Department of Radiology University of California San Diego Imaging the Spinal Cord & Intradural Disease John R. Hesselink, M.D.
Spinal Cord Diseases Tumors Syringohydromyelia Trauma Ischemia / Infarction Vascular malformations Inflammatory / Degenerative
Spinal Cord Tumors Ependymoma Astrocytoma Oligodendroglioma Hemangioblastoma Teratoma, epidermoid, dermoid, lipoma Metastases
Spinal Cord Tumors Imaging Features Expansion of the cord Heterogeneous T2 signal Cysts & necrosis Variable enhancement
History: 58 y/o man with neck pain & paresthesias in fingertips 642
Dx: Ependymoma {Page 2}
History: 43 y/o male with bilateral arm paresthesias & weakness 673
Dx: Pilocytic astrocytoma {Page 2}
480 History: 19 y/o male with progressive leg weakness for 2 years
{Page 2} Dx: Pylocytic astrocytoma
CD 33-35 Hemangioblastoma
History: 55 y/o woman with pain & tingling in the extremities Dx: Hemangioblastoma 754
Dorsal Dermal Sinus with Dermoid Tumor LB 19-20
History: 69 y/o man with progressive weakness in his arms & legs 458
Dx: Lung CA {Page 2}
History: 40 y.o. man with pain & paresthesias in both arms & shoulders 136
{Page 2} Dx: NF 2 with intramedullary neurofibroma
Chiari I with syrinx CB-7
History: 22 y/o male with brain stem dysfunction Dx: Chiari I malformation with syringohydromyelia 339
C1 History: 45 y.o. male with a progressive myelopathy C5 C6 101
T5 {Page 2} T6 T9
History: 31 y/o woman with severe back pain 556
Dx: Pilocytic astrocytoma {Page 2}
223 History: 56 y/o man with C6 quadriplegia following an MVA 5 years ago
A {Page 2} B A B C C Dx: Old cord contusion with a post-traumatic syrinx and cord atrophy
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
Spinal Cord Masses Non-Tumorous Lesions Cord contusion Multiple sclerosis Vascular malformation Parasitic disease Abscess Sarcoidosis
History: 18 y/o male became tetraplegic while surfing in Puerto Vallarta 278
{Page 2} C3 C4
Dx: Fractures C3 & C4; Posterior ligamentous injury; Cord contusion Tetraplegia {Page 3}
History: 44 y.o. man fell off a roof onto his head
History: 35 woman with MS T2 FSE PD 784-24604803 STIR T1 FSE
{Page 2} T2 FSE Dx: MS - MERGE MERGE
History: 27 y/o woman with muscular dystrophy & new left sided numbness Dx: Transverse myelitis (ADEM) - Bronchitis 3 weeks ago 577
History: 23 y/o female with leg weakness & sensory changes 593
{Page 2}
Dx: Neuromyelitis optica Devic s disease {Page 3} 2 years later
History: 95 y/o woman with acute bilateral upper extremity weakness Dx: Acute cord infarction 746-05121249
Intramedullary AV Malformation LH 9-12
History: 36 y/o man with a chronic C6-8 radiculopathy 620
Dx: Spinal dural AVM {Page 2}
TC 13-15 Tuberculoma of the Spinal Cord
Schistosomiasis T1W T1W+GD Courtesy of Bassem Georgy, San Diego, California
Intradural Extramedullary Tumors Schwannoma / Neurofibroma Meningioma Metastatic disease
Primary Intraspinal Tumors Schwannoma Meningioma 25% 35% 20% 10% 2% 3% 5% Other Chordoma Vascular Glioma Sarcoma
Schwannoma CD 29-31
History: 42 y/o woman with anterior chest pain & lower extremity weakness 608
Dx: Schwannoma {Page 2}
Nerve Sheath Tumors Originate from Schwann cells Associated with Neurofibromatosis Foraminal enlargement Intradural/extradural components Long T1, long T2 Bright enhancement
History: 23 y/o male with cauda equina syndrome 501
Dx: Schwannoma {Page 2}
Neurofibromatosis Type 1 CD-15
Dx: NF 1 {Page 4}
History: 54 male with leg weakness & a T3 sensory level Dx: Meningioma 743 h1079
Spinal Meningioma Arise from meninges - intradural Middle-aged females 80% in thoracic region MR signal similar to cord Intense enhancement
218 History: 43 y/o male with back & bilateral leg pain
Dx: Intradural Paraganglioma {Page 2}
553 CV History: 43 y/o man with back pain for several months
Dx: Hemangioblastoma {Page 2}
History: 35 y/o female with pain & weakness in both legs DWI 763 - Dx: Arachnoid cyst
History: 22 y/o female with flank pain & progressive leg weakness 526
Dx: Lymphocytic Leukemia {Page 2}
Intradural Metastases CNS neoplasms - "drop metastases" Medulloblastoma, ependymoma pineal tumors, glioblastoma Non-CNS neoplasms Breast, lung, melanoma, lymphoma, leukemia Imaging: Gadolinium with fat suppression
Intradural Metastases MR Appearance Nodular masses Coating of cord & nerve roots Gelatinous & non-enhancing Intramedullary
494 History: 59 y/o man with increasing leg weakness
{Page 2}
{Page 3} Dx: Melanoma with drop mets
Cerebellar Glioblastoma with Diffuse Pial Seeding TD 53-54
{Page 2} TD 53-54
Medulloblastoma with Leptomeningeal Seeding td-10-12
{Page 2} T1W T2W T1-Gd
Infection and Inflammation Intradural Meningitis Sarcoidosis CMV polyradiculopathy Guillain Barre syndrome Arachnoiditis
Chronic Cocci Meningitis
History: 37 man with progressive lower body weakness over 4 days 782-26016550
Dx: Gullain Barre Page 2
273 History: 54 y/o male s/p multiple surgeries with chronic back & leg pain
{Page 2} Dx: Chronic arachnoiditis with "empty sac sign"