Neoplastic disorders of spinal cord

NEOPLASTIC DISEASES OF THE
SPINAL CORD
9/3/2020 SPINAL NEOPLASMS 1

Normal Anatomy- SPINE
• Anterior elements: vertebral
body, IV disc
• Posterior elements: pedicle &
neural arch (articular pillar,
facet joint, lamina, spinous
process)
• Ligaments
• Soft tissues (epidural fat,
venous plexus)
• Neural tissue

• Body:
• Marrow: from 7 years to adolescence, conversion from
red to yellow,
• Young: marrow isointense to paraspinal muscle in T1WI,
enhance with contrast
• Adult: high SI in T1WI (Fat SI), no enhancement
• IV disc:
• Slightly concave posteriorly except at L5-S1 which is
rounded
• Infant: in T2WI, outer high SI with central low SI
(notochordal remnant) vs
• Adult: in T2WI, outer low SI (also in T1WI, fibrous annulus
fibrosus) with central high SI (nucleus pulposus)

• Facet jt orientation:
• parasagittal in upper lumbar
spine
• More oblique in lower lumbar
spine
• Axial: Mushroom shaped; Sup art
facet is cap & inf art facet with
spinal lamina is stem
• ALL: thicker, basiocciput to S1,
contacts both vertebral body & IV
disc,
• PLL: thinner, C1 to S1, contacts IV
Disc only but spans body
concavity like a bowstring

General Approach
• Detection of the lesion.
• Localize the lesion in the anatomical
compartment- extradural, intradural or
intramedullary.
• Consider age and narrow down D/D.
• Characterize the lesion in terms of
density/intensity, enhancement pattern, cystic
changes, necrosis and calcification - Give most
probable diagnosis
• Tissue sampling, if radiologically accessible .

Detection of the lesion
Imaging
– Plain x-ray
– Myelogram
– CT/CT myelogram
– MRI
– Angiogram
– Bone scintigraphy
MRI:
• Better detection of tumor not involving bone
• Even with intrathecal contrast, crucial internal details of cord
not visualized in CT, so MR study of choice.
• Signal alteration from tumor infiltration within normally
bright marrow fat on T1WIs usu precede any bony changes
detectable on plain film or CT MR is probably the earliest
reliable method for detection of mets

Localizing the lesion.
Myelographic features

Age is very important factor:
• Large number (38%) of symptomatic spinal
canal lesions are developmental in children.
• Metastasis are the most common neoplastic
conditions involving the spine in adult.
• Meningiomas constitute 25% of all intraspinal
lesion in adult but are rare in children.

INTRAMEDULLARY
TUMOURS
• 20% spinal neoplasm (adult); 35% (children)
• MOSTLY Malignant- glioma (ependymoma 60% and
low grade astrocytoma 30%)- 90-95 % of all
intramedullary tumours are gliomas.
• Benign- Ganglioglioma, Paraganglioma
• Nonneoplastic cysts and tumour like spinal cord
masses- hydrosyringomyelia, hematomyelia and
noninfectious inflammatory disease (multiple
sclerosis, ADEM and transverse myelitis)

• Best tool: MR without & with contrast (revolutionary technique)
(study 70% accurate histological dx– most difficult was ependymoma
vs astrocytoma)
• “basic” spinal MR imaging study:
 Unenhanced T1WI & T2WI sagittal
 Enhanced T1WI sagittal and axial planes.
• Contrast: internal characteristic; postop for recurrence
• In contrast to intracranial neoplasms, vast majority of spinal cord
neoplasms, including even low-grade forms, enhance at least some
degree. Enhanced areas probably represent more active portions of
the tumors and may indicate potential sites for biopsy if resection is
not feasible.
• If intramedullary cord lesion discovered imaging of remainder of
neuraxis is important
• The higher the location of an intramedullary spinal tumor, the more
likely that a syrinx will develop.
• Every pt with a syrinx  contrast enhanced MR at least once to
exclude cord neoplasm

3 tenets- 1. Cord expansion
• Essential imaging criterion for an
intramedullary spinal neoplasm is cord
expansion
• If this feature is absent, it should suggest a
nonneoplastic etiology
• Neoplasm gross total resection of mass
after the tumor is debulked
• Nonneoplastic only a biopsy

3 tenets- 2. enhancement
• Vast majority of intramedullary spinal
neoplasms show at least some enhancement;
• Converse is not true: The absence of
enhancement does not exclude an
intramedullary neoplasm in the presence of
cord expansion
• contrast-enhanced images in at least two
different planes is essential

