Table 15 Continued

Mass

Imaging Appearance

Other Features

Figures

Tumors

Astrocytoma

Ependymoma

Mass with JT1 and |T2 SI

Homogeneous or heterogeneous enhancement

Cord expansion

Cysts and syrinxes often present

Often indistinguishable from astrocytoma, but is usually more well circumscribed and more often has cysts and hemorrhage (|T2 SI) at margins

Hemangioblastoma Enhancing nodule with associated prominent flow voids Syringohydromyelia may be present

Metastases Mass with variable SI and enhancement

Syringohydromyelia may be present

-60% of pediatric intramedullary tumors 56

-30% of pediatric intramedullary tumors 57

Associated with von Hippel-Lindau disease

Rare f = increased; J = decreased; SI = signal intensity

Figure 55. Acute disseminated encephalomyelitis. Scattered foci of intramedullary T2 hyperintensity within the cervical and upper thoracic spinal cord. (sagittal T2-WI)

Figure 56. Astrocytoma of the cervical cord. Heterogeneous enhancing T1-hypointense and T2-hyperintense intramedullary mass. (sagittal T1-WI with and without contrast)

Figure 56. Astrocytoma of the cervical cord. Heterogeneous enhancing T1-hypointense and T2-hyperintense intramedullary mass. (sagittal T1-WI with and without contrast)

Figure 57. Ependymoma of cervical cord. Peripherally enhancing, partially cystic, intramedullary mass expanding the upper cervical spinal cord. (sagittal T1-WI with contrast, T2-WI)

Table 16. Extramedullar)/spinal masses

Mass

Intradural or Extradural?

Imaging Appearance

Other Features

Figures

Epidural empyema

Extradural

Epidural fluid collection |T1 and JT2 SI compared to CSF Homogeneous or peripheral enhancement

Spinal infection (discitisor osteomyelitis) may be present May cause spinal cord compression

59

Epidural hematoma

Extradural

Epidural fluid collection may cause cord compression Density and MR-SI vary depending on age of blood products Organizing hematomas can enhance

Other evidence of spinal trauma may be present: paraspinous soft tissue injury, fractures, loss of normal alignment

Meningeal cyst (e.g., arachnoid cyst or arachnoid loculation)

Intra- or extradural

Well-defined cyst

Homogeneous, isodense and isointense to CSF No enhancement

Non-neoplastic Can cause cord compression Rarely caused by herniation of arachnoid through dura

Perimedullary spinal arteriovenous fistula

Prominent flow voids on cord surface T2-hyperintensity in cord Subarachnoid hemorrhage rare

Reported association with Osler-Weber-Rendu syndrome

Nerve sheath tumors: Neurofibroma and Schwannoma

Intradural (neurofibromas can extend extradurally)

Neurofibroma: peripheral |T2 and central

JT2 SI; variable enhancement Schwannoma: iso- or hypodense, isointense T1 and |T2 SI, enhance

NF1: neurofibromas NF2: schwannomas Both can extend through neuroforamina

49-51

f = increased; J = decreased; CSF = cerebrospinal fluid; NF1 = neurofibromatosis type 1; NF2

= neurofibromatosis type 2; SI = signal intensity

continued on

next page

Table 16. Continued

Mass

Intradural or Extradural?

Imaging Appearance

Other Features

Figures

(rarely extradural)

Well-circumscribed mass isotense to cord

Homogeneous enhancement

Very rare in children

Associated with NF2

Drop metastases

Intradural

Nodular or diffuse enhancement over surface of cord, nerve roots and cauda equina

Medulloblastoma, Ependymoma, Germinoma, Glioblastoma

60

Neuroblastoma

Extradural

Homogeneous paraspinal mass, extending through neural foramina Iso- or hyperdense Homogeneous enhancement

Arise from adrenal medulla and spinal sympathetic chain Distant metastases not uncommon

Leukemia and Lymphoma

Extradural

Homogenous mass Isodense and isointense to cord Homogeneous enhancement

Abrnormal JT1 SI of marrow of vertebral bodies may be seen

PNET (primitive neuroectodermal tumor)

Extradural

Heterogeneous mass with cysts and necrosis Isointense or hyperdense Isointense or |T1, and isointense or |T2 SI Variable enhancement

Paraspinous mass may be present

Dermoid and epidermoid

Intradural

see Table 8

Associated with dermal sinus tracts

Lipoma

Intra- or extradural

Homogeneous mass isointense to fat on all sequences Hypointense on T1 -Wl with fat saturation

Lipomyelocele Lipomyelomeningocele Fibrolipoma of tilum

61

t = increased; J = decreased; NF2 = neurofibromatosis type 2; SI = signal intensity t = increased; J = decreased; NF2 = neurofibromatosis type 2; SI = signal intensity

Figure 60. Drop metastases from germinoma. Abnormal enhancing intradural and extramedullary nodule in the left thecal sac at the L5-S1 level. (sagittal T1-WI with contrast and fat saturation)

Figure 59. Epidural abscess. Large epidural T2-hyperintense (compared to CSF) collection along ventral lumbar spinal canal. (sagittal T2-WI with fat saturation)

Figure 60. Drop metastases from germinoma. Abnormal enhancing intradural and extramedullary nodule in the left thecal sac at the L5-S1 level. (sagittal T1-WI with contrast and fat saturation)

Figure 61. Spinal cord lipoma. Tethered cord with intradural T1-hyperintense lipoma along the dorsal upper sacrum. Lipoma becomes markedly hypointense on sagittal T2-WI with fat saturation. (sagittal T1-WI, and T2-WI with fat saturation)
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