ARRS 2022 Abstracts


E1976. A Review of Pediatric Intramedullary Spinal Cord Lesions, with an Emphasis on Neoplasms
  1. Jennifer Huang; Vanderbilt University Medical Center
  2. Asha Sarma; Vanderbilt University Medical Center
  3. Sumit Pruthi; Vanderbilt University Medical Center
Spinal cord lesions are relatively frequently encountered in the pediatric population. They can be grouped broadly into categories of neoplastic and non-neoplastic etiologies; however, these are often difficult to distinguish clinically due to vague and nonspecific symptoms. Neuroimaging of the spine with MRI is therefore often indicated in the search for an underlying etiology and to assist with clinical management decisions. Key sequences include multiplanar T2-weighted imaging, DWI, and pre- and post-gadolinium T1-weighted imaging. The first step in determining the etiology of a pediatric spinal cord lesion is to identify if the lesion is neoplastic. Intramedullary neoplasms often result in spinal cord expansion and narrowing of the adjacent CSF space, while non-neoplastic etiologies often demonstrate abnormal cord signal without cord expansion. Beyond this branch point, several key features can be used to determine the most likely etiology, noting that overlapping or nonspecific imaging findings are encountered in many cases.

Educational Goals / Teaching Points
This exhibit is an organized review of the most common and more uncommonly encountered pediatric intramedullary spinal cord tumors. The discussion will also include several non-neoplastic lesions that may be mistaken for tumors. Potential key distinguishing neuroimaging features will be highlighted.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The etiologies will be grouped as below. Intramedullary spinal cord lesions can be grouped into neoplastic and non-neoplastic etiologies, with neoplastic etiologies further divided into glial, mixed, and non-glial tumors. Neoplastic, glial tumors include astrocytoma and ependymoma. Neoplastic, mixed neuronal/glial tumors include diffuse leptomeningeal glioneuronal tumor and ganglioglioma. Neoplastic, non-glial tumors are atypical teratoid/rhabdoid tumor, immature teratoma, and hemangioblastoma. Miscellaneous neoplastic lesions include extramedullary neoplasms with substantial intramedullary involvement (e.g., Ewing sarcoma). Non-neoplastic lesions include cavernous malformation, arteriovenous fistula, lipoma, and others. For brevity, inflammatory and infectious disease such as myelitis will not be discussed.

Thus, in this review, each entity will be reviewed with a focus on common neuroimaging findings, associated complications, and key clinical and pathophysiologic features. This educational exhibit aims to help the radiologist distinguish neoplastic from non-neoplastic causes when a pediatric intramedullary lesion is encountered.