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Type 1 Vascular Malformation (Dural Arteriovenous Fistula)

KEY FACTS Terminology Synonyms: Type 1 spinal arteriovenous fistula (AVF), dural AVF, dural fistula Spinal arteriovenous (AV) fistula, present within dura, with intradural distended draining veins Imaging Cord enlarged, T2WI hyperintense, vessel flow voids on cord surface Multiple enhancing serpentine veins on cord surface Dynamic contrast-enhanced MRA capable of defining dilated intradural veins; very useful to guide catheter angiography Spinal catheter arteriography is gold standard for…

Approach to Vascular Conditions

History Development of the distal vertebral artery (VA) is classically defined by the works of Congdon (1922) and Padget (1948). Contributions of the lateral spinal artery (LSA) were initially defined by Kadyi (1889) but were more recently emphasized by Lasjuanias (1985) and Siclari (2007). Imaging Anatomy Three main longitudinal vascular axes supply blood to the spinal cord. Two of these axes are composed of the familiar…

Vascular Anatomy

Terminology Abbreviations : Anterior spinal artery (ASA), posterior spinal artery (PSA), artery of Adamkiewicz (AA) Synonyms : Great anterior radicular artery, arteria radicularis magna = AA radicularis magna = AA Imaging Anatomy You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Hirayama Disease

KEY FACTS Terminology Synonyms: Hirayama flexion myelopathy, juvenile spinal muscular atrophy, monomelic amyotrophy, juvenile asymmetric segmental spinal muscular atrophy Definition: Cervical myelopathy related to anterior displacement of posterior cervical dura with flexion Imaging Asymmetric cord atrophy Flexion study shows increased posterior epidural space with ventral dural displacement, cord compression T1WI C+ shows enhancing enlarged posterior epidural space with flexion Top Differential Diagnoses Motor neuron disease Chronic…

Kümmell Disease

KEY FACTS Terminology Posttraumatic avascular necrosis of vertebral body Imaging Radiographs, CT Loss of height, sclerosis of vertebral body Narrow, horizontally oriented band of gas in vertebral body Filling cleft in vertebral body due to fracture nonunion MR Vertebral body collapse Gas-filled cleft is low signal intensity on all sequences (unless fluid-filled) Fracture line may or may not be visible Less well seen than on CT…

Fibrous Dysplasia

KEY FACTS Terminology McCune-Albright syndrome: Polyostotic fibrous dysplasia (FD), precocious puberty, café au lait skin lesions You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Syringomyelia

KEY FACTS Terminology Hydromyelia = cystic central canal dilatation Syringomyelia = cystic spinal cord cavity not contiguous with central cord canal Syringobulbia = brainstem syrinx extension You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

CSF Flow Artifact

KEY FACTS Terminology CSF flow-related phenomenon due to time of flight (TOF) effects and turbulent flow Imaging Location: Intrathecal, subarachnoid space Most prominent in cervical and thoracic spine Low or high signal intensity Ill-defined margins Top Differential Diagnoses Vascular malformation, type I dural arteriovenous fistula Vascular malformation, type IV arteriovenous fistula CSF drop metastases Clinical Issues TOF effects Dark CSF signal Positive relationship between CSF velocity…

Myxopapillary Ependymoma

KEY FACTS Terminology Slow-growing glioma arising from ependymal cells of conus, filum terminale, cauda equina You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Cellular Ependymoma

KEY FACTS Terminology Neoplasm arising from ependyma lining spinal cord central canal Imaging Circumscribed, enhancing hemorrhagic cord mass with surrounding edema Associated cysts common Cervical > thoracic > conus T1WI: Isointense or slightly hypointense to spinal cord T2WI: Hyperintense relative to spinal cord Cap sign: Hemosiderin at cranial or caudal margin Most tumors enhance Peripheral enhancement of tumoral cysts Top Differential Diagnoses Astrocytoma Hemangioblastoma Demyelinating disease…

Astrocytoma

KEY FACTS Terminology Primary neoplasm of astrocytic origin within spinal cord Imaging Fusiform expansion of cord with enhancing component of variable morphology Almost always enhances Cervical > thoracic Usually ≤ 4 segments Occasionally multisegmental, even holocord (more common with pilocytic astrocytoma) ± cyst/syrinx (fluid slightly T1 hyperintense to CSF) Hyperintense on proton density and T2WI MR Top Differential Diagnoses Ependymoma Hemangioblastoma Metastasis Syringohydromyelia Autoimmune or inflammatory…