E1638. Navigating the Spinal Canal: Approach to Spinal Canal Collections and Mimics
  1. Grace Siew Lim Tan; Changi General Hospital
  2. Perry Jia Ren Liew; Changi General Hospital
  3. Sook Chuei Cheong; Changi General Hospital
  4. Yan Rong Yong; Changi General Hospital
Spinal canal collections can be challenging to assess with MRI as there are a wide range of pathologies with differing but overlapping signal characteristics. To further complicate matters, epidural lesions can also mimic collections. Lack of awareness of these different entities may result in misdiagnosis and delay in initiating appropriate management.

Educational Goals / Teaching Points
We present a series of cases including epidural, subdural and subarachnoid hemorrhages, epidural abscess, epidural fluid collection from cerebrospinal fluid leak / spontaneous intracranial hypotension, epidural lipomatosis, epidural venous varices / dilated veins, and spinal canal vascular malformations. We also propose a systematic stepwise approach to spinal canal collection, which may help radiology residents and even senior radiologists to come to a reasonable diagnosis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Our flow-chart incorporates anatomic knowledge of the spinal canal compartments to specify the correct location of the collection / lesion, before evaluating the MRI signal characteristics and enhancement pattern to help distinguish between the different entities.

Given the prevalence of neck or back pain, MRI of the spine is commonly performed. The ability to distinguish between the various spinal canal collections and potential mimics will provide value-added patient care. When faced with diagnostic challenges, a systematic approach to spinal canal collection may help radiologists to come to a reasonable diagnosis.