46 year old with back pain
IMG 1


IMG 2


IMG 3


IMG 4

• Dx = Metastases from lung carcinoma.
• Replacement of the bone marrow of the spine results in the typical MR appearance of metastatic bone lesions. Low signal intensity is seen on T1-weighted images, while T2 – weighted images show increased signal. The intervertebral disks are usually not involved. This can be a useful sign to distinguish metastatic disease from inflammatory disease.
• T1-weighted sagittal images (IMG 1) show compression of T3 with abnormal low signal intensity and cord compression.
• Gradient echo sagittal images (IMG 2) show mixed signal intensity.
• A large mixed signal mass lesion is seen on T1-weighted axial images IMG 4) with destruction of the right second rib
• Question commonly asked about Intramedullary vs intradural extramedullary vs extradural.

Intramedullary tumors, cysts and tumorlike masses

• Lesions of the spinal cord
• Most are malignat neoplasms
• 90-95% are gliomas - >95% of the gliomas are ependymomas and low grade astrocytomas

Intradural extramedullary tumors, cysts and tumorlike masses

• Arise inside the dura but outside the spinal cord

Extradural tumors, cysts and tumorlike masses

• Occur outside the spinal dura
• Typically arise from the osseous spine, intervertebral discs and adjacent soft tissues
• Imaging hallmarks – focal displacement of the thecal sac away from the mass