E1403. Tumors of the Spine from Bone to Cord: Compartmental Approach with Radiologic-Pathologic Correlation
Authors
Esraa Al-Jabbari;
University of Texas Medical Branch
Rasha Alfattal;
University of Texas Medical Branch
Shahin Owji;
University of Texas Medical Branch
Atefeh Zeinoddini;
University of Texas Medical Branch
Huda Al Jadiry;
University of Texas Medical Branch
Background
according to the tissue/structure of origin. It can arise from or involve the spinal cord, dura, spinal nerves or the surrounding osseus and soft tissue structures. A systematic approach to the spinal lesions is essential. The need for surgical planning, a pre-operative, and sometimes non-operative diagnosis is frequently required as biopsy of these lesions (especially the tumors within the cord) has the potential of serious neurological impairment. This presentation provides a systemic approach to these tumors and highlights their characteristic neuroimaging appearances, with emphasis on radiologic-pathologic correlation.
Educational Goals / Teaching Points
The purpose of this educational exhibit is to illustrate systemic approach for spinal tumors and determine if the lesion is extradural, intradural extramedullary, or intramedullary. The reader should also be able to recognize the most common differential diagnosis in each compartment and their imaging characteristics that allow a specific diagnosis to be favored. Furthermore, correlate the imaging appearance with their gross pathologic appearance.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Magnetic resonance imaging is the modality of choice for diagnosis and preoperative assessment of patients with spinal abnormalities. It is not difficult to identify the compartment in which these tumors are situated; however, sometimes it can be uncertain.
The relationship of the mass to the cord and dura is of prime importance. Spinal tumors are usually divided into two broad categories: Extradural lesions and Intradural lesions. Extradural lesions are located outside of the surrounding dura. The main hints favoring an extradural tumor are extrinsic compression of the dura and tumor extension into the neural foramen. Another clue is the subarachnoid space between the dura and spinal cord is obliterated at the margin of the tumor.
Intradural lesions occur within the dural sac and are further categorized as either intradural intramedullary or intradural extramedullary lesions. With extramedullary lesions, the dura bulges out instead having a convex appearance. The outer contour of the cord is compressed by the tumor, resulting in widening of the subarachnoid space at the edge of the tumor.
With Intramedullary intradural lesions, cord expansion is commonly seen, and the outer contour of the spinal cord has a convex bulge resulting in narrowing of the subarachnoid space and the level of the tumor. Also, change/ alteration in the signal intensity of the cord is another clue.
The radiologist’s ability to narrow the differential diagnosis of spinal abnormalities has the potential to avoid invasive approaches for diagnosis and also guide appropriate management.
Conclusion
A reasonable differential diagnosis can be developed for most spinal lesions on the basis of the patient’s age, lesion location, and radiological imaging characteristics. For Radiologists, having a systematic approach for these lesions and being familiar with their imaging characteristics helps in at least narrowing the possible differential diagnosis, guides the surgeon with surgical planning and possibly avoiding invasive procedures.