3 tenets- 3. cysts
• cysts are a common associated finding
• two basic types of cysts: tumoral and nontumoral
Tumoural Non tumoural
Within the tumor itself Poles (aka polar or satellite cyst)
Tumour component Simply reactive dilatation of the
central canal (syringomyelia)
Peripheral enhancement Not enhance on imaging studies.
They are not septated
Needs to be resected as well Only the solid component of a spinal
cord tumor must be resected

Ependymoma
• Arise from ependymal cell lining the central canal or its
remnant or from the cell of ventriculus terminalis in the
filum terminale.
• Incidence-
 60% of glial spinal cord tumour,
 30% of pediatric intramedullary spinal neoplasm
 Most common intramedullary tumour in adult.
 Middle aged patients (39 yr is mean age of presentation)
 Slight female predominance.
• Typically cellular ependymoma
• Myxopapillary ependymoma of the cauda equina region.
Slight male predominance.
9/3/2020
Unlike intracranial ependymomas, calcification is not
common in spinal ependymomas. 15

Location
• Cervical cord most common site
of intramedullary ependymoma
• Conus medullaris and fillum
terminale commonest neoplasm
is myxopapillary ependymoma
(13% of spinal ependymoma)
• Displace rather than infiltrate
(like astrocytoma), thus more
resectable in surgery
C/F:
• neck/back localised pain- long
history (since slow growing)
• mild objective neuro deficit

• The frequent presentation of sensory
symptoms may be explained by the proximity
of these centrally located tumors to the
spinothalamic tracts. Dominant motor
symptoms are commonly associated with very
large ependymomas.

Imaging
• Plain film
– Widened canal or bone destruction in 20 % of cases.
– Scoliosis
– Vertebral body scalloping; pedicle erosion; laminar thinning
• Myelography
– Nonspecific cord widening
– Multisegmental lesions are common.
– Small conus medullaris and filum terminale ependymoma are seen as
well delineated intradural masses with a contrast meniscus around
the tumour. Contrast block may be seen.
– Large myxopapillary ependymoma can fill the entire canal.
• CT findings
– May show nonspecific canal widening
– Scalloped posterior vertebral bodies
– Neural foraminal enlargement

• MR
– Widened cord or filum terminale mass
– Symmetrical cord expansion.
– Central, well circumscribed
– Isointense to cord on T1WI.
– Mixed signal lesions are seen if cyst
formation. Cyst common at poles
– Tumour necrosis and hemorrhage
(hyperintense T1, susceptibility artifact,
hemosiderin ‘cap sign’) may occur.
– In contrast to intracranial ependymomas,
calci is uncommon.
– Focal intense homogenous enhancement
(vascular)
– Hyperintense on T2WI.
– Hypointensity in the tumour margin at
T2WI is common (1/3rd cases) in
intramedullary tumor and s/o but not
pathognomonic of ependymoma.
– Tumor & adj edema diff by IV contrast
– Hemosiderin cap sign is also seen in
hemangioblastomas and paragangliomas.

• D/D-
Cord astrocytoma is the major d/d of
intramedullary ependymoma.
Schwannoma is the major d/d of small conus
and filum terminale ependymoma.
Spinal cavernous malformation – no
enhancement; complete hemosiderin ring
Myxopapillary variant: T1 hyperintensity - myxoid material
within the connective tissue elements. Vs Cellular
ependymoma elsewhere

MYXOPAPPILARY EPENDYMOMA: EXPANSIILE INTRAMEDULLARY
LESION

Figure 3a. Ependymoma in a 32-year-old woman with upper- and lower-extremity weakness
and numbness and bowel and bladder dysfunction.
Koeller K K et al. Radiographics 2000;20:1721-1749
©2000 by Radiological Society of North America
C+ sag T1WI:
• heterogeneously enhancing mass
expanding cervical spinal cord
• cyst with faint peripheral
enhancement at superior pole of
mass

T2WI ISOINTENSITY SUBTLE
HYPOINTENSITY AT C2/C3 LEVEL S/O
HAEMORRHAGE
Central location of tumor

