Age / Sex : 38 / F

Chief complaint :

Lower back pain, both flank pain (onset; The day of visit, no event)


What is your diagnosis?


Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).


Courtesy : 차장규 Jang Gyu Cha, 부천 순천향대학교 병원 Soonchunhyang University Bucheon Hospital

Intramedullary cavernoma

Discussion

Findings:

T spine MR with contrast;

 Intramedullary mixed signal intensity lesion is noted in the level of T9 with low signal Rim. In the gradient T2 weighted image shows blooming artifact. There is also multisegment high signal intensity with swelling of spinal cord around the lesion.

 Differential Diagnosis:

 Spinal cord AVM,  Spinal cord metastasis,  Ependymoma

Discussion:

 Epidemiology

• F>M (2:1)


• 20–50 years

 Characteristic imaging findings

• Reticulate appearance with areas of mixed signal intensity on both T1WI and T2WI


• Rim of low signal (T2WI) due to hemosiderin


• No definite enhancement

 Spectrum of imaging findings

• Acute hemorrhage

- Foci of acute hemorrhage: low signal on T2-weighed image and high signal on T1-weighed image

- Spinal cord edema and swelling: area of T2-hyperintensity around the hemorrhagic foci

 Differential diagnosis

• Spinal cord AVM

- Abnormal vascular mass in the spinal cord

- Engorged perimedullary veins

• Spinal cord metastasis

- Enhancing mass with extensive cord edema

• Ependymoma

- Enhancing mass

- Syrinx

Reference;

Heung Sik Kang, Joon Woo Lee, Eugene Lee. Oncologic Imaging: Spine and Spinal Cord Tumors. Singapore: Springer, 2017;109pg