Extradural Lesion, No Enhancement
Julia Crim, MD
DIFFERENTIAL DIAGNOSIS
Common
Nonbony
Stenosis, Acquired Spinal, Lumbar
Facet Joint Synovial Cyst
Hematoma, Epidural-Subdural
Sequestered Disc Fragment
Perineural Root Sleeve Cyst
Pseudomeningocele
Arachnoid Cyst
Lipoma, Spinal
Epidural Lipomatosis
Metal Artifact
Bony
Limbus Vertebra
Schmorl Node
Bone Island
Degenerative Endplate Changes (Type III)
OPLL
Ossification Ligamentum Flavum
Post Irradiation Vertebral Marrow
Myelofibrosis
Partial Vertebral Duplication
Diastematomyelia
Less Common
Osteochondroma
Dorsal Dermal Sinus
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Enhancement may be difficult to see against fatty bone marrow unless fat saturation used
Post-contrast MR should include at least 1 sequence using fat saturation
Nonenhancing extradural masses can often be distinguished by location
Sequestered disc anterior to thecal sac
Facet joint cyst adjacent to arthritic facet joint
Perineural cyst in neural foramen or lateral
Hematoma often mimics disc
Helpful Clues for Common Diagnoses
Some lesions will enhance when acute/active but not in chronic stages
Hematoma
Post-operative scar after discectomy enhances for 12-18 months
Schmorl node
Degenerative endplate changes
Acute disc sometimes shows peripheral enhancement due to inflammatory tissue
All spinal bone tumors enhance except osteochondroma, bone island
Facet joint cyst can be followed to arthritic facet joint
Pseudomeningocele vs. abscess
Pseudomeningocele: Homogeneous fluid with thin rim of enhancement
Abscess: Heterogeneous fluid, thick, irregular rim of enhancement
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