Astrocytoma
• Usually low grade astrocytoma (75% in adult, 85-90% in
child); anaplastic astrocytoma, GBM rare.
• Second most common spinal tumour overall (30% of glioma)
• Most common cord tumour in children (60%)
• Median age at presentation is 21 yrs (range 9 months to 70
yrs). M:F 3:2
• Increased NF 1.
• Location; cervical spinal cord is the most common site
followed by thoracic cord. Multisegmental involvement is the
rule. Holocord involvement usu in children.
• Diffuse expansion of cord with intratumoural cyst; absence of
a surrounding capsule.
• In contrast to cord ependymomas, a cleavage plane is not
present in most intramedullary spinal astrocytomas.
• i.e. ILL DEFINED (vs WELL DEFINED ependymoma)

• C/F: pain +, neuro dysfn lacking
• Imaging
– Plain film- normal/ mild scoliosis
(usu in holocord involvement);
widened interpedicular distance
in few cases
– Myelography- typically
demonstrate nonspecific
multisegmental cord
enlargement. May cause the
block to the normal flow of
cotrast past the lesion (but usu
with ependymoma)
– NECT- widened canal
22 month

MR:
• investigation of choice.
• Iso to hypointense on T1WI or hyperintense on
T2WI.
• Enhance after contrast (though low grade),
more heterogenous than ependymoma
• If GBM, CSF tumor dissemination
Intratumoural cyst syrinx
CSF SI CSF SI
Irregular area Parallel walls
Rim enh after IV contrast No enhancement

Sag T1WI C+: large
tumor with
heterogeneous
enhancement-
pilocytic astrocytoma
Sag T2WI: intramedullary
lesion in cervicothoracic
spinal cord & cord
expansion. low-grade
astrocytoma

Astrocytoma Vs Ependymoma
• Astrocytomas and ependymomas are the two
most common intramedullary tumors
• Involvement of entire cord diameter and
longer cord segment (avg 7 vs 1-5
ependymoma)– favor of astrocytoma
• Presence of hemorrhage – favor ependymoma

Ependymoma a/w NF2 vs astrocytoma a/w NF1

Spinal cord hemangioblastoma
• Vascular nodule with benign intramedullary
cyst is most common
• Rare (1-5%) cord tumor
• Symptom onset: 30-40yrs
• Usu solitary 80%, multiple in VHL syndrome
• 85% intramedullary or combined intradural-
extramedullary
• Location: 50% thoracic, 40% cervical

Imaging findings:
• Angiography:
– Dense vascular stain
– Prominent draining vein
CT
On NECT – soft tissue nodule often with
prominent hypodense cyst like component.
Contrast administration – vivid
enhancement of the solid component.
• MRI:
– Iso to cord on T1
– Hyperintense on T2
– Foci of signal void common
– Cyst formation or syrinx seen in 50-70%
– Strong enhancement of tumor nodule
– Stm may be the source of SAH or
hematomyelia.
T1C+

Sag T1WI: dorsal location, enhances homogeneously, does not show any flow voids
that may be seen with larger tumors.

Axial T1WI: confirms dorsal hemangioblastoma that abuts the pial surface, whose
position is typical of these tumors and makes removal easy

Miscellaneous spinal cord tumors
• Primary:
– Oligodendroglioma
– Ganglioglioma
– Intramedullary schwannoma
• Metastases:
– Rare
– Most mets are to the pia
– Pial mets are seen on post contrast T1WI image as a thin rim of
enhancement along the cord surface.
– Focal nodular pial & intraparenchymal lesions occur less commonly
than carcinomatous meningitis
– Common primary malignancies are breast, lung carcinoma,
lymphoma, malignant melanoma

• Syringomyelia:
• Abnormal cystic cord lesion;
typically longitudinal;
variable cord expansion
• Due to chronic injury or
altered CSF dynamics
• Intramedullary AVM:
• T2 high SI in cord
• Tortuous vessels/flow voids
on MR; hypervascularity in
CTA

INTRADURAL EXTRAMEDULLARY TUMOURS
• Location- inside thecal sac but outside the cord.
• Tissue- nerve roots, leptomeninges,
• Benign tumours
– Nerve sheath tumours
– Spinal meningioma
– Paraganglioma
– Cysts and other benign tumour like masses as Epidermoid cyst,
Dermoid cyst, Neurenteric cyst, Arachnoid cyst, Hypertrophic
neuropathies
• Malignant tumours
– Mets (spinal leptomeningeal)
– Non-hodgkins lymphoma

Classically:
• Spinal cord
displacement
• Enlargement of
ipsilateral SAS
• Sharp crescentic
interface between
contrast column &
undersurface of
mass

