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Department of Radiology
University of California
San Diego
John R. Hesselink, M.D.
Imaging the Spinal Cord
& Intradural Disease
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
Expansion of the cord
Heterogeneous T2 signal
Cysts & necrosis
Variable enhancement
Imaging Features
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}
History: 19 y/o male with progressive
leg weakness for 2 years
480
Dx: Pylocytic astrocytoma
{Page 2}
CD 33-35
Hemangioblastoma
Dx: Hemangioblastoma
History: 55 y/o woman with pain
& tingling in the extremities
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
Dx: NF 2 with intramedullary
neurofibroma
{Page 2}
Chiari I with syrinx
CB-7
Dx: Chiari I malformation
with syringohydromyelia
339
History: 22 y/o male with
brain stem dysfunction
History: 45 y.o. male with a
progressive myelopathy
101
C1
C6
C5
{Page 2}
T5
T9
T6
History: 31 y/o woman with severe back pain
556
Dx: Pilocytic astrocytoma
{Page 2}
History: 56 y/o man with C6 quadriplegia
following an MVA 5 years ago
223
Dx: Old cord contusion with
a post-traumatic syrinx
and cord atrophy
{Page 2}
A
B
C
A
B
C
Spinal Cord Cysts
Fluid isointense to CSF
Smooth, well-defined internal margins
Thinned adjacent parenchyma
Cord atrophy
No contrast enhancement
Presence of Chiari malformation
Evidence for Benign Syrinx
Spinal Cord Masses
Cord contusion
Multiple sclerosis
Vascular malformation
Parasitic disease
Abscess
Sarcoidosis
Non-Tumorous Lesions
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
784 - 24604803
T2 FSE PD
T1 FSE STIR
Dx: MS - MERGE
{Page 2}
T2 FSE MERGE
History: 27 y/o woman with muscular
dystrophy & new left sided numbness
577
Dx: Transverse myelitis (ADEM)
- Bronchitis 3 weeks ago
History: 23 y/o female with leg
weakness & sensory changes
593
{Page 2}
Dx: Neuromyelitis optica –
Devic’s disease
{Page 3}
2 years later
Dx: Acute cord infarction
History: 95 y/o woman with acute
bilateral upper extremity weakness
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}
Tuberculoma of the
Spinal Cord
TC 13-15
T1W T1W+GD
Schistosomiasis
Courtesy of Bassem Georgy, San Diego, California
Intradural
Extramedullary Tumors
Schwannoma / Neurofibroma
Meningioma
Metastatic disease
Primary Intraspinal Tumors
Schwannoma
Meningioma
Glioma Sarcoma
Vascular
Chordoma
Other
2% 3%
5%
10% 20%
35% 25%
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}
Dx: Meningioma
History: 54 male with leg weakness
& a T3 sensory level
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}
History: 43 y/o man with
back pain for several months
553 CV
Dx: Hemangioblastoma
{Page 2}
Dx: Arachnoid cyst
History: 35 y/o female with pain
& weakness in both legs
763 -
DWI
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
Nodular masses
Coating of cord & nerve roots
Gelatinous & non-enhancing
Intramedullary
MR Appearance
History: 59 y/o man
with increasing leg weakness
494
{Page 2}
Dx: Melanoma with drop mets
{Page 3}
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
Meningitis
Sarcoidosis
CMV polyradiculopathy
Guillain Barre syndrome
Arachnoiditis
Intradural
Chronic Cocci Meningitis
History: 37 man with progressive lower
body weakness over 4 days
782 - 26016550
Dx: Gullain Barre
Page 2
History: 54 y/o male s/p multiple
surgeries with chronic back & leg pain
273
Dx: Chronic arachnoiditis
with "empty sac sign"
{Page 2}