Spine Tumors Flashcards
intramedullary lesions
ependymoma, astrocytoma, hemangioblastoma, demyelinating lesion
intradural extramedullary lesions
schwannoma, neurofibroma, meningioma, myxopapullary ependymoma, epidermoid/dermoid, arachnoiditis
extradural
degenerative disease, vertebral neoplasm, epidural mets, hemangioma, epidural lipomastosis
spinal lesion localization areas
intramedullary, intradural extramedullary, extradural
intramedullary lesions, most common type
deep to pia, typically within the spinal cord
all intramedullary lesions are intradural
cmmonly astrocytoma (kids), ependymoma (adults)
astrocytoma: intramedullary
most common intramedullary tumor in kids; typically low grade and can cause fusiform dilation of spinal cord
can cause cystic components/syrinx; enhance and rarely hemorrhage
similar appearing to ependymoma
ependymoma: intramedullary
most common itnramedullary tumor in adults; associated with NF2
arises from ependymal cells lining spinal canal
enhance; often hemorrhagic with heterogenous MRI appearance; peripheral hemosiderin deposition with dark T2 rim
causing scalloping of the vertebral bodies
hemangioblastoma: intramedullary
associated with VHL
marked enhancement, cyst formation, flow voids; may have intramedullary and intradural-extramedullary components
demyelinating lesion: intramedullary
active MS lesions may enhance and mimic spinal tumor; no cord expansion
intradural-extramedullary lesions
usually located in subarachnoid space; cSF cleft between lesion/cord
nerve-sheath tumor: intradural-extramedullary tumor
most common intradural-extramedullary tumor; schwannoma vs neurofibroma
schwannoma vs neurofibroma
schwannoma: more common, older pts
neurofibroma: associated with NF1, younger patients ; lacks capsule
meningioma: intradural-extramedullary tumor
older women, benign neoplasm from arachnoid cap cells
broad dural base, calcifications; usually anterior to cord in cerical spine and posterior to cord in thoracic spine
dermoid cyst: intradural-extramedullary tumor
macroscopic fat; presents in childhood
hyperintense T1
may rupture and cause fatal meningitis
epidermoid cyst:intradural-extramedullary tumor
implantation of skin elements during neonatal spine puncture
simple cystic structure on MR with peripheral rim enhancement; may be proteinaceous
restricts diffusion (unlike arachnoid cysts)
myxopapillary ependymoma: intradural-extramedullary tumor
ependymoma exclusively within conus medullaris/filum terminale; arises from ependymal cells
slow growth»_space; vertebral scalopping/spinal canal enlargement
highly vascular, hemorrhagic, lobulated; peripheral hemosiderin; heterogenous appearance
archnoiditis: intradural-extramedullary tumor
inflammation of arachnoid surrounding nerve roots with fibrinous exudate and secondary dural adhesions
usually caued by TB/syphilis
displaces nerve roots
imaging patterns fo arachnoiditis
group 1: central conglomeration of nerve roots
group 2: peripheral clumping of nerve roots; empty thecal sac sign
group 3: obliteration of subarachnoid space with soft tissue; most severe form
extradural lesions
external to dura
include degenerative lesions (herniated discs, osteophytes; mets, infection)
vertebral body/epidural mets
breast, lung, prostate mets
T1 focal decrease
diffuse T1 decreased signal is nonspecific (leukemia, lymphoma, myelofibrosis, HIV, idiopathic)
hemangioma
benign lesion of endothelium lined vascular strucures
striated corduroy appearance; T1/2 hyperintense
ddx primary osseous vertebral body tumors in older adults
chordoma: notocord remnant tumor; sacrococcygeal > clivus > vertebral bodies (cervical); destructive T2 lesion/enhances
plasmocytoma: lytic expansile bony lesion; precursor to MM
chondrosarcoma: low grade malignancy with chondroid rings/arc calcifications; T2 hyperintense
ddx primary osseous vertebral body tumors in adolescents/young adults
ABC: benign destructive lesion with fluid levels on MRI
chondroblastoma: vertebral column; benign; secondary aneurysmal bone cyst may be present
osteoid osteoma: benign sclerotic lesion of vertebral posterior elements; nocturnal pain relieved by NSAIDS; central radiolucent nidus (vascular fibrous connecting tissue)
osteosarcoma: malignant tumor with osteoid matrix
epidural lipomatosis
rare overgrowth of fat in extradural space; most sevre can cause cauda equina
may be caused by exogenous steroid administration, Cushing syndrome; morbid obesity
goal of MRI spine
identify surgically correctible lesion or process that can be treated with steroid injection
disc bulge/herniation
disc (nucleus pulposus, annulus fibrosis) extends beyond normal margins
broad based disc bulge
> 180 disc circumference
disc herniation
focal disc bulge
protrusion: diameter of neck greater than diameter fo dome
extrusion: diameter of neck < diameter of dome; saccular aneurysm
positions of herniation
central, paracentral, foraminal, far-lateral
sequestered disc
protruded disc fragment can migrate inferior or superiorly along posterior longitudinal ligament
degenerative changes to disc
disc dessication with T2 shortening (T2 dark)
Schmorl’s node
Modic changes
type 1: T1 dark/T2 bright; bone marrow edema/inflammation; active symptoms
type 2: T1/2 bright; fatty proliferation with affected marrow; chronic marrow ischemia
type 3: T1/2 hypointense; sclerosis
ligamentum flavum infolding/hypertrophy
can narrow posterior aspect of spinal canal»_space; spinal canal stenosis
facet arthropaty
degenerative intervertebral facet joints»_space; cartilage loss, osteophytosis, sclerosis, subchondral cystic change
tarlov cyst
perineural cyst of sacrum; formed within nerve rooth sheath; asymptomatic
annular fissure
high intensity zone; T2 bright signal in annulus fibrosis
diffuse idiopathic skeletal hyperostosis/DISH
flowing anterior osteophyte exteding 4+ vertebral levels
presevation of disc spaces; ossification of PLL
ossification of posterior longitudinal ligament
calcification of OPLL which can cause spinal canal stenosis/compression of anterior aspect of cord
usually begins in cervical spine
postoperative spine
contrast can distinguish between disc disease and scar tissue
scar tissue will enhance throughout; disc will only have peripheral enhancement
pyogenic discitis/osteomyelitis
infection of disc/adjacent vertebrae, usually from S. aureus
adults: vascular subchondral bone is site
children: intervertebral disc is normally site
T1 dark on both sides of disc, T2 hyperintense; loss of endplate definition and disc height; soft tissue infection may be present
TB osteomyelitis
Pott disease; disc spared since they cannot break down disc substance
wedge shaped compression of anterior aspect of vertebral body; gibbus deformity (acutely angled kyphosis)
may also have pulmonary TB
dAVF in the spine
older males with back pain/progressive myelopathy
cognard type V dural AVF
flow voids seen surrounding cord; abnormal intramedullary T2 prolongation
spinal cord infarction
upper thoracic/thoracolumbar spine due to artery of Adamkiewicz infarct
loss of bowel/bladder control, perineural sensation, motor/sensory imparment
causes: aortic surgery, AAA, arteritis, sickle cell, vascular malformation, disc herniation
T2 hyperintense/enlarged; restricts diffusion; vertebral body infarction may be present
tethered cord syndrome
tethered by thickened filum/lipoma if conus terminates below L2 level
back/leg pain, gait spasticity, decreased lower extremitysensation
diastematomyelia
congenital split spinal cord which causes scoliosis
fatty filum
fat within filum terminale; associated with diastematomyelia, tethered cord; may also be insignificant
