Spinal tumours

Question 1

Most common intra-dural extramedullary tumours (2), imaging appearance, location

Answer 1

Meningioma and schwanomma
When multiple (or in younger patients in meningiomas), highly associated with NF2 

M: poterolateral thoracic, slightly hyper T2, avidly enhancing; ddx: hemangiopericytoma

S: dorsal spinal nerve root, hypo T1 (unless melanocytic subtype), T2 hyper, enhancing but heterogeneous if cystic degeneration (antoni A versus B)

Question 2

Location and imaging features of spinal neurofibromas

Answer 2

CERVICAL spine, intradural extra-medullary 
Encase rather than displace nerve roots
Patients asymptomatic (unlike schwanommas)
Marked T2 hyperintensity and enhancement

Plexiform neurofibromas: bag of worms

Question 3

Features of myxopapillary ependymoma

Answer 3

Intradural, extramedullary lesion occurring at the conus, spanning multiple vertebral levels with scalloping and canal expansion, sausage shape, myxoid content, avidly enhancing (both adults and kids)

Ddx: paraganglioma - much less common, usually more heterogeneous with prominent vessels

Question 4

Tumours most likely to cause leptomeningeal mets

Answer 4

Solid - melanoma, breast, lung
Hematologic - leukemia and lymphoma
Drop mets from primary brain (astrocytoma, ependymomas, choroid plexus tumours, GCTs, etc)

Ddx: INFECTION! (intracranially and in the spine)

Question 5

Ddx for intramedullary cord lesions

Answer 5

1) Trauma/edema
2) Demyelinating disease (MS, ADEM)
3) Syrinx, hydromyelia, lipoma
4) Neoplasm: ependymoma, astrocytoma, hemangioblastoma, mets
5) Vascular (AVM, cavernoma)
6) Infections (sarcoid, TB, lyme)

VINDICATE DDX (vascular, iatrogenic, neoplastic, demyelation, infection, congenital, trauma etc.)

Question 6

Difference on imaging b/w ependymoma and astrocytoma

Answer 6

E: Adults, cervical region, cysts and hemorrhage common (cap sign), +/- canal expansion, heterogeneous enhancement
A: Younger patients, thoracic cord, cyst/syrinx less common, enhancing/ infiltrative, spans less than 4 levels

Question 7

Imaging features of hemangioblastoma of the cord

Answer 7

Adults, associated with VHL in 1/3 cases
Subpial/post cord (intramedullary)
FLOW VOIDS, highly vascular

Question 8

Ddx for intradural-extramedullary lesions

Answer 8

MANDELIN
meningioma/mets
arachnoid cyst/web
nerve sheath tumour
dermoid/epidermoid cyst
ependymoma (myxopapillary)
lipoma
infection 
no more...

Question 9

Imaging features of epidermoid

Answer 9

Follow CSF on all sequences, peripheral rim of enhancement, DWI!!! (unlike arachnoid cysts)

Question 10

Most common extradural lesions

Answer 10

Mets
Disc herniation/degenerative lesions
Infection/abscess
Lymphoma

Question 11

Causes of diffuse marrow replacement in the spine

Answer 11

Marrow should be higher signal than the vertebral bodies on T1 weighted imaging

Causes:

• Idiopathic
• Mets
• Myelofibrosis
• Leukemia/Lymphoma
• Chronic illness (HIV)
• Chronic anemia (smoking, athletes, female/fat)

Question 12

Primary vertebral neoplasms

Answer 12

BENIGN:
Hemangioma 
ABC, GCT 
Osteoid osteoma (younger pt)
Osteoblastoma (younger pt)
Chondroblastoma (younger pt)
Osteochondroma 
EG

MALIGNANT:
Chordoma (middle age/adult)
Plasmocytoma (middle age/adult)
Chondrosarcoma (middle age/adult)
Lymphoma
Ewings

Question 13

Imaging findings of chordoma

Answer 13

High signal on T1 and T2, avid enhancement
Sacrum > clivus > cervical spine
Ddx: Chondrosarcoma - look for arcs and ring matrix

Question 14

Causes of epidural lipomatosis

Answer 14

Obesity, exogenous steroids, Cushings

Proliferation of fat in the extradural space, which can cause nerve and cord compression

Question 15

Most common intraspinal tumour

Answer 15

Schwanommas