This document discusses the localization, characterization, and key imaging features of various spinal tumors. It covers both intradural and extradural tumors, including their location within or outside the spinal cord. Common tumor types discussed include ependymoma, astrocytoma, hemangioblastoma, and spinal cord metastases. Key distinguishing imaging features between tumor types are provided, such as differences in location, enhancement patterns, presence of cysts, and association with other findings.

2.  Localization
› Extradural
› Intradural
 Extramedullary
 Intramedullary
› Of which level of the spinal cord.
› Of which part in the cross section.
 Characterization
› Margin: Well/ ill define
› The present of: Calcification, hemorrhage, cyst,
restricted diffusion part, pattern enhancement.
› Effect to the surrounding structure: Cord edema,
vertebral scalloping.

4. Look for
1. Dura: Dark line on
T2w
2. CSF space
› Compare the lesion
side with another
side
3. Spinal cord
› Compressed
› Fusiform enlarged.
Epidural abscess Spinal
meningioma
Astrocytoma
Ref. Spinal tumor, Radiopaedia.org

5.  Extradural : Spinal column tumor (esp.
vertebral metastasis)
 Intradural
› Extramedullary: Schwannoma, Meningioma
› Intramedullary: Ependymoma (50%),
Astrocytoma (25%)

6.  Extradural
› Spinal column tumor
 Intradural
› Extramedullary: CSF spreading (esp.
medulloblastoma)
› Intramedullary: Astrocytoma (60%),
Ependymoma (15-30%), etc. (ganglioglioma,
germinoma, PNET, ATRT)
 **Congenital tumor**

7.  From clinical history and physical
examination
› Age of the patient
› Congenital anomalies: Myelocele,
myelomeningocele, dorsal dermal sinus,
tethered cord.
 From imaging
› Fat component
› Cystic lesion
› Dermal sinus track

8.  Lipoma
 Dermoid/ Epidermoid
 Teratoma
 Hamartoma
 Enterogeneous cyst

9. T1w T2w T1FS
• Most common type of occult spinal
dysraphism
• Classified as follows
• Lipomyelocele or
lipomyelomeningocele (84%)
•Fibrolipoma of the filum terminale
(12%)
• intradural lipoma (4%).
•MRI
• Sharply circumscribed masses
• Follow fat signal on all sequences:
•T1: hyperintense
•T2: hypointense
•T1 C+ (Gd): no enhancement
•fat-suppressed
sequences: hypointense

10.  Location
› Intramedullar or extramedullary
 Dermoid:
› Content : skin appendages(sebaceous glands,
sweat glands, hair, and hair follicles, fat
component)
› Location: midline
 Epidermoid:
› Content: desquamation and breakdown of
keratin not skin appendages
› Location: Paramedian
 Chemical meningitis.

11.  Dermoid
› Fat component  High T1w and T2w
› But for spinal dermoid, fat component may not
be identified  cannot differentiate from
epidermoid.
› No restricted diffusion
 Epidermoid
› Signal similar to CSF on T1w, T2w
› Restricted diffusion.
 Both: No enhancement unless infected or
inflamed.

12.  About 50% of dorsal
dermal sinuses end in
dermoid or
epidermoid tumors.
 20-30% of dermoid
and epidermoid
tumors are associated
with dorsal dermal
sinus.

15.  Dorsal dermal sinus with infected/
inflamed epidermoid (intra and
extramedullar part).
 Leptomengitis.
 Intraoperative findings
 Pathological findings

16. Primary : more common than secondary or
metastasis
 Astrocytoma
 Ependymoma
 Hemangioblastoma

17.  > 50%of intramed in children; epen 24-38%
 Peak incidence 30-40 yrs (mean 31 yrs)
 MC at thoracic level, rare at filum teminale
 75-92% low grade
 Findings
› Plain film : Widen spinal canal and bony erosion
› Mark fusiform expansion of cord; frequently eccentric and
posterior.
› Less hemorrhage, necrosis, hypervascularity and less
heterogeneous as compared to ependymoma.
› Almost always enhanced.
› No capsule -> infiltrative, poorly define margin
› Cyst : Rostal and caudal tend to be benign (not tumoral
cyst => within the tumor and enh)

18.  MC tumor in adult
 MC primary cord tumor of the lower spinal cord, conus
medullaris and filum terminale
Features Ddx from astrocytoma
1. Location : Lower cord <Astro : thoracic>
2. Location : Central (cell lining central canal) with
centrifugal growth. <Astro : eccentric posterior>
3. Prone to hemorrhage  can come with
unexplained subarachnoid hemorrhage.;
Hemorrhage with hemosiderin caps <Astro : Not
uncommon>
4. Area of hypointense on T2w which enh = reflecting
hypercellularity <Astro : less common>
5. Delicate capsule : Well define <Astro : infiltrative>

19. Ependymoma Astrocytoma
1. Location : Lower cord
2. Location : Central (cell lining central
canal) with centrifugal growth.
3. Prone to hemorrhage  can come
with unexplained subarachnoid
hemorrhage.; Hemorrhage with
hemosiderin caps
4. Area of hypointense on T2w which
enh = reflecting hypercellularity
5. Delicate capsule : Well define
1. Location : thoracic
2. Location : eccentric posterior
3. Hemorrhage : Not uncommon
4. Area of hypointense on T2w: less
common
5. Astro : infiltrative

20.  MC primary posterior fossa tumor in
adult but rarely involves cord.
 30% of cord hemangioblastoma
have vHL.
› AD
› Cerebellar hemangioblastoma, retinal
angiomatosis, RCC,
pheochromocytoma and spinal
hemangioma
 Findings :
› Plain film : Widen spinal canal.
› Location : Thoracic (51%)
› Cyst 40-60%; may larger than the tumor
› Asso with meningeal varicosities at the
posterior cord. <helps DDx metastasis>

21.  Metastasis
› From Breast, melanoma, lymphoma, colon,
kidney
› Findings
 Location : Thoracic then cervical and lumbar
 Fast progression  Plain film negative.
 Disproportional edema compare to the size of
metastatic tumor.
 Rarely cyst
 Rarely may be hemorrhage
 Homogenous and marked enhancement

22. Intramedullary spinal cord metastasis with central cystic change/necrosis.
Rykken J et al. AJNR Am J Neuroradiol 2013;34:2043-2049
©2013 by American Society of Neuroradiology