Cord Lesion, T2 Hyperintense, Ventral

Lubdha M. Shah, MD

DIFFERENTIAL DIAGNOSIS

Common

Less Common

Rare but Important

ESSENTIAL INFORMATION

Key Differential Diagnosis Issues

Axial T2WI: Useful to localize lesion center in relationship to spinal cord long tracts

Helpful Clues for Common Diagnoses

Multiple Sclerosis, Spinal Cord
- STIR MR is sensitive for detecting demyelinating lesions
- Ill-defined = partial demyelination; well-defined = complete demyelination
Contusion-Hematoma, Spinal Cord
- Acute contusion shows T2 hyperintensity with susceptibility artifact from blood products on GRE
- STIR detects marrow edema & ligamentous injury
Infarction, Spinal Cord
- T2 hyperintensity in gray matter ± adjacent white matter, classically anterior horn cells
- Vertebral body infarct with increased T2 marrow signal in the anterior vertebral body/deep medullary portion near the endplate
Spondylotic Myelopathy
- Pathophysiologic factors may be static mechanical, dynamic mechanical, & spinal cord ischemia

Helpful Clues for Less Common Diagnoses

Spinal Cord Herniation
- Focal anterior cord displacement through a ventral dural defect with expansion of dorsal subarachnoid space
- Often in mid-thoracic spine with cord deformity

Helpful Clues for Rare Diagnoses

Viral Myelitis
- Disease of lower motor neurons that affects the gray matter of the spinal cord, specifically ventral horns
- Includes poliomyelitis
Toxin Exposure
- Reported cases of T2 hyperintensity & enhancement in the anterior horns & lumbar nerve roots after heroin & amphetamine exposure
Amyotrophic Lateral Sclerosis
- Earliest manifestations of ALS on imaging may be diffusion restriction