Multiple Sclerosis, Spinal Cord

ADEM, Spinal Cord

Acute Transverse Myelitis, Idiopathic

Typically located eccentrically, not involving the entire cord on axial imaging; relatively short in length (< 2 vertebral bodies)

Enlargement of the cord is unusual (6-14%)

Multiphasic lesions: Some enhance, some don’t

5-24% of patients with MS cord plaques may not have supratentorial disease at presentation

Clinical: Self-limited, monophasic demyelinating illness 5-14 days following viral infection or vaccination

Usually indistinguishable from multiple sclerosis on imaging

Clinical: Acute onset myelopathy, ascending or static loss of sensory and motor function in a bilateral and symmetric distribution

Infiltrative signal abnormality may extend above level of deficit, variable enhancement

Mild fusiform enlargement may be present and simulate the appearance of primary cord neoplasm

Circumscribed, enhancing intramedullary mass; located centrally within the cord

Can show signs of necrosis (heterogeneity, cyst formation) and hemorrhage (hyperintense T1, susceptibility artifact, hemosiderin “cap sign”)

Most common intramedullary neoplasm in adults

Fusiform enlargement, infiltrative margins, long segment of involvement; no or variable enhancement

Most commonly located in the cervical and upper thoracic cord

Uncommon/rare imaging features: Hemorrhage, necrosis, caudal location, exophytic growth, holocord involvement

Cannot be reliably differentiated from ependymoma by imaging

Second most common cord neoplasm in adults, most common cord neoplasm in children (60%)

Abnormal cystic cord lesion with surrounding gliosis; variable expansion of the cord; focal or extensive; typically longitudinal

Secondary to chronic insult/injury (cavitation) or to altered CSF dynamics in the central canal of the cord (technically termed hydromyelia, such as seen in Chiari 1 malformation)

Intensely enhancing, hypervascular tumor(s); usually located dorsally within the cord

Multiple lesions common (check the posterior fossa!)

May or may not have an associated syrinx, which can be disproportionately large relative to the size of the actual enhancing tumor

Often with signs of prior hemorrhage

Often with prominent serpiginous subarachnoid flow voids due to enlarged draining veins

70-90% NOT associated with von Hippel-Lindau

Hyperintense T2 signal in the cord

Tortuous vessels/flow voids on MR, hypervascularity on CT angiography

Hyperintensity on T2WI, possibly with mild expansion

Conus and variable thoracic cord involvement, cervical ischemia is atypical

Most often associated with aortic pathology (dissection, thoracoabdominal aortic surgery), rarely with atherosclerotic disease or embolism

Variable hyperintensity on T1, heterogeneously hyperintense on T2 with surrounding rim of susceptibility due to prior episodes of hemorrhage that blooms on gradient echo sequences

Rare enhancement; may have some surrounding edema if recent bleed