Intramedullary Lesion, No Enhancement

Lubdha M. Shah, MD

DIFFERENTIAL DIAGNOSIS

Common

Less Common

Rare but Important

ESSENTIAL INFORMATION

Key Differential Diagnosis Issues

Imaging of ADEM may be similar to fulminant multiple sclerosis; however, the former is monophasic

Helpful Clues for Common Diagnoses

Syringomyelia
- Cystic intramedullary lesions that may be loculated with septations
- Enhancement suggests inflammatory or neoplastic lesion
Multiple Sclerosis, Spinal Cord
- Enhancement during acute/subacute phase & lasts 1-2 months
  - Does not reflect disease progression
- Cord atrophy usually in late stage & correlates with clinical disability
Contusion-Hematoma, Spinal Cord
- Acute: Iso-/hypointense with cord swelling
- Chronic: Focal/segmental atrophy
Acute Transverse Myelitis, Idiopathic
- Centrally located lesion, 3-4 segments in length
- Variable enhancement depending on age

Helpful Clues for Less Common Diagnoses

Astrocytoma, Spinal Cord
- 10% of cord tumors may show no enhancement
- Typically low grade astrocytomas (WHO grade I, II)
- Fusiform cord expansion, T2 hyperintensity
- Cysts uncommon in nonenhancing tumor subclass
Infarction, Spinal Cord
- Early stage may have no T1 signal abnormality
- ± Patchy enhancement in subacute phase
Cavernous Malformation, Spinal Cord
- Absent or minimal enhancement