Neuroradiology 2

Question 1

Common causes of Central Canal Stenosis

Answer 1

Facet joint degenerative change (most common). Lligamentum flavum hypertrophy.

Question 2

Most common cause of neuroforaminal stenosis

Answer 2

Facet joint degenerative change with bony encroachment.

Question 3

Distinguishes postop scar from disk material

Answer 3

Scar tissue enhances. Disk material has only minimal peripheral enhancement.

Question 4

Myelopathy neurologic signs

Answer 4

Ataxia. Bowel and bladder incontinence. Babinski sign.

Question 5

Radiculopathy neurologic signs

Answer 5

Muscle weakness. Decreased reflexes. Dermatomal sensory deficits.

Question 6

Intradural intramedullary lesions

Answer 6

Ependymoma. Astrocytoma. Hemangioblastoma. Lipoma/(Epi)dermoid. Syringohydromyelia. Intramedullary AVM.

Question 7

Intradural extramedullary lesions (includes subarachnoid space)

Answer 7

Meningioma. Schwannoma/neurinoma. Neurofibroma. Hemangiopericytoma. Lipoma/(Epi)dermoid. Arachnoid cyst/adhesion. Drop/leptomeningeal metastasis. Veins (extramedullary AVM).

Question 8

Extradural extramedullary lesions

Answer 8

Degenerative: Herniated disc. Synovial cyst. Osteophyte. Rheumatoid pannus. Nondegenerative: Metastasis. Abscess.

Question 9

Urgency for imaging acute myelopathy

Answer 9

Poor prognosis if left untreated for greater than 24 hours.

Question 10

Common causes of myelopathy

Answer 10

Extramedullary: Epidural mass cord compression. Cervical spine stenosis. Intramedullary: Tumor. Inflammation,

Question 11

Atlantoaxial instability and rheumatoid arthritis

Answer 11

Inflammatory changes (pannus) destroy transverse ligament of C1. Dens may slide posteriorly and intermittently compress cord causing myelomalacia. 5% of RA patients frank atlantoaxial instability.

Question 12

Vertebral body and disc infection findings

Answer 12

Adjacent vertebral bodies and disc usually involved. Destruction greatest at endplates. Posterior elements usually spared. Low T1 and high T2 marrow signal with normal diffusion. If pyogenic disk enhances, granulation tissue extends above and below affected vertebrae.

Question 13

Vertebral body neoplasm findings

Answer 13

Isolated or noncontiguous involvement. Pedicles typically affected. Low T1 and high T2 signal with restricted diffusion. Disk typically spared (except prostate cancer). Enhancement may obscure metastases within fatty marrow.

Question 14

Vertebral body osteoporosis findings

Answer 14

Several vertebral bodies with height loss. Anterior weding with posterior elements spared. Normal T1 and T2 unless fracture. Disk spared.

Question 15

TB of the spine, or Pott disease

Answer 15

Causes slow collapse of one or more vertebral bodies. Gibbus deformity, acute kyphosis. Infection spreads underneath longitudinal ligaments. Can lead to cord compression. May spare disks.

Question 16

Most common neoplasm of the spine

Answer 16

Metastases

Question 17

Two most common primary intramedullary tumors

Answer 17

Astrocytoma. Ependymoma.

Question 18

Spinal cord astrocytoma and ependymoma shared features

Answer 18

Expansile. Low T1 and high T2 signal with variable enhancement. Increased incidence in neurofibromatosis.

Question 19

Spinal cord Ependymoma features

Answer 19

Most common spinal cord tumor in adults. Divided into cellular (intramedullary) and myxopapillary (filum terminale) types. Peak incidence inf ourth decade. Male predominance. These slow-growing neoplasms arise from ependymal cells lining the central canal of the cord or cell rests along the filum. Expansile. Low T1 and high T2 signal with variable enhancement. Increased incidence in neurofibromatosis.

Question 20

Spinal cord Astrocytoma features

Answer 20

Most (75%) occur in cervical and upper to midthoracic cord. Fusiform cord widening. High T2 signal. Contrast enhancement over several vertebral body segments.

Question 21

Hemangioblastoma features

Answer 21

Occur in spinal cord and posterior fossa. High association with Von Hippel-Lindau syndrome. Densely enhancing nidus with related cyst and or cord expansion. May be extramedullary and multiple. May be mistaken for arteriovenous malformation (AVM).

Question 22

Syrinx

Answer 22

Shorter term for syringohydromyelia. Hydromyelia, dilation of central canal and lined by ependyma. Syringomyelia, cavity outside central canal lined by glial cells. Suspect tumor as a cause of unexplained syrinx.

Question 23

Most common intradural tumor in thoracic region

Answer 23

Meningioma

Question 24

Spinal meningioma features

Answer 24

Most (80%) occur in women. Average age of 45. Multiple meningiomas suspicious for neurofibromatosis. Usually extramedullary/intradural. Can have extradural component. Dense calcification can occur. Dense homogenous enhancement. Broad dural tails.

Question 25

Most common intraspinal mass

Answer 25

Schwannoma