Browse > Article
http://dx.doi.org/10.13104/jksmrm.2014.18.2.144

Intramedullary Spinal Lesions Involving the Conus Medullaris: MR Imaging Features for Differential Diagnosis  

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)
Publication Information
Investigative Magnetic Resonance Imaging / v.18, no.2, 2014 , pp. 144-150 More about this Journal
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.
Keywords
Conus medullaris; Intramedullary lesion; Spinal arteriovenous fistula; Ventriculus terminalis Hemangioblastoma; Dermoid cyst; Ependymoma;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Admiraal P, Hazenberg GJ, Algra PR, Kamphorst W, Wolbers JG. Spinal subarachnoid hemorrhage due to a filum terminale ependymoma. Clin Neurol Neurosurg 1992;94:69-72   DOI
2 Hassan MF, Mohamed MB, Kalsi P, Sinar EJ, Bradey N. Intramedullary pyogenic abscess in the conus medullaris. Br J Neurosurg 2012;26:118-119   DOI
3 Sharma M, Mally R, Velho V. Ruptured conus medullaris dermoid cyst with fat droplets in the central canal . Asian Spine J 2013;7:50-54   DOI
4 Chen CY, Chen PH, