Enhancing Intramedullary Spinal Cord Lesions

Case A: Marked lower cervical and upper thoracic spinal cord expansion is noted with mild associated enhancement. No cystic or hemorrhagic features are identified.

Case B: Multiple, predominantly small, enhancing intramedullary nodules are noted with a disproportionately large associated syrinx resulting in marked cord expansion in a patient with a known history of von Hippel-Lindau disease.

Case C: Focal, prominent spinal cord expansion is present and is associated with a well-marginated, heterogeneous, solid, and cystic enhancing intramedullary mass with hemorrhagic components identified on a gradient refocused echo image.

Case D: Several enhancing cervical and thoracic intramedullary lesions with marked edema are present. Additional cerebral intraparenchymal lesions also are noted in a patient with a known metastatic cervical carcinoma.

Case E: Two cervical T2-hyperintense intramedullary lesions with associated enhancement are noted in a patient with a known history of systemic lupus erythematosus (SLE). Note that the upper cervical lesion spans more than three vertebral body segments and that cord expansion is mild.

Case F: An enhancing T2-hyperintense lesion with minimal cord expansion is noted in a patient with a known history of multiple sclerosis (MS). Note that the lesion spans less than one to two vertebral body segments.

Case G: An irregularly marginated enhancing lesion associated with more extensive T2-hyperintense spinal cord signal abnormality and mild cord expansion in a patient with a known history of sarcoidosis and bilateral hilar adenopathy is evident on a chest CT scan.

Case H: Disk-osteophyte complexes that are present at the C4/C5 and C5/C6 disc levels in association with ligamentum flavum thickening result in severe central spinal canal stenosis and ventral and dorsal cord compression. An abnormal central spinal cord T2-hyperintense signal extends from the C4-C7 levels, with focal central intramedullary enhancement at the level of maximal compression at the C5/C6 level, consistent with compressive cervical myelopathy. A follow-up study after surgical decompression demonstrates central cord myelomalacia consistent with chronic spinal cord infarction.