White Spot In Spinal Cord

Fig. 3.17. Tl-weighted, contrast-enhanced, sagittal (a) and axial (b) MRI scans of a cavernoma at Th4 in a 57-year-old patient. The patchy contrast enhancement and irregular shape of the tumor as well as the black hemosiderin remnants on T2 (c) are typical for this tumor

Fig. 3.18. Tl-weighted sagittal (a) and axial ( i) MRI scans of an ependymal cyst of the conus in a 45-year-old woman. The cyst is located anteriorly on the left side. Please note the considerable space-occupying effect of this cyst

Fig. 3.18. Tl-weighted sagittal (a) and axial ( i) MRI scans of an ependymal cyst of the conus in a 45-year-old woman. The cyst is located anteriorly on the left side. Please note the considerable space-occupying effect of this cyst

Fig. 3.19. Tl- (a) and T2-weighted (b) MRI scans of an ep-endymal cyst at Th10-Th12 in a 42-year-old woman with an 18-month history of pain in her right leg. The cyst is in a central position, as apparent on the axial T2-weighted image (c).

The cyst causes marked expansion of the cord and appears like a regular, symmetric cyst with sharp demarcation toward the spinal cord. There are no septations inside the cyst

Syrinx Cervical Spine
Fig. 3.20. (a) T2-weighted sagittal MRI scan of a cervicothoracic syrinx with flow void signals inside the cyst (arrowhead). The cardiac gated cine MRI scans demonstrate flow signals within the syrinx in systole ( 5) and diastole (c)
Fig. 3.21 (a) T2-weightedsagittalMRI scan of an ependymal cystatC4-C5 ina62-year-oldwoman. The cardiac gatedcine MRI scans display no flow signals within the cyst in systole ( 5) or diastole c)
Cervicothoracic Syrinx

Fig. 3.22. This T2-weighted sagittal MRI scan shows a syrinx at C4-Th3 caused by an arachnopathy at Th3. The syrinx expands in an upward direction away from the area of CSF flow obstruction. This causes an asymmetric shape of the syrinx: its diameter is largest close to the arachnopathy at Th3 (arrowhead) and gradually tapers off toward C4

Fig. 3.22. This T2-weighted sagittal MRI scan shows a syrinx at C4-Th3 caused by an arachnopathy at Th3. The syrinx expands in an upward direction away from the area of CSF flow obstruction. This causes an asymmetric shape of the syrinx: its diameter is largest close to the arachnopathy at Th3 (arrowhead) and gradually tapers off toward C4

Fig. 3.23. T1-weighted sagittal MRI scan (without contrast) of a predominantly intramedullary dermoid cyst at L1-L2 in a 42-year-old woman. The hyperdense signal of the cyst wall and part of the cyst contents represent fatty components
White Spot Spinal Cord Near
Fig. 3.24. Sagittal (a) and axial (3) T1-weighted images (without contrast) of an intramedullary lipoma at L1 in a 32-year-old patient with an additional tethered cord related to a low conus position. The typical hyperdense signal of the lesion is apparent
Intramedullary Spinal Cord Tumors

Fig. 3.25. MRI scans of a 50-year-old woman with multiple sclerosis. a This contrast-enhanced, T1-weighted image shows an enhancing intramedullary spot at C4, which could be mistaken for an angioblastoma. b Sagittal T2-weighted image showing some perifocal edema and another hyperdense lesion at C2. c Axial T2-weighted image demonstrating a lesion in the posterior midline and a normally shaped cord. d Cranial T2-weighted scan displaying further lesions in the white matter, particularly on the left side.

Fig. 3.25. MRI scans of a 50-year-old woman with multiple sclerosis. a This contrast-enhanced, T1-weighted image shows an enhancing intramedullary spot at C4, which could be mistaken for an angioblastoma. b Sagittal T2-weighted image showing some perifocal edema and another hyperdense lesion at C2. c Axial T2-weighted image demonstrating a lesion in the posterior midline and a normally shaped cord. d Cranial T2-weighted scan displaying further lesions in the white matter, particularly on the left side.

Spinal Cord Signal Change

Fig. 3.26. Signal characteristics of inflammatory lesions may change with time. These T1-weighted sagittal MRI scans without (a) and with contrast (b), show an inflammatory lesion at C2-C3. The lesion does not cause a space-occupying effect. Without contrast, the cord looks absolutely normal. After contrast application, there is some enhancement surrounding the lesion. The sagittal (c) and axial (d) T2-weighted images present an ill-defined, hyperdense lesion in the left side of the cord. On follow up after 12 weeks, the lesion appears larger and better demarcated on the sagittal (e) and axial (f) T2-weighted image, but there is still no space-occupying effect

The differential diagnosis to inflammatory and demyelinating diseases may be difficult, especially with lesions that take up no or little contrast. If an intramedullary lesion is suspected to be a tumor, the following questions should be asked:

1. Is the lesion space occupying?

2. Does the lesion display different signal characteristics with time?

3. Does the pathology affect different parts of the spinal cord with time?

As a general rule, inflammatory and demyelinating lesions almost never displace cord tissue at all, or to an extent that would explain the clinical symptoms (Figs. 3.25-3.29) [173, 190]. Multiple spinal cord lesions maybe detected in demyelinating (Fig. 3.25) and

^ 1 / J

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