness 526
62 Dx: Lymphocytic Leukemia {Page 2}
63 Intradural Metastases CNS neoplasms - "drop metastases" Medulloblastoma, ependymoma pineal tumors, glioblastoma Non-CNS neoplasms Breast, lung, melanoma, lymphoma, leukemia Imaging: Gadolinium with fat suppression
64 Intradural Metastases MR Appearance Nodular masses Coating of cord & nerve roots Gelatinous & non-enhancing Intramedullary
65 494 History: 59 y/o man with increasing leg weakness
66 {Page 2}
67 {Page 3} Dx: Melanoma with drop mets
68 Cerebellar Glioblastoma with Diffuse Pial Seeding TD 53-54
69 {Page 2} TD 53-54
70 Medulloblastoma with Leptomeningeal Seeding td-10-12
71 {Page 2} T1W T2W T1-Gd
72 Infection and Inflammation Intradural Meningitis Sarcoidosis CMV polyradiculopathy Guillain Barre syndrome Arachnoiditis
73 Chronic Cocci Meningitis
74 History: 37 man with progressive lower body weakness over 4 days
75 Dx: Gullain Barre Page 2
76 273 History: 54 y/o male s/p multiple surgeries with chronic back & leg pain
77 {Page 2} Dx: Chronic arachnoiditis with "empty sac sign"
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