22. Spine and spinal cord - tumours

Question 1

Classification:

Answer 1

intramedullary - intradural (inside SC)

intradural - extramedullary (outside SC but inside dura mater)

extradural (outside dura mater, in skeleton)

Question 2

Intradural - intramedullary:

Answer 2

Tumors: Ependymoma, Astrocytoma

t1w CONTRAST: hypointense
t2w: hyperintense (may have syringomyelic cavity around)

Ependymoma: arises from ependymal cells of central canal or epithelium of terminal ventricle of filum terminale

Question 3

Extramedullary - Intradural:

Answer 3

Tumors: Meningioma, Schwannoma

Meningioma - MRI:
t1w/t2w - isointense to gray matter
t1w CONTRAST: hyperintense
“dural tail sign”: Thickening + enhancement

SchwannomaI: arises from spinal nerve roots in spinal canal

Schwannoma - MRI:
t1w - hypointense
t2w - hyperintense

Question 4

Extradural:

Answer 4

Benign: Hemangioma, osteoblastoma, osteoid osteoma

Malignant: MTS (prostate, breast, lungs), multiple myeloma

Imaging:
CT: osteosclerotic/osteolytic/mixed masses
Osteosclerotic - prostate carcinoma (radio-opaque)
Osteolytic - lung carcinoma (radio-lucent)
Mixed - breast carcinoma

MRI:
t1w - hypointense
t2w - hyperintense

Question 5

Extradural - Hemangioma:

Answer 5

Definition: benign vascular tumor

Location: vertebral bodies

Symptoms: asymptomatic

Imaging: Polka-dot sign (vascular channels)
MRI:
t1/t2w: hyperintense
fat-supression: hypointense

MTS:
t1w: hypointense
t2w: hyperintense
fat-supression: hyperintense