1. Spinal tumors are classified based on their anatomical location as intramedullary, extradural intradural, or extradural. 2. Common intramedullary tumors include ependymoma, astrocytoma, and hemangioblastoma. Ependymomas typically appear central on MRI while astrocytomas are eccentric. 3. Common extradural intradural tumors include schwannomas, meningiomas, and metastases. Schwannomas appear as well-encapsulated enhancing lesions that displace nerve roots.

1. Spinal tumor

2. CLASSIFICATION OF SPINAL TUMOR
The classification is based on the anatomic location
Intramedullary Extramedullary Intradural Extradural
Spinal cord Dura ,
Arachnoid,
Nerve sheath
Bone, Discs
Paraspinal soft
tissues

3. INTRADURAL(40%) EXTRADURAL(60%)mc
INTRAMEDULLARY
Adults(4-10%)
Children(35%) mc
EXTRAMEDULLARY
(20-30%)2nd mc
METASTASIS(90%)
mc
PRIMARY
VERTEBRAL
TUMOR(10%)
90% GLIOMA
EPENDYMOMA(60%)
ASTROCYTOMA(30%)
HEMANGIOBLASTOMA
GANGLIOGLIOMA
LYMPHOMA
METASTASIS
MENINGIOMA(50%)
PERIPHERAL NERVE SHAETH
TUMOR (50%)
SCHWANOMA
NEUROFIBROMA
METASTASIS

4. PRIMARY VERTEBRAL TUMOR
BENIGN LOCALLY AGGRESSIVE MALIGNANT
HEMANGIOMA
OSTEOID OSTEOMA
OSTEOBLASTOMA
ANEURYSMAL BONE CYST
EOSINOPHILIC GRANULOMA
CHORDOMA
GCT
MULTIPLE MYELOMA
PLASMACYTOMA
CHONDROSARCOMA
EWING SARCOMA
OSTEOSARCOMA

5. CLINICAL PRESENTATION
SIGNS INTRAMEDULLARY EXTRAMEDULLARY
Radicular Pain unusal common
Vertebral pain unusal common
Funicular pain common Less common
UMN Sign late early
LMN Sign Diffuse Unusal , Segmental
Sensory inv Descending Ascending
Sphincter Early Late

6. INVESTIGATIONS
Plain radiographs : First imaging study in evaluation of
patients presenting with back pain
CT :evaluation of cortical bone destructions & calcifications
MRI : imaging technique of choice
 d/t better evaluation of spinal cord & nerve roots
 lesion extension
 specific imaging features

7. INTRAMEDULLARY TUMOR
EPENDYMOMA(CENTRAL)
ASTROCYTOMA
(ECCENTRIC)
HEMANGIOBLASTOMA
(DORSAL SUBPIAL)

8. EPENDYMOMA
 MC in adults
 2nd MC in children
Peak incidence 4th -5th decade
Male >Female
Increase incidence with NF2
Location – MC Cervical >Upper thoracic>Conus
Epidemiology
Pathophysiology
Cell of origin : ependymal lining of the spinal cord
central canal
WHO Grade –II low tendency to infiltrate

9. Imaging
Plain radiographs & CT
Non specific finding
Scoliosis & spinal canal widening
Vertebral body scalloping
MRI( IOC)
Central location ,well circumscribed
Symmetric cord expansion
Involve avg 4 vertebrae
60-90% a/w cysts
Syrinx occurs in cervical ependymomas

10. T 1: Isointense to Hypointense
T2 : Hyperintense
Cap sign deposition of hemosiderin in rostral &
caudal margins d/t chronic hemorrhage.
T1 C+(gd) : Well defined margins with a homogenous
pattern
DWI : Don’t restrict
DTI : Displace the white matter track
MRS :Choline & Lipid

12. Differential diagnosis
Spinal astrocytoma
Spinal cavernous malformation
Thoracic cord
more than half cord
on MRI heterogeonous signal intensity
d/t different ages of blood products
Popcorn appearnce

13. MYXOPAPILLARY EPENDYMOMA
Epidemiology
Predominantly in children & young adults
Male >Female
Location : conus medullaris & filum terminale
Very slow growing ,so very large before
diagnosis
 More prone to hemorrhage
Pathophysiology
Same as ependymoma

14. Imaging
MRI
Well defined
T1: Isointense to hyperintense (d/t prescence of mucin)
T2 :Hyperintense
T1c+(gd) : Homogenous
Diffential diagnosis
Schwannoma
Paragnglioma

15. ASTROCYTOMA
Epidemiology
Mc intramedullary tumor in children
2nd mc intramedullary tumor in adults
Peak incidence 4th decade in adults
Pilocytic astrocytoma age 1to 5yr
Fbrillary astrocytoma age app. 10yr
Male > Female
Associated with NF1
Location mc Thoracic > cervical
Pathophysiology
Arises from astrocytic glial cell
Pilocytic astrocytoma WHO grade I don’t infiltrate
Fibrillary astrocytoma WHO grade II infiltrate

16. Imaging
MRI
Eccentrically located
Assymetric & fusiform cord expansion
About 4 vertebrae segment involvement .
however holocord involvement may occurs in children
& early adolescent
T1: Hypointense
T2 : Hyperintense , Hemorrhage is not commonly seen
T1 c+(gd) : Enhances inhomogenously in a nodular &
patchy manner

17. DWI : No restrictions
DTI : Diffuse infiltration of the cord with disruption of
white matter tracts
MRS : Elevated choline & decrease NAA

19. ASTROCYTOMA VS EPENDYMOMA
Long segment Short segment
Infiltrative border well defined border
Heterogenous enhancement Homogenous enhancement
Eccentric Central
a/w NF1 a/w NF2
Children Adults
Differential diagnosis

20. HEMANGIOBLASTOMA
Epidemiology
3rd MC tumor
Peak incidence 4th decade
Male > Female
70% sporadic 30% a/w VHL
Location sporadic disease has single lesion
thoracic> cervical
but in VHL multiple lesion
Pathophysiology
Arise from non glial mesenchymal cells
WHO Grade I tumor

21. Imaging
MRI
 Well demarcated hyperenhancing nodular masses
T1 : isointense
T2 : Hyperintense
T1 c+(gd): vividly enhances
DTI : White matter tracts wrapped around the tumor
without infiltration

23. GANGLIOGLIOMA
Epidemiology
 Very rare in adults
15% of intramedullary tumor in pediatrics
Children between 1-5 yrs
 Slightly female predominant
Location : cervicothoracic >thoracic>cervicomedullary
>cervical>conus
Pathophysiology
Arises from ganglion cells & glial cells
WHO Grade I&II

24. Imaging
Scoliosis & Bone remodelling is common
MRI : Long tumor length on an avg 8 vertebral bodies
tumoral cyst
absent of edema
mixed signal intensity on T1 ( d/t dual celluar
component)
eccentric location
patchy tumor enhancement
Hemorrhage & calcifications rare

26. EXTRAMEDULLARY INTRADURAL

27. SCHWANOMA
 AKA Neurinomas /Neurilemmomas
 Mc extramedullary intradural tumor in adults.
 Multiple schwannomas occurs in children in NF2 a/w
higher risk of malignant transformation.
Location cervical & lumbar region.
MRI : well encapsulated tumor with cystic components
T1 : Iso to hypointense
T2 : Hyperintense
T1+C(gd) : varry intense & homogenous
D/D : Myxopappilary Ependymoma of filum
pushes the nerve roots to the periphery where
as schwannoma of the cauda pushes the roots in
an eccentric fashion

29. NEUROFIBROMA
A/W NF 1 & NF2
 NF 1 , Multiple plexiform neurofibroma
MRI : Not well encapsulated , ill defined , multiple
if solitary not able to differentiate between
schwannoma & neurofibroma.
Target sign : Hyperintense rim with low centre

31. MENINGIOMA
 Mainly Dural based tumor
Peak age 5th -6th decade
A/w NF 2
Female predominance
Location : Thoracic > cervical
CT : Iso to Hyperattenuating
with calcifications
MRI : T1 : Hypointense
T2 : Hyperintense
T1 C +(Gd) : strong homogenous enhancement
except for the calcified areas.
Dural tail sign less commonly seen as compared to
intracranial meningioma

33. METASTASIS
Leptomeningeal spread
NON CNS CNS
Breast Drop Metastasis
Lung Meduloblastoma
Ependymoma
Choroid plexus Carcinoma
Pineloblastma
Germinoma
Older patients younger patients

34. MRI : on MRI Leptomeningeal metastasis demonstrates
3 patterns
1. Diffuse CE along the pia & nerve roots
Sugar coating pattern / Zukerguss pattern
2. Multiple small CE nodules in subarchnoid space
3 .Single CE mass

35. EXTRA DURAL TUMOR
 Mc spinal tumor
 Local pain is the Mc presenting features
Draped curtain sign
Extension of the tumor in the ant epidural space
displaces the lateral aspect of PLL d/t strong medial
Fixation by medial menigovertebral ligament
( Ligament of Trolard & Hofmann )

36. METASTASIS
Spine is the 3rd MC site of metastasis following Lung &
Liver
MC primary malignancies are Breast, Prostate, Lung
Peak incidence 40-65 yr
MC location Thoracic > Lumbar > Cervical
Most frequently , metastasis occurs in vertebral body.
Plain Radiographs : Pedicle erosion Winking owl sign
f/b vertebral compression fracture.
CT :Osteolytic Multiple lytic lesions with irregular non
sclerotic margins.
Osteoblastic increased density & sclerosis “ Ivory
Vertebrae

37. MRI :
T1 : Any lesion of Spinal marrow hypo to muscle &
disc abnormal
T2 : Hyperintense to bone marrow

38. OSTEOBLASTIC MIXED OSTEOLYTIC
Prostate Breast Lung
Osteosarcoma Lymphoma RCC
Medullary thyroid Ca Malignant melanoma
Multiple Myeloma

39. Tumor Age Sex
Osteoid osteoma 10-20 M>F
osteoblastoma 10-20 M>F
Eosinophilic Granuloma 10-20 M>F
ABC <30 F>M
Ewing Sarcoma 10-30 M>F
GCT 20-40 F>M
Osteosarcoma >40 M>F
Chondrosarcoma >40 M>F
Multiple myeloma >50 M> F
Chordoma 50-60 M>F
PRIMARY VERTEBRAL TUMOR

40. HEMANGIOMA
Mc benign tumor of spine in adults
Vertebral body involvement is mc
Most are asymptomatic discovered accidentally
PLAIN RADIOGRAPHS : Corduroy cloth appearance
CT : Polka Dot sign
MRI : T1 : Hyperintense d/t prescence of fat
d/d : Metastatic melanoma, Exostosis
T2 : Hyperintense
T1 C +gd : Enhancement

42. OSTEOID OSTEOMA
Mc benign vertebral tumor in children
Lumbar > cervical > thoracic
CT : Calcified / non calcified Small circumscribed area of
osteolysis ( radioluscent) with surrounding reactive
sclerosis
MRI : T1 : low
T2 : High with marked edema in the surrounding
bone marrow

44. OSTEOBLASTOMA
 Spine is the MC site
Equally distributed vertebral column
CT : Expansile lytic lesion with multiple small
calcifications & peripheral sclerotic rim
MRI : similar to osteoid osteoma

46. ANEURYSMAL BONE CYST
 Lumbar > Thoracic =Cervical
CT : Lytic mass with multifocal matrix mineralization
multicystic architecture with fluid fluid levels
MRI : well defined low signal rim with differernt ages of
hemorrhage within the cystic component

48. EOSINOPHILIC GRANULOMA
Most benign form of Langerhans cell histiocytosis
Primarily affect children < 15yr
Mc thoracic > lumbar> cervical
Mc part vertebral body
A/W 2 systemic disease
Hand schuller christian disease
Letterer siwe disease
X RAY : Vertebra plana
CT : Lytic lesion /collapsed vertebral bodies without
surrounding sclerosis.
MRI : Non specific

50. CHORDOMA
 MC primary bone tumor of sacrum
Sacrum> base of skull
Plain Radiographs : Midline destructive bone lesions
CT: Expansile midline lytic lesion with irregular
borders & infiltration of surrounding tissues
calcifications & bone sclerosis are frequently
present
MRI : T1 : Hypointense with areas of hyperintense
d/t hemorrhage & mucin
T2 : Hyperintense
T1+c(gd) : Varriable homogenous to peripheral
septal enhancement

52. GIANT CELL TUMOR
 2nd MC primary tumor of sacrum
 Mc sacrum > Thoracic > cervical> Lumbar
Increases size during pregnancy
Plain radiographs : well defined lytic & expansile
lesion crosses the midline
CT : Absence of mineralisation & lack of sclerotic rim
MRI : T1 : Hypointense
T2 : Hypointense

54. MULTIPLE MYELOMA
 MC malignant vertebral tumors
Commonly occurs in thoracic spine
Vertebral body is the mc site of involvement
Plain radiographs : multicystic expansile lytic
lesion with thickened trabeculae
CT : Hollow vertebral body
MRI : T1 : Hypointense
T2 : Hyperintense
T1C +(gd) : Homogenous vivid enhancement

56. CHONDROSARCOMA
 2nd mc primary malignant tumor of spine
Thoracic & Lumbar spine most frequently involved
CT : Large calcified mass with bone destructions
MRI :T1 : Hypointense
T2 : Very high signal d/t water content of
hyaline cartilage
T1+C (gd): Ring & Arcs d/t lobulated growth
pattern cartilaginous tumors

58. OSTEOSARCOMA
 3rd Mc primary malignant tumor excluding non
lymphoproliferative tumor
Thoracic = Lumbar segment> Sacrum> Cervical
Most osteosarcomas osteoblastic type .
CT :Cortical destruction,expansile aggressive remodelling,
Matrix mineralisation
MRI :T1 : low to intermidiate
T2 : High
Areas of mineralisation are low in all sequences

60. EWING SARCOMA
 Mc Primary malignant tumor in children excluding
non lymphoproliferative tumor
Location Sacrum > Lumbar spine > Cervical
Typically centred vertebral body
CT : Lytic bone destruction
MRI : T1 : Intermediate
T2 : Hyperintense
T1+C(Gd) : Homogenous enhancement

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