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Cystic Intradural Extramedullary Lesions
A 42-year-old woman presenting with worsening lower extremity discomfort. ADC, apparent diffusion coefficient; Ax, axial; DWI, diffusion-weighted imaging; Sag, sagittal.
A 37-year-old man presenting for evaluation of low back pain for the past 3 to 4 years. Ax, axial; Sag, sagittal.
A 35-year-old man presenting with back pain. Ax, axial; Sag, sagittal.
DESCRIPTION OF FINDINGS
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MRI demonstrates three cases of intradural extramedullary (IDEM) cystic-appearing masses of the spine.
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In Case A, the images show a T1 hypointense, T2 hyperintense, nearly isointense to CSF, nonenhancing IDEM, cystic-appearing mass in the lower spinal canal scalloping the posterior vertebral bodies. Diffusion-weighted images demonstrate relative diffusion restriction.
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In Case B, the images show a T1 mildly hyperintense compared with CSF, T2 mildly hypointense compared with CSF, nonenhancing cystic IDEM mass inferior to the conus that is displacing adjacent cauda equina nerve roots posteriorly.
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In Case C, a T1 and T2 isointense to CSF, nonenhancing IDEM lesion displaces the cord anteriorly. On an axial T2 image, a subtle thin cystic wall is noted.
Diagnosis
Case A
Epidermoid cyst
Case B
Neuroenteric cyst
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