SPINAL MALIGNANCY

1. SPINAL TUMORS
Under guidance of Dr A.Munshi
DRSANTOSH
JR2PMCH

10. 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 craniocaudal margin
• Most tumors enhance

11. (Left) Coronal graphic depicts
an intramedullary
ependymoma mildly
expanding the cervical cord.
Cranial and rostral cysts &
hemorrhagic products, are
associated with this mass.
(Right) Sagittal T1WI C+ MR
demonstrates a cervical
intramedullary mass with
solid and cystic components
causing fusiform cord
expansion. There are 2 areas
of enhancing solid
components & rostral cyst
extending into brainstem.
(Left) Axial T1WI C+ MR reveals an expansile intramedullary ependymoma with robust
enhancement pattern. (Right) Sagittal T2WI MR illustrates the mixed cystic and solid
appearance of cervical ependymomas in a patient with neurofibromatosis type 2.

13. IMAGING
• Usually spans 2-4 vertebral segments
 May fill entire lumbosacral thecal sac
• Ovoid, lobular,sausage-shaped
• CT/MRI
 osseous canal expansion,thinned pedicles, vertebral
scalloping
 May enlarge,extend through neural foramina
• T1WI:Isointense→hyperintense to cord
• T2WI:Almost always hyperintense to cord
 Hypointensity at tumor margin = hemosiderin
• T1WI C+: Intense enhancement

14. (Left) graphic image shows a
multilevel cauda equina
myxopapillary ependymoma.
Vascular mass with old
intratumoral hemorrhage along
the dorsal conus.
(Right) Coronal T1WI MR shows a
well-delineated, intradural
extramedullary mass in lumbar
spine Lesion is predominantly
isointense with cord & nerves.
(Left) Sagittal T2WI MR reveals an extensive intradural tumor
distorting the conus and cauda equina.
(Right) Sagittal T1WI C+ MR exhibits avid homogeneous
tumor enhancement .

20. (Left) Sag graphic of cervical spine
astrocytoma shows a fusiform solid
mass with a rostral cystic cord
component.
(Right) (Sagittal T1WI C+ MR reveals a
heterogeneously enhancing cervical
cord mass
(Left) Axial T1WI C+ MR depicts an intramedullary
enhancing tumor in the cervical cord.
(Right) Axial CECT illustrates a heterogeneously
enhancing mass within the central spinal canal.

24. (Left) Sagittal graphic depicts a focal
intramedullary mass in the cervical cord
with prominent feeding vessels, adjacent
cysts , and cord expansion with edema.
(Right) H/p shows typical "stromal cells"
(neoplastic component of the tumor) with
pale vacuolated cytoplasm (clear cells).
(Left) Sagittal T1WI C+ MR shows a focal enhancing mass in the
dorsal cervical cord at the C4 level. associated syrinx & diffuse
cord enlargement present.
(Right) T2WI MR displays a peripheral cystic component and focal
mass with edema enlarging the cervical cord .

31. (Left) Sagittal T1WI C+ FS MR of the
upper thoracic spine shows an
intensely enhancing intradural mass
with a broad dorsal dural attachment.
A small enhancing dural tail is seen, a
finding suggestive of meningioma.
(Right)Sagittal T1WI C+ MR shows a
rounded, circumscribed, intradural
extramedullary mass with
homogeneous, intense enhancement.
(Right) Axial T1 C+ image shows a large cervical
meningioma with a ventral, dural-based attachment at
the C5-6 level.

35. (Left) Axial graphic portrays a right-sided
dumbbell-shaped spinal nerve root
schwannoma, enlarging the neural foramen
and compressing the spinal cord. Both intra-
and extradural components ("dumbbell") are
present.
(Right) Axial CECT shows a hypodense
transforaminal mass enlarging the right
neural foramen.
(Left) Axial NECT demonstrates a large soft tissue mass enlarging the right L1-2 neural
foramen.
(Right) Axial T2WI MR in the same patient reveals heterogeneous mass with signal
intensity. Foraminal enlargement and vertebral body scalloping are again seen. The
extradural component within the spinal canal is causing significant canal stenosis .

36. (Left) Sagittal T1WI C+ FS MR reveals a well-defined intradural mass at the L3 level with
vivid enhancement.
(Right) Sagittal T1WI C+ MR shows an extensive intraspinal lumbar schwannoma with
markedly heterogeneous enhancement extending from the lower thoracic spine to the
L4 level.

39. (Left) Sagittal T1WI C+ MR shows a mixed nodular and smooth leptomeningeal tumor
along the distal cord and conus medullaris due to drop metastases.
(Right) Sagittal T2WI shows multiple nodular low signal intensity rounded drop
metastases involving roots of the cauda equina.

49. (Left) Sagittal STIR MR shows
marrow heterogeneity that is due
to numerous lesions in the
anterior and posterior elements
of the lumbosacral spine.
(Right) The multitude of lesions
are difficult to appreciate
individually on this sagittal T1WI
MR. The "salt and pepper"
appearance of the marrow is
suspicious for an infiltrative
process

50. (Left) Sagittal CT shows diffuse
osteopenia with multiple
vertebral body lytic lesions.
Pathologic compression fractures
are seen in multiple midthoracic
vertebral bodies.Compression
fractures can cause variable
central canal narrowing.
(Right) Sagittal PET illustrates mild
heterogeneity of the spine bone
marrow. The spine has a
background of mottled diffuse
activity and a large
hypermetabolic area at L3 .
(Left) Sagittal T1WI MR demonstrates diffuse thoracic spine heterogeneity due to marrow
infiltration. The large focal lesions in T2 and the posterior T6 body cause slight bowing of the
posterior convexity. Cortical breakthrough with epidural extension may result in cord
compression. (Right)Sagittal STIR MR increases the conspicuity of the variegated marrow.
Hyperintense foci are noted in spinous processes.

55. (Left) Sagittal graphic of the thoracolumbar junction shows the typical striated pattern of
hemangioma, with thickened bony trabeculae. There is neither extraosseous extension
nor thecal sac compromise.
(Right)Axial NECT shows lucency with interposed thickened bony trabeculae
demonstrating characteristic CT findings of a vertebral hemangioma.

65. Sag T2WI & Axial T2WI cervicodorsal spinbe showing multicystic
expansile mass involving the posterior arch,rt pedicle and body of D1
vertebra . The mass contains multiple septa with fluid fluid levels . The
spinal cord is displaced posteriorly and to the left. CT Scan shows the
thin rim of bone marginating the mass.

66. Thank You