Nerve sheath tumours
• Most common intradural extramedullary mass
• Types
– Schwannoma, neurofibroma, ganglioneuroma,
neurofibrosarcoma .
• Primarily seen in middle aged adults
• Variable location
– Intradural extramedullary (70-75%)
– Dumbbell (15%)- combined extra and intradural masses.
– Extradural (15%)
– Intramedullary ( < 1%)
– Multiple lesions common with neurofibromatosis -1

• Both constitute 80-90% intradural extramedullary
tumors (Both from Schwann cell)- cannot be reliably
distinguished
• Dorsal sensory root
• Slight lumbar predominance
• C/F: as disc herniation (pain, radiculopathy)
• Malignant transformation: never in Schwannoma &
4-11% in NF (Benign tumour with cyst, hmg, necrosis
mimic malignancy)9/3/2020 SPINAL NEOPLASMS 41
Schwannoma Neurofibroma
Lobulated, round to oval fusiform
encapsulated unencapsulated
Necrosis & cystic degeneration
common
rare
Nerve fibers do not course
through tumour; nerve fibers
in capsule; mass eccentric
Nerve fibers course through
tumour; thus mass cannot be
dissected from parent nerve

Imaging
• X ray:
 Pedicle erosion and enlarged neural foramina,
 Para spinal soft tissue masses common with dumbbell and
extradural lesion.
 Kyphoscoliosis and so called ribbon-ribs are seen with
neurofibromatosis.
 Posterior vertebral body scalloping can occur with Intradural
lesion but is more commonly due to dural ectasia than
neoplasm
• Myelography: typical of intradural extramedullary

• NECT- bone erosion, variable
density (hypo to slightly
hyperdense), calcifications and
hmg rare.
• MR- Vary.
• T1WI 75% isointense, 25%
hypointense
• T2WI >95% hyperintense
• Enhancement with contrast
• T2WI and CET1WI, lesions with
hyperintense rim and
hypointense centre (target sign)
seen in neurofibroma.

Giant Schwannoma
• Extends more than 2 vertebral segments
• Paraspinal extension more than 2.5 cm
• Posterolateral extension into myofascial plane
k/a giant invasive schwannoma
• Common in lumbosacral region

SPINAL MENINGIOMA
• Origin from Denticulate ligaments
• Mostly benign
• 2nd commonest (25%)
• Ratio of spinal to intracranial meningioma is about
1:8.
• Peak incidence is 5th and 6th decade. More than 80%
occur in women.
• Most common location: thoracic spine (80%), cervical
(15%), lumbar spine uncommon. Mostly occurs
lateral to the spinal cord.
• 90% intradural and extramedullary. 5% dumbbell &
5% extradural

IMAGING
• C/F: neuro deficits- motor 90%, sensory 60%, pain
(Despite usu small, due to confines of spinal canal
signifi neuro dysfn)
• Plain film
– Usually normal.
– Bone erosion uncommon
– Calcification is rare, visible in 1-5% of cases.
• CT (non-contrast)
 Isodense or moderately hyperdense mass
 hyperostosis may be seen but is not as common as in the
intracranial forms
 calcification may be present
• Myelography
– Typical picture

• MR
– Show extension and relation
to the spinal cord. Ventral or
ventrolateral
– Isointense with the spinal
cord on both T1 and T2WI.
– Moderate homogenous
enhancement seen after
contrast.
– Broad based dural
attachment.
– Dural tail sign
– Occasionally densely calcified
meningioma are profoundly
hypointense on MR and
show only minimal contrast
enhancement.

w9Meningioma Nerve sheath tumour
Female predominance
Cord compression features Pain, radiculopathy
Usu Solitary May be multiple esp in NF
Anterolateral to cord Dorsal to cord
Neural foraminal remodelling commoner
Target sign (peripheral high SI & central low
SI in T2WI & C+T1WI)
Dural tail sign & broad dural attachement

Leptomeningeal Metastasis
CNS Source Non-CNS source
GBM lung
Anaplastic astrocytoma breast
Ependymoma melanoma
Medulloblastoma lymphoma
Pineal (germinoma, pineoblastoma) leukemia
Choroid plexus tumours

• Lumbosacral SAS
• Multiple lesions
• Tumor cells exfoliate into CSF and
‘drop’ down into spinal canal, implant
on the pia, and grow into small
nodules= drop metastasis
• Diffuse sheetlike infiltration or nodular
deposits
• X ray: multifocal bony mets &
pathologic compression #
• MR:
• unenhanced MR may be normal,
thickened root or nodular lesions
(isointense)
• Contrast MR dramatically strong
enhancement (smaller lesions easily
seen)

