Spine DDx Flashcards
Spinal Ependymoma vs Spinal Astrocytoma:
Ependymoma:
- Child or adult (“E - Elderly).
- More central in location.
- Bone remodelling common.
- 3 - 4 segments long.
- Low T1 signal
- Haemosiderin Cap sign on T2.
- Surrounding cord oedema.
- Well defined homogenous enhancement
- Associated cysts common
- Syrinx more common
- Haemorrhage more common
- cervical > thoracic.
Astrocytoma:
- Child ( “C containing Child”)
- more eccentric, with fusiform expansion of cord.
- Cervical > thoracic.
- Short segment < 4 segments.
- Bone remodelling less common
- Low T1 signal
- Ill defined heterogenous enhancement
- Syrinx less common
- Haemorrhage less common
Adult Sacral Mass:
Lytic osseous Mets Sacral stress Fracture Occult intra sacral meningocele Chordoma Lymphoma Giant cell tumour Multiple Myeloma Chondrosarcoma
Paediatric sacrococcygeal Mass:
Sacrococcygeal teratoma Presacral abscess Chordoma Neuroblastic tumour Plexiform neurofibroma Lymphoma Chondrosarcoma Ewings.
Solitary flattened vertebral body:
Osteoporosis Lytic osseous Mets Plasmacytoma MM Steroids LCH Giant cell tumour Ewing Sarcoma Leukaemia Lymphoma Pyogenic OM
Multiple flattened Vertebral Fractures:
Trauma Osteoporosis Lytic osseous Mets MM Leukaemia Lymphoma Sickle cell disease Osteogenesis Imperfecta
Aggressive bony lesion:
Lytic osseous Mets Blastic osseous mets lymphoma MM Pyogenic Infection Granulomatous OM LCH Haemodialysis Spondyloarthropathy Neurogenic arthropathy Ewings in child
Diffuse Vertebral body T1 Hypointense Signal
Hyperplastic Marrow Blastic osseous Mets MM Lymphoma Leukaemia HIV Sickle Cell Renal Osteodystrophy Myelofibrosis Osteopetrosis Fibrous dysplasia
Ventral / lateral paraspinal Mass:
Lymphadenopathy - Lymphoma - Mets Vertebral body Met Aortic Aneurysm Paraspinal abscess Retroperitoneal haemorrhage Lateral meningocele Neurogenic tumour: - schwannoma - Neuroblastoma - ganglmioneuroma Extramedullary haematopoiesis.
Extra dural lesion with solid enhancement
Peridural fibrosis Osseous Mets Neurofibroma Schwannoma Lymphoma Plasmacytoma Ewings LCH
Intra dural intra medullary lesion with solid enhancement:
Tumour like conditions:
- Spinal cord ependymoma
- Spinal cord astrocytoma
- Haemangioblastoma
- Mets: assess bones, and leptomenigneal enhancement.
Demyelinating:
- MS
- ADEM
- Neuromyelitis optica
Cavernous malformation.
Intra dural extra medullary lesion with solid enhancement:
schwannoma Meningioma Neurofibroma Myxopapillary ependymoma. CSF Mets.
INtra dural extra medullary lesion with ring / peripheral enhancement:
Arachnoid cyst Schwannoma cystic Meningioma cystic Neurenteric cyst Meningitis Cysticercosis
Intra dural extra medullary lesion T1 hyperintense
Metal artifact Filum terminale fibrolipoma Lipoma Subdural haematoma SAH Lipomyelomeningocele Dermoid / epidermoid.
Intra dural extra medullary lesion T2 hyperintense T1 isointense:
Schwannoma Neurofibroma Epidermoid CSF Mets Myxofibrillary ependymoma Cysticercosis.
Vertebral body scalloping:
POSTERIOR: "SALMON" S: spinal cord tumour: astrocytoma, ependymoma, schwannoma. A: Achondroplasia, acromegaly. L: Loeys Dietz M: Marfans, Mucopolysaccharidoses O: Osteogenesis Imperfecta N: NF1 --> lateral menigocele.
ANTERIOR: Retroperitoneal lymphadenopathy: - Leukaemia - Lymphoma - TB. Abdominal aortic aneursym Down syndrome.
Vertebral Body Focal T1 hyperintense signal
Normal Haemangioma Degenerative endplate Focal fatty marrow Enhancement Paget Mets - Melanoma
Diffuse Vertebral Body Sclerosis:
Discogenic Sclerosis Sclerotic Mets Chronic OM Renal Osteodystrophy Paget Sickle Cell Osteopetrosis Radiation Myelofibrosis
Focal Vertebral body Sclerosis:
Bone Island Haemangioma Degenerative Endplate changes Sclerotic Mets Insufficiency fracture Compression fracture Chronic OM ankylosing spondylitis Osteoid Osteoma. Ewings in child
Enlarged vertebral body with soap bubble appearance:
Lytic Mets: lung, thyroid, renal. MM / plasmacytoma Osteoblastoma Giant Cell Tumour Aneurysmal Bone Cyst Chordoma
Intramedullary Mass:
MS Neuromyelitis Optica ADEM Acute transverse myelitis Ependymoma astrocytoma Contusion Haemangioblastoma AV malformation Infarction.
Multiple Intra medullary lesions:
MS Mets ADEM Haemangioblastoma Ependymoma (NF2)
Intramedullary Lesion no enhancement:
Syringomyelia MS Contusion Acute transverse myelitis astrocytoma ADEM
Intramedullary lesion with diffuse / ill defined enhancement:
MS Acute transverse myelitis ADEM Viral myelitis neuromyelitis optica Dural AVF Met
Intramedullary lesion with ring / peripheral enhancement:
MS Astrocytoma Ependymoma Met Cysticercosis
Intramedullary lesion T2 hyperintense T1 isointense:
MS Neuromyelitis Optica Acute transverse myelitis Contusion Cellular ependymoma Astrocytoma Dural AVF Haemangioblastoma ADEM
Intramural Extramedullary Leptomeningeal enhancement:
Gullian barre syndrome CSF Mets Meningitis Myxopapillary ependymoma Neurofibroma Schwannoma
Marrow summary signal:
T1 money sequence
- Yellow marrow bright
- Red marrow is darker / isointense to muscle
Red marrow should never be darker than normal disc or muscle on T1.
Red marrow increases if need for haematopoesis.
Posterior elements lesion:
G: giant cell tumour O: osteoblastoma T: tuberculosis A: aneurysmal bone cyst P: Paget disease E: eosinophilic granuloma
