Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
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Intramedullary Spinal Lesions Involving the Conus Medullaris: MR Imaging Features for Differential Diagnosis

척수 원추부에 발생한 척수내 병변: 자기공명영상을 이용한 감별 진단

  • Eun, Na Lae (Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Ahn, Sung Jun (Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Chung, Tae-Sub (Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Cho, Yong-Eun (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University) ;
  • Kim, Keun Su (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University) ;
  • Kuh, Sung-Uk (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University) ;
  • Suh, Sang Hyun (Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • 은나래 (연세대학교 의과대학 강남세브란스병원 영상의학교실) ;
  • 안성준 (연세대학교 의과대학 강남세브란스병원 영상의학교실) ;
  • 정태섭 (연세대학교 의과대학 강남세브란스병원 영상의학교실) ;
  • 조용은 (연세대학교 의과대학 강남세브란스병원 척추신경외과교실) ;
  • 김근수 (연세대학교 의과대학 강남세브란스병원 척추신경외과교실) ;
  • 구성욱 (연세대학교 의과대학 강남세브란스병원 척추신경외과교실) ;
  • 서상현 (연세대학교 의과대학 강남세브란스병원 영상의학교실)
  • Received : 2014.02.21
  • Accepted : 2014.05.21
  • Published : 2014.06.30
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Abstract

Purpose : Intramedullary spinal lesions in the conus medullaris (CM), including tumors and vascular lesion, are rarely reported. We reported various MR features of intramedullary spinal cord lesions involving the CM including ependymoma, hemangioblastomas, dermoid cyst, ventriculus terminalis and spinal AVF and tried to discuss them for differential diagnosis. Materials and Methods: Six patients (male: female = 4:2, mean age = 44.3 year old) were enrolled from the clinical database of our institute from 2004 to 2010 and their radiological images and clinical symptoms were reviewed retrospectively. All patients had taken initial and postoperative MRI with contrast enhancement using gadopentate dimeglumine (Gd-DTPA). These images were analyzed by tumor size, location, signal intensity relative to the spinal cord, vascular flow voids, syrinx or cyst, edema and enhancement pattern. Results: Contrast enhancement was seen in all intramedullary masses. An eccentric enhancing nodule was noted in two hemangioblastomas and unusual peripheral rim enhancement with septation was seen in ventriculus terminalis. Patchy enhancement of the CM was observed in spinal arteriovenous fistula (AVF). Extensive cord edema adjacent to the intramedullary lesions was seen in four cases and syrinx was noted in three cases. Vascular signal voids were found in two hemangioblastomas and one spinal AVF. Conclusion: In evaluation of intramedullary spinal lesions in the CM, it is necessary to consider these unusual MR findings and discriminate various pathologies with prudence and caution.

목적: 척수 원추부에 국한된 척수내 병변은 현재까지 보고된 바가 드물다. 이 논문에서는 척수 원추부에 국한된 척추내 병변인 상의세포종, 혈관모세포종, 유피낭종, 종말 뇌실, 척추 동정맥류 등 6 증례의 자기공명영상의 다양한 소견을 보고하고 감별점을 논의해 보고자 한다. 대상과 방법: 2004년부터 2010년까지 본원의 자료를 바탕으로 하여 총 6명의 환자 (남:여 = 4:2, 평균연령 = 44.3세)가 대상이 되었으며 이들의 방사선학적소견과 임상증상 등을 각각 검토하였다. 모든 환자들은 수술 전 후 가돌리늄 조영증강 자기공명영상을 시행하였다. 그리고 종양 크기, 위치, 자기공명 신호강도, 혈관성 유동공백의 유무, 관 혹은 낭의 존재 유무, 부종의 존재 유무, 조영증강 양상에 따라 영상을 비교하였다. 결과: 조영 증강은 모든 척수내 병변에 나타났다. 2 증례의 혈관모세포종에서 편심적 조영증강 결절이 보였으며 종말 뇌실 증례에서 흔치 않은 테두리 조영증강과 격막이 보였다. 척추 동정맥류에서는 반점형 조영증강이 관찰되었다. 3개의 증례에서 척수내 병변에 근접하여 광범위한 척수 부종과 수관이 보였다. 2 증례의 혈관모세포종과 1 증례의 척추 동정맥류에서 혈관성 유동공백이 관찰되었다. 결론: 척수 원추부에 있는 척수내 질환을 평가하는데 있어 이러한 드문 자기공명영상의 특징과 다양한 병리를 신중하게 고려해야 할 필요가 있다.

Keywords

References

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