Extradural masses
• Occurs outside the spinal dura.
• Typically arises from
i. Osseous spine
ii. Intervertebral disc
iii. Paraspinous soft tissue
• Benign:
degenerative & traumatic e.g. disc herniation,
osteophyte, fracture
Hemangioma, osteoid osteoma, GCT, ABC,
osteoblastoma
• Malignant: Metastasis

• Hallmark: focal displacement of
thecal sac & contents away from
the mass
• Myelography:
• Extrinsic compression of thecal sac
• Myelographic “block” large
lesion, displaced thecal sac,
obliterated SAS & compressed
spinal cord
• “Feathered” appearance border
betn lesion & head of contrast
column

• MR:
• + Dura drapped over mass
• Stm, displaced epidural fat
crescent capping lesion

Metastasis
• Common primaries:
• In adult: breast, lung & prostate
• In children: Ewing, neuroblastoma, osteosarcoma
• Location: that of Red BM, thus lower thoracic &
lumbar spine
• In adult: posterior aspect of vertebral body then
epidural space & pedicle
• In child: invade spinal canal via neural foramen
• C/F: pain, progressive neurologic deficit (most
dreaded cord compression)
• Note: extradural mass with block; LP can cause
‘coning’ of cord at level of block rapid neuro
deterioration

• X ray:
• Need >1cm, 40-50% bone loss for
detection (high false negative)
• Most common pedicle
destruction
• mostly osteolytic, stm
osteosclerotic (prostate, breast,
stomach, carcinoid)
• Frequent multifocal lytic
vertebral body lesion, pathologic
compression fracture, paraspinal
soft tissue mass
• Subtle but useful indistinct
posterior vertebral body margin

Bone scintigraphy:
• Standard initial imaging method for screening for skeletal metastases
• Sensitive, 5-10% change for detection
• However nonspecific (trauma, infection, arthropathy, or osteopenia of disuse)
• Hot lesion, but may be cold in aggressive mets
• known primary tumor, a scan showing multiple lesions strongly suggests metastases.
However, only 50% of solitary foci represent metastases, even in patients with cancer.

• CT:
• Detection of cortical destruction
• Epidural mass present as amorphous
soft tissue displacing thecal sac or
filling neural foramen
• metastatic lesions without significant
bone destruction may be missed
• diagnostic accuracy of MRI (98.7%) to
be significantly superior to 16/64-row-
MDCT (88.8%) for detection of osseous
metastases
• Disadv:
 Beam hardening artifact obscures adj
soft tissues & bones
 Cortical destruction difficult to detect
when osteoporosis or degenerative
changes occur

• MR:
• most sensitive
• four patterns:
Focal sclerotic (low SI in T1WI &
T2WI)
Focal lytic,
diffuse homogenous,
diffuse inhomogenous (low SI in
T1WI & high SI in T2WI)
• Enhancement degree & pattern
variable

Vertebral Hemangioma
• Commonest benign spinal neoplasm
• Commonest type: cavernous
• Dilated vessels interspersed among longitudinally
oriented trabeculae (fewer but thicker)
• 4th-6th decade
• Lower thoracic & lumbar spine
• Vertebral body usu, concomitant posterior
elements
• 60% asymptomatic; 20% progressive neuro deficits
• Fatty VH inactive; vascular VH active with
potential to cause cord compression

• X ray: lytic foci with
honeycomb
trabeculation or thick
vertical striations
• NECT: Lucent lesion
with typical ‘polka-dot’
sign (coarsened vertical
trabeculations)

• MR: variable (d/o fatty or
vascular predominantly)
• Mostly round, well defined,
high SI in T1WI & T2WI with
low SI of trabeculae - fatty
• Low SI in T1WI, enhance
with contrast- vascular

• IV disc herniation:
• Commonest epidural mass
• Always ventral or
ventrolateral to thecal sac
• Epidural lipomatosis:
• Prominent epidural fat,
prolonged steroid, Cushing’s
• Mass effect on thecal sac
with ‘Y’ or trefoil shape of
thecal sac

• Synovial cyst:
• Facet degeneration
• Circumscribed, fluid filled
str adj to facet jt
• Cyst on ant aspect may
impinge thecal sac or nerve
root
• Pseudomeningocele:
• Epidural fluid collection
• Surgical or traumatic dural
defect causing a CSF leak

• Abscess:
• a/w disc space infection
• Approx fluid SI in T1 & T2
with marked peripheral
enhancement
• Arachnoid cyst:
• CSF SI
• Thin walled, nonenhancing
• a/w vertebral scalloping,
pedicle remodeling

SUMMARY

Questions
• Approach in spinal tumors
• Differentiating features of extradural, intradural extramedullary and
intradural intramedullary lesions
• 3 tenets of intramedullary tumours
• Imaging findings in spinal ependymoma
• What is hemosiderrin cap sign?
• Imaging findings in spinal astrocytoma
• Differences between spinal astrocytoma and ependymoma
• Imaging findings in spinal schwannoma
• Imaging findings in spinal meningioma
• Differences between spinal meningioma and schwannoma
• Common primaries of leptomeningeal metastasis
• Importance of contrast in MR in suspicious leptomeningeal metastasis
• Imaging findings in spinal metastasis
• Imaging findings in vertebral haemangioma

Patient Data:
Age: 65-year Radicular leg pain
Gender: Female
Race: Caucasian
Imaging findings?
Differentiate from Astrocytoma?

Pattern Approach for cord lesions
• Pattern one: abnormal signal on T2 with focal
solid enhancement with cord expansion and
cysts EPENDYMOMA HAEMANGIOBLASTOMA
INRAMEDULLARY METASTASIS MS PLAQUES
transient enhancement less than 2 months
• Pattern two: abnormal signal on T2 with non solid
patchy and diffuse inhomogenous enhancement
with cord expansion ASTROCYTOMA SPINAL
CORD INFARCTION DURAL AVM MYELITIS

• Pattern three: T2 hyperintensity with no
enhancement cord normal atrophic or
enlarged MS DURAL AVM MOTOR NEURON
DISEASE POST TRAUMATIC MYELOMALACIA
• Pattern four: mixed signal intensity in T1 and
T2WI hallmark is blood degradation products
AVM

• Pattern five: intramedullary lesion with
leptomeningeal enhancement and cord
enlargement INFECTION LYMPHOMA
METASTASIS
• Pattern six: atrophy of cord with or without
abnormal signal intensity dysmyelination and
inflammatory demyelination

PATTERN ONE
55/M EPENDYMOMA CENTRAL
ENHANCING LESION WITH SYRINX
AND SWELLING OF CORD
25/F BREAST CA METS ENHANCING
LESION WITH CORD EDEMA/EXPANSION
NO CYST/SYRINX

PATTERN ONE
30/F TB GRANULOMA T2
HYPERINTENSE LESION WITH
ENHANCEMENT
2O/F MS MULTIPLE NODULAR
ENHANCING T2 HYPERINTENSE
LESION IN POSTEROLATERAL ASPECT

PATTERN TWO
ASTROCYTOMA7/M
INHOMOGENOUS LONG SEGMENT
ENHANCING LESION WITH CORD
EXPANSION
CORD INFARCTION SUDDEN ONSET T2
HYPERINTENSE PATCHY ENHANCING
LESION IN ANTERIOR AND CENTRAL
REGION

PATTERN TWO
MYELITIS PATCHY ENHANCING T2
HYPEINTENSE LESION
CERVICAL/THORACIC CORD INVOLVE
ALMOST HOLOCORD
2 YRS POST RADIATION FATTY
REPLACEMENT OF MARROW WITH
T8 ENHANCING LESION CORD
NORMAL

PATTERN THREE
DURAL AVM LINEAR ENHANCING ON DORSAL
SURFACE IN THORACIC CORD

PATTERN FOUR
60/F CAVERNOUS HAEMANGIOMA WELL DEMARKATED INHOMOGENOUS
NODULE WITH PERIPHERAL LOW SIGNAL INTENSITY S/O HAEMOSIDERIN
DEPOSITS

PATTERN FIVE
57/M ENHANCING NODULE AT T9 PATCHY ENHANCEMENT AT CONUS AND
LEPTOMENINGEAL ENHANCEMENT D/D METS MYELITIS LYMPHOMA LEUKEMIA
SARCOIDOSIS

PATTERN SIX
FAMILY HISTORY HEREDITARY ATAXIA DIFFUSE ATROPHY OF CERVICAL AND THORACIC CORD
WITH VERMIAN ATROPHY NO ABNORMAL SI IN CORD

Neoplastic disorders of spinal cord

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