Intramedullary Tumors

      Expansion of the cord is the hallmark of an intramedullary neoplasm. Most cord tumors are hyperintense on T2-weighted images and hypo intense on T1-weighted images. Areas of increased T2 signal extending above or below the expanded cord segment represent micro infiltration of tumor or associated edema. Conventional MR techniques cannot reliably make this distinction. Gadolinium enhances areas of blood-brain barrier breakdown to help detect, characterize and define the extent of intramedullary neoplasms. Endnote

      Focal areas of hemorrhage, intratumoral cysts or necrotic cavities can give cord tumors a heterogeneous appearance on MR scans. The signal intensity depends on the concentration of protein within the cysts and the specific components of hemorrhage that are present. Endnote

      In general, the MR appearance of cord neoplasms varies widely, and making a specific diagnosis is difficult in most cases. An enhancing tumor in the conus is highly likely to be an ependymoma. In the cervical and upper thoracic cord, the frequency of ependymoma and astrocytoma is about equal. The classic features of hemangioblastoma include a cyst with an enhancing mural nodule. Fat signal components are an important clue for a lipoma or teratoma. Hematogenous metastases from breast or lung carcinoma and melanoma may produce a similar appearance to primary intramedullary neoplasms, although metastases may involve several segments of the cord and subarachnoid spread of tumor is common. Primary CNS lymphoma can, on occasion, involve the spinal cord. Endnote  

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