Intramedullary Lesion, T1 Hypointense
Lubdha M. Shah, MD
DIFFERENTIAL DIAGNOSIS
Common
CSF Flow Artifact
Syringomyelia
Multiple Sclerosis, Spinal Cord
Contusion-Hematoma, Spinal Cord
ADEM, Spinal Cord
Ependymoma, Cellular, Spinal Cord
Astrocytoma, Spinal Cord
Hemangioblastoma, Spinal Cord
Less Common
Type II AVM
Cavernous Malformation, Spinal Cord
Abscess/Myelitis, Spinal Cord
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Prominent flow voids seen with type II AVM & hemangioblastomas
Helpful Clues for Common Diagnoses
CSF Flow Artifact
Caused by
Time of flight loss
Flow-related enhancement
Varied turbulent flow velocities/directions → rapid dephasing, signal loss, “intravoxel dephasing”
Artifacts propagate across cord, subarachnoid space
Most common in thoracic spine
Especially common in pediatric patients
Syringomyelia
Expanded cord with nonenhancing dilated or beaded cystic cavity
Multiple Sclerosis, Spinal Cord
Unlike supratentorial lesions, cord lesions are rarely visible as T1 hypointense
Contusion-Hematoma, Spinal Cord
Acute contusion appears iso-/hypointense with cord swelling
Hematoma later hyperintense 2° metHB
ADEM, Spinal Cord
Multifocal hypointensity & slight cord swelling
Ependymoma, Cellular, Spinal Cord
Iso- or slightly hypointense to spinal cord with polar or intratumoral cysts (50-90%)
Fusiform cord enlargement
Astrocytoma, Spinal Cord
Multisegmental, usually < 4 segments
Hypo-/isointense eccentric, infiltrative solid portion, indistinct margins ± syrinx
Hemangioblastoma, Spinal Cord
Cystic lesions with enhancing nodule & extensive surrounding edema
Helpful Clues for Less Common Diagnoses
Type II AVM
Enlarged cord with heterogeneous signal 2° blood products & flow voids
Cavernous Malformation, Spinal Cord
Speckled “popcorn” appearance 2° varying ages of blood productsRelated posts:
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