Intramedullary Lesion, T1 Hypointense, T2 Hypointense



Intramedullary Lesion, T1 Hypointense, T2 Hypointense


Lubdha M. Shah, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Instrumentation/Implants


  • Contusion-Hematoma, Spinal Cord


  • Cavernous Malformation, Spinal Cord


Less Common



  • Cysticercosis


  • Type II AVM


Rare but Important



  • Diastematomyelia


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Assess for post-surgical changes


  • Flow voids suggest vascular lesion


  • Associated vertebral body anomalies in diastematomyelia


Helpful Clues for Common Diagnoses



  • Instrumentation/Implants



    • Intrathecal & epidural catheters allow infusion of anesthetics


    • Syringomyelia (hindbrain herniation or post-traumatic) treated with shunting into subarachnoid, peritoneal or pleural spaces


    • Complications: Infectious/inflammatory process, misplacement, cord or nerve injury, CSF leak, & spinal hematoma


  • Contusion-Hematoma, Spinal Cord



    • Acute contusion is T1 iso-/ hypointense


    • Blood products hypointense on T2 & T2* GRE sequences


    • ± Cord swelling


  • Cavernous Malformation, Spinal Cord



    • T1 & T2 heterogeneous due to blood products of varying ages


    • T2 hypointense rim (hemosiderin)


    • No edema unless recent hemorrhage


    • No prominent vascular flow voids or nidus


Helpful Clues for Less Common Diagnoses



  • Cysticercosis



    • Focal cystic lesion(s) with or without syrinx cavity


    • T2 hypointensity may be due to cyst wall degeneration with calcification


    • Peripheral cyst enhancement


  • Type II AVM



    • Intramedullary nidus with dorsal subpial extension


    • Cord enlargement with heterogeneous T1/T2 signal due to blood products & flow voids


    • Intra-/perinodal aneurysm in 40%



      • Subarachnoid is most common symptom


Helpful Clues for Rare Diagnoses



  • Diastematomyelia



    • Type 1 has separate dural sac & arachnoid space, more common



      • Iso-/hypointense spur (osseous or fibrous)


    • Type 2 has a single dural sac & arachnoid space



      • ± Iso-/hypointense fibrous spur


    • Two hemicords with or without syringohydromyelia (50%)






Image Gallery









Sagittal T1WI MR shows a linear T1 hypointense catheter within the cervical syrinx cavity image. Susceptibility artifact at the entry site of the catheter is also seen image.

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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Intramedullary Lesion, T1 Hypointense, T2 Hypointense

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