Intramedullary Masses of the Spinal Cord: Radiologic-Pathologic Correlation

Abstract

Spinal cord tumors are a challenge for patients and neurosurgeons because of the high risk of neurologic deficits from the disease process and surgical interventions. Spinal cord tumors are uncommon, and approximately 2%-3% of primary intra-axial tumors of the central nervous system occur in the spinal cord. Primary intra-axial tumors are usually derived from neuroepithelial tissue, especially glial cells. This often leads to a classic intramedullary mass differential diagnosis of ependymoma or astrocytoma, which together constitute up to 70% of spinal cord tumors. For example, ependymomas occur predominantly in adults, and astrocytomas (specifically pilocytic astrocytomas) occur predominantly in children. While that is an excellent starting point, in order to refine the differential diagnosis, the authors review the radiologic-pathologic features of specific neoplastic categories and entities recognized by the World Health Organization (WHO) in the 2016 WHO Classification of Tumours of the Central Nervous System and a few additional congenital-developmental entities. Radiologists can add value by providing a reasonable preoperative differential diagnosis for the patient and neurosurgeon, in many cases by favoring the most common conditions, and in other cases by identifying radiologic features that may point toward a less common entity. Some of the less common entities include intramedullary myxopapillary ependymoma, spinal subependymoma, and spinal hemangioblastoma. Whenever possible, the characteristic imaging features and locations of these tumors are explained or traced back to the underlying cell of origin and findings seen at histopathologic examination.

Intramedullary Spinal Cord Lesions: A Single-Center Experience

“…After confirming the intramedullary topography, the location within the spinal cord, the signal intensity, the enhancement, and the margins must be analyzed [ 19 ]. Intramedullary masses usually expand the spinal cord parenchyma whereas extramedullary lesions displace it.…”

A Survey of Methods and Technologies Used for Diagnosis of Scoliosis

“…Scoliosis also causes a number of dysfunctions in a person who is sick. In addition, diseases emerge from the formation of scoliosis, such as syringomyelia [53], vertebral segmentation anomaly, intramedullary spinal tumor [54] or Chiari malformation [55].…”

Invited Commentary: A Framework for the Differential Diagnosis of Benign and Malignant Intramedullary Tumors

“…In recent years, there have been advances in MRI techniques that can advance our under-standing and characterization of intramedullary spinal masses. Most recently, these advances have included the development of diffusion-tensor imaging (DTI) of the spinal cord, which can provide information on the infiltrative nature of some of these intramedullary tumors related to the disruption of traversing spinal cord white matter tracts, as emphasized in the article (1).…”