Advertisement

Intramedullary tumours and tumour mimics

      Spinal cord lesions are traditionally classified as either extradural or intradural extramedullary or of intramedullary origin. Intramedullary spinal cord tumours are histopathologically similar to cranial tumours with a diverse range of pathologies. Astrocytomas and ependymomas account for approximately 80% of all intramedullary tumours, with other primary and secondary lesions accounting for the remaining 20%. Magnetic resonance imaging is the preferred imaging modality for diagnosing and characterising spinal cord lesions; however, accurate characterisation of tumour histology can be challenging, and is further confounded by intramedullary non-neoplastic lesions, such as demyelinating vascular, inflammatory, infectious, or traumatic lesions. This review illustrates the spectrum of intramedullary tumours and tumour mimics with emphasis on the imaging findings.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Duong L.M.
        • McCarthy B.J.
        • McLendon R.E.
        • et al.
        Descriptive epidemiology of malignant and nonmalignant primary spinal cord, spinal meninges, and cauda equina tumours, United States, 2004-2007.
        Cancer. 2012; 118: 4220-4227
        • Grimm S.
        • Chamberlain M.C.
        Adult primary spinal cord tumours.
        Expert Rev Neurother. 2009; 9: 1487-1495
        • Tobin M.K.
        • Geraghty J.R.
        • Engelhard H.H.
        • et al.
        Intramedullary spinal cord tumours: a review of current and future treatment strategies.
        Neurosurg Focus. 2015; 39E14
        • Maj E.
        • Wojtowicz K.
        • Aleksandra
        • et al.
        Intramedullary spinal tumour-like lesions.
        Acta Radiol. 2019; 60: 994-1010
        • Mohajeri Moghaddam S.
        • Bhatt A.A.
        Location, length, and enhancement: systematic approach to differentiating intramedullary spinal cord lesions.
        Insights Imaging. 2018; 9: 511-526
        • Kahan H.
        • Sklar E.M.
        • Post M.J.
        • et al.
        MR characteristics of histopathologic subtypes of spinal ependymoma.
        AJNR Am J Neuroradiol. 1996; 17: 143-150
        • Goy A.M.
        • Pinto R.S.
        • Raghavendra B.N.
        • et al.
        Intramedullary spinal cord tumours: MR imaging, with emphasis on associated cysts.
        Radiology. 1986; 161: 381-386
        • Rossi A.
        • Gandolfo C.
        • Morana G.
        • et al.
        Tumours of the spine in children.
        Neuroimaging Clin N Am. 2007; 17: 17-35
        • Merhemic Z.
        • Stosic-Opincal T.
        • Thurnher M.M.
        Neuroimaging of spinal tumours.
        Magn Reson Imaging Clin N Am. 2016; 24: 563-579
        • Koeller K.K.
        • Rosenblum R.S.
        • Morrison A.L.
        Neoplasms of the spinal cord and filum terminale: radiologic–pathologic correlation.
        RadioGraphics. 2000; 20: 1721-1749
        • Klekamp J.
        Spinal ependymomas. Part 1: intramedullary ependymomas.
        Neurosurg Focus. 2015; 39: E6
        • Raco A.
        • Esposito V.
        • Lenzi J.
        • et al.
        Long-term follow-up of intramedullary spinal cord tumours: a series of 202 cases.
        Neurosurgery. 2005; 56: 972-981
        • Sun B.
        • Wang C.
        • Wang J.
        • et al.
        MRI features of intramedullary spinal cord ependymomas.
        J Neuroimaging. 2003; 13: 346-351
        • Kim D.H.
        • Kim J.H.
        • Choi S.H.
        • et al.
        Differentiation between intramedullary spinal ependymoma and astrocytoma: comparative MRI analysis.
        Clin Radiol. 2014; 69: 29-35
        • Kobayashi K.
        • Ando K.
        • Kato F.
        • et al.
        Variety of preoperative MRI changes in spinal cord ependymoma of WHO grade II: a case series.
        Eur Spine J. 2019; 28: 426-433
        • Dauleac C.
        • Messerer R.
        • Obadia-Andre N.
        • et al.
        Cysts associated with intramedullary ependymomas of the spinal cord: clinical, MRI and oncological features.
        J Neurooncol. 2019; 144: 385-391
        • Huisman T.A.
        Pediatric tumours of the spine.
        Cancer Imaging. 2009; 9: S45-S48
        • Ledbetter L.N.
        • Leever J.D.
        Imaging of intraspinal tumours.
        Radiol Clin North Am. 2019; 57: 341-357
        • Horger M.
        • Ritz R.
        • Beschorner R.
        • et al.
        Spinal pilocytic astrocytoma: MR imaging findings at first presentation and following surgery.
        Eur J Radiol. 2011; 79: 389-399
        • Babu R.
        • Karikari I.O.
        • Owens T.R.
        • et al.
        Spinal cord astrocytomas: a modern 20-year experience at a single institution.
        Spine (Phila Pa 1976). 2014; 39: 533-540
        • Hasan D.I.
        • Abowarda M.H.
        • Taha M.M.
        Diffusion-weighted MRI and apparent diffusion coefficient value in assessment of intra-medullary spinal cord masses.
        Egypt J Radiol Nucl Med. 2016; 47: 1575-1584
        • Gessi M.
        • Dorner E.
        • Dreschmann V.
        • et al.
        Intramedullary gangliogliomas: histopathologic and molecular features of 25 cases.
        Hum Pathol. 2016; 49: 107-113
        • Patel U.
        • Pinto R.S.
        • Miller D.C.
        • et al.
        MR of spinal cord ganglioglioma.
        AJNR Am J Neuroradiol. 1998; 19: 879-887
        • Chu B.C.
        • Terae S.
        • Hida K.
        • et al.
        MR findings in spinal haemangioblastoma: correlation with symptoms and with angiographic and surgical findings.
        AJNR Am J Neuroradiol. 2001; 22: 206-217
        • Peckham M.E.
        • Hutchins T.A.
        Imaging of vascular disorders of the spine.
        Radiol Clin North Am. 2019; 57: 307-318
        • Baker K.B.
        • Moran C.J.
        • Wippold 2nd, F.J.
        • et al.
        MR imaging of spinal haemangioblastoma.
        AJR Am J Roentgenol. 2000; 174: 377-382
        • Berlis A.
        • Schumacher M.
        • Spreer J.
        • et al.
        Subarachnoid haemorrhage due to cervical spinal cord haemangioblastomas in a patient with von Hippel–Lindau disease.
        Acta Neurochir (Wien). 2003; 145: 1009-1013
        • Koda M.
        • Mannoji C.
        • Itabashi T.
        • et al.
        Intramedullary haemorrhage caused by spinal cord haemangioblastoma: a case report.
        BMC Res Notes. 2014; 7: 823
        • Imagama S.
        • Ito Z.
        • Wakao N.
        • et al.
        Differentiation of localization of spinal haemangioblastomas based on imaging and pathological findings.
        Eur Spine J. 2011; 20: 1377-1384
        • Chason J.L.
        • Walker F.B.
        • Landers J.W.
        Metastatic carcinoma in the central nervous system and dorsal root ganglia. A prospective autopsy study.
        Cancer. 1963; 16: 781-787
        • Costigan D.A.
        • Winkelman M.D.
        Intramedullary spinal cord metastasis. A clinicopathological study of 13 cases.
        J Neurosurg. 1985; 62: 227-233
        • Rykken J.B.
        • Diehn F.E.
        • Hunt C.H.
        • et al.
        Intramedullary spinal cord metastases: MRI and relevant clinical features from a 13-year institutional case series.
        AJNR Am J Neuroradiol. 2013; 34: 2043-2049
        • Sung W.S.
        • Sung M.J.
        • Chan J.H.
        • et al.
        Intramedullary spinal cord metastases: a 20-year institutional experience with a comprehensive literature review.
        World Neurosurg. 2013; 79: 576-584
        • Rykken J.B.
        • Diehn F.E.
        • Hunt C.H.
        • et al.
        Rim and flame signs: postgadolinium MRI findings specific for non-CNS intramedullary spinal cord metastases.
        AJNR Am J Neuroradiol. 2013; : 34908-34915
        • Haque S.
        • Law M.
        • Abrey L.E.
        • et al.
        Imaging of lymphoma of the central nervous system, spine, and orbit.
        Radiol Clin North Am. 2008; 46: 339-361
        • Koeller K.K.
        • Smirniotopoulos J.G.
        • Jones R.V.
        Primary central nervous system lymphoma: radiologic–pathologic correlation.
        RadioGraphics. 1997; 17: 1497-1526
        • Feng L.
        • Chen D.
        • Zhou H.
        • et al.
        Spinal primary central nervous system lymphoma: case report and literature review.
        J Clin Neurosci. 2018; 50: 16-19
        • Yang W.
        • Garzon-Muvdi T.
        • Braileanu M.
        • et al.
        Primary intramedullary spinal cord lymphoma: a population-based study.
        Neuro Oncol. 2017; 19: 414-421
        • Flanagan E.P.
        • O'Neill B.P.
        • Porter A.B.
        • et al.
        Primary intramedullary spinal cord lymphoma.
        Neurology. 2011; 77: 784-791
        • Bhatoe H.S.
        • Singh P.
        • Chaturvedi A.
        • et al.
        Nondysraphic intramedullary spinal cord lipomas: a review.
        Neurosurg Focus. 2005; 18: Ecp1
        • Cavusoglu M.
        • Ciliz D.S.
        • Duran S.
        • et al.
        Intramedullary lipoma of the cervico-thoracic spinal cord.
        JBR-BTR. 2014; 97: 346-348
        • Karikari I.O.
        • Powers C.J.
        • Bagley C.A.
        • et al.
        Primary intramedullary melanocytoma of the spinal cord: case report.
        Neurosurgery. 2009; 64: E777-E778
        • Farrokh D.
        • Fransen P.
        • Faverly D.
        MR findings of a primary intramedullary malignant melanoma: case report and literature review.
        AJNR Am J Neuroradiol. 2001; 22: 1864-1866
        • Painter T.J.
        • Chaljub G.
        • Sethi R.
        • et al.
        Intracranial and intraspinal meningeal melanocytosis.
        AJNR Am J Neuroradiol. 2000; 21: 1349-1353
        • Dlouhy B.J.
        • Awe O.
        • Rao R.C.
        • et al.
        Autograft-derived spinal cord mass following olfactory mucosal cell transplantation in a spinal cord injury patient: case report.
        J Neurosurg Spine. 2014; 21: 618-622
        • Amariglio N.
        • Hirshberg A.
        • Scheithauer B.W.
        • et al.
        Donor-derived brain tumour following neural stem cell transplantation in an ataxia telangiectasia patient.
        PLoS Med. 2009; 6e1000029
        • Waziri A.
        • Vonsattel J.P.
        • Kaiser M.G.
        • et al.
        Expansile, enhancing cervical cord lesion with an associated syrinx secondary to demyelination. Case report and review of the literature.
        J Neurosurg Spine. 2007; 6: 52-56
        • Lee M.
        • Epstein F.J.
        • Rezai A.R.
        • et al.
        Nonneoplastic intramedullary spinal cord lesions mimicking tumours.
        Neurosurgery. 1998; 43: 788-794
        • Egger K.
        • Hohenhaus M.
        • Van Velthoven V.
        • et al.
        Spinal diffusion tensor tractography for differentiation of intramedullary tumour-suspected lesions.
        Eur J Radiol. 2016; 85: 2275-2280
        • Liu X.
        • Tian W.
        • Kolar B.
        • et al.
        Advanced MR diffusion tensor imaging and perfusion weighted imaging of intramedullary tumours and tumour like lesions in the cervicomedullary junction region and the cervical spinal cord.
        J Neurooncol. 2014; 116: 559-566
        • Hood B.
        • Wolfe S.Q.
        • Trivedi R.A.
        • et al.
        Intramedullary abscess of the cervical spinal cord in an otherwise healthy man.
        World Neurosurg. 2011; 76 (361.e315-369)
        • Bakhsheshian J.
        • Kim P.E.
        • Attenello F.J.
        Intramedullary cervical spinal cord abscess.
        World Neurosurg. 2017; 106: e1041-e1049
        • Liu J.
        • Zhang H.
        • He B.
        • et al.
        Intramedullary tuberculoma combined with abscess: case report and literature review.
        World Neurosurg. 2016; 89 (726.e721-724)
        • Nussbaum E.S.
        • Rockswold G.L.
        • Bergman T.A.
        • et al.
        Spinal tuberculosis: a diagnostic and management challenge.
        J Neurosurg. 1995; 83: 243-247
        • Lu M.
        Imaging diagnosis of spinal intramedullary tuberculoma: case reports and literature review.
        J Spinal Cord Med. 2010; 33: 159-162
        • Soni N.
        • Bathla G.
        • Pillenahalli Maheshwarappa R.
        Imaging findings in spinal sarcoidosis: a report of 18 cases and review of the current literature.
        Neuroradiology J. 2019; 32: 17-28
        • Junger S.S.
        • Stern B.J.
        • Levine S.R.
        • et al.
        Intramedullary spinal sarcoidosis: clinical and magnetic resonance imaging characteristics.
        Neurology. 1993; 43: 333-337
        • Do-Dai D.D.
        • Brooks M.K.
        • Goldkamp A.
        • et al.
        Magnetic resonance imaging of intramedullary spinal cord lesions: a pictorial review.
        Curr Probl Diagn Radiol. 2010; 39: 160-185
        • Jeon I.
        • Jung W.S.
        • Suh S.H.
        • et al.
        MR imaging features that distinguish spinal cavernous angioma from haemorrhagic ependymoma and serial MRI changes in cavernous angioma.
        J Neurooncol. 2016; 130: 229-236
        • El-Koussy M.
        • Stepper F.
        • Spreng A.
        • et al.
        Incidence, clinical presentation and imaging findings of cavernous malformations of the CNS. A twenty-year experience.
        Swiss Med Wkly. 2011; 141: w13172
        • Ren J.
        • Hong T.
        • He C.
        • et al.
        Surgical approaches and long-term outcomes of intramedullary spinal cord cavernous malformations: a single-center consecutive series of 219 patients.
        J Neurosurg Spine. 2019; : 1-10
        • Krings T.
        Vascular malformations of the spine and spinal cord: anatomy, classification, treatment.
        Clin Neuroradiol. 2010; 20: 5-24
        • Miller T.R.
        • Eskey C.J.
        • Mamourian A.C.
        Absence of abnormal vessels in the subarachnoid space on conventional magnetic resonance imaging in patients with spinal dural arteriovenous fistulas.
        Neurosurg Focus. 2012; 32E15
        • Krings T.
        • Lasjaunias P.L.
        • Hans F.J.
        • et al.
        Imaging in spinal vascular disease.
        Neuroimaging Clin N Am. 2007; 17: 57-72
        • Gibbs I.C.
        • Patil C.
        • Gerszten P.C.
        • et al.
        Delayed radiation-induced myelopathy after spinal radiosurgery.
        Neurosurgery. 2009; 64: 67-72