HEALSME: Differential Diagnosis for Intramedullary Spinal Cord Lesions

Abstract

Our purpose is to illustrate and review the differential diagnosis for intramedullary spinal cord lesions and masses and to discuss their distinguishing MR imaging features and clinical presentations. An approach to these lesions by using location, signal-intensity characteristics, and patient age significantly narrows the differential diagnosis. The mnemonic HEALSME can help recall a location-based differential diagnosis, accounting for most intramedullary spinal cord lesions, which can be further refined on the basis of patient age, presentation, and imaging features. HEALSME encompasses a variety of intramedullary pathologies, including but not limited to hemangioblastoma, ependymoma, astrocytoma, lymphoma, syrinx, metastasis, MS, and edema. Images of representative entities are presented, and distinguishing imaging features, diagnostic imaging pearls, patient demographics, and prognoses are discussed. Additional less common entities will also be reviewed.

Spinal Hematomas: What a Radiologist Needs to Know

“…While rare, both primary spinal cord lesions and metastatic tumors can cause hematomyelia. Primary neoplasms known to cause hematomyelia most commonly include ependymoma and hemangioblastoma (52). Spinal metastasis accounts for up to 8.5% of central nervous system (CNS) metastasis and 1%-3% of intramedullary neoplasms.…”

Magnetic resonance imaging of the spinal epidural space

“…Epiduralni prostor sadrži vezivno tkivo, polutekuću mast, unutarnji vertebralni venski pleksus, arterije i korijene spinalnih živaca (slika 1). Zbog manjka limfatičnih žila i limfonodula patološki procesi se najčešće šire hematogeno, a činjenica da radikularne vene nemaju valvule omogućava širenje procesa "per continuitatem"². U radu ćemo kratko prikazati najčešće ekstrinzič-ne lezije spinalnog epiduralnog prostora -degenerativne promjene kralježnice, a potom ćemo detaljnije prikazati magnetsko-rezonantnu (MR) dijagnostiku intrinzičnih patoloških promjena spinalnog epiduralnog prostora jer one predstavljaju poseban dijagnostički izazov 3 (tablica 1). MR je slikovna metoda izbora za prikaz patologije spinalnih mekih tkiva zbog njihovog izvrsnog kontrastnog razlučivanja, uključujući koštanu srž, dok izostaju artefakti susjedne koštane strukture koja daje vrlo slab MR signal zbog manjka protona vodika iz kojih se generira MR signal.…”

Longitudinally extensive myelopathy in children

“…The most common inflammatory diseases (primarily demyelinating diseases) that affect the spinal cord are immune-mediated, including multiple sclerosis (MS), neuromyelitis optica (NMO), acute disseminated encephalomyelitis (ADEM), and idiopathic and post-infectious/ post-vaccination transverse myelitis [6]. There is radiographic and clinical overlap for many of these entities [1,3,7]. Rare but other treatable causes of LEM such as infectious myelitis or spinal cord ischemia should be considered and excluded [2,8].…”

“…We prefer to use the term longitudinally extensive myelopathy (LEM) because "myelitis" implies inflammation only. Traditionally, longitudinally extensive transverse myelitis (LETM) was described in the setting of neuromyelitis optica (NMO); however other inflammatory, infectious, vascular, metabolic and degenerative disorders can have a similar MRI appearance and clinical presentation [1][2][3]. Intramedullary tumors, relatively common in the pediatric population, can mimic LEM.…”