Spine tumors 3 – Intramedullary tumor mimics

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09/10/23

There are a wide range of lesions occurring in the spinal cord which can mimic tumors. This includes vascular lesions, inflammatory/demyelinating disease, sarcoid, and CSF flow abnormalities. This video takes a look at some of the range of possibilities.

0:43 Cord infarcts are areas of disruption of blood flow. Primary characteristics are abnormal diffusion imaging and acute onset. Often patients have other pathology such as recent aortic surgery or aortic dissection.

1:38 Sarcoidosis is another common granulomatous disease that can affect the cord. The most common appearance is T2 abnormality within the cord with some enhancement. Enhancement is often along the surface of the cord.

2:19 Neuromyelitis optica is a demyelinating disease characterized by long segment myelitis, often in the cervical cord. It is associated with optic neuritis and abnormal anti-aquaporin antibodies.

3:04 Radiation myelopathy can happen in patients that have had radiation to the cord or surrounding region. Knowing the history is important. Radiation necrosis frequently will have less mass effect than other tumors and will respond to steroids.

4:20 Syrinx or presyrinx can occur in the setting of CSF flow obstruction. This can commonly occur with conditions such as Chiari malformation or due to a large disc bulge. A cystic syrinx can cause mass effect and mimic tumor but will rarely have enhancement.

5:17 Arachnoid adhesions or webs are special situations of CSF obstruction where an adhesion in the CSF space deflects the cord contour. Due to deflection, CSF flow within the central canal can be disrupted and cause cyst-like expansion mimicking a tumor. The characteristic finding is the “scalpel sign” where the cord contour takes on the appearance of a surgical scalpel.

6:36 Summary. History is extremely important in evaluating potential spine tumors as additional history may inform you that a lesion isn’t a tumor at all.

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