Intramedullary Lesion, Ring/Peripheral Enhancement



Intramedullary Lesion, Ring/Peripheral Enhancement


Lubdha M. Shah, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Multiple Sclerosis, Spinal Cord


  • Astrocytoma, Spinal Cord


  • Ependymoma, Cellular, Spinal Cord


Less Common



  • Metastases, Spinal Cord


Rare but Important



  • Cysticercosis


  • Abscess/Myelitis, Spinal Cord


  • Epidermoid Tumor, Acquired


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Look for adjacent vertebral or disc abnormalities as a source of infection


  • Assess for supratentorial enhancing lesions


Helpful Clues for Common Diagnoses



  • Multiple Sclerosis, Spinal Cord



    • Enhancement may be homogeneous, nodular, or peripheral



      • During acute or subacute phase & lasts 1-2 months


      • Does not reflect disease progression


  • Astrocytoma, Spinal Cord



    • Enhancement is characteristic



      • Mild/moderate ⇒ intense enhancement


      • Partial ⇒ total


      • Infiltrating ⇒ well-delineated


      • Enhancing area is target for biopsy


    • Asymmetric, can be exophytic


  • Ependymoma, Cellular, Spinal Cord



    • Avid, sharply delineated enhancement (50%)


    • Central > eccentric location


    • Polar or intratumoral cysts (50-90%)


    • Hemorrhage T1 hyperintense


Helpful Clues for Less Common Diagnoses



  • Metastases, Spinal Cord



    • Focal enhancing cord lesion(s) with extensive edema


    • Lesions < 1.5 cm & well-circumscribed


    • Hemorrhagic mets from thyroid CA, melanoma show T2 hypointensity


Helpful Clues for Rare Diagnoses



  • Cysticercosis



    • Peripheral cyst enhancement


    • Cord pial surface enhancement & arachnoiditis


    • Adjacent acute/chronic inflammatory cell infiltrate, “cysticercal abscess”


  • Abscess/Myelitis, Spinal Cord



    • Irregular ring-enhancing intramedullary lesion with cord expansion


    • ± Restricted diffusion


    • T2 hyperintensity from abscess core & surrounding edema


  • Epidermoid Tumor, Acquired



    • Isointense to CSF/cord on T1WI; iso-/hyperintense to CSF on T2WI; more hyperintense than CSF on DWI


    • Absent or faint peripheral enhancement


    • Think infected cyst if prominent enhancement


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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Intramedullary Lesion, Ring/Peripheral Enhancement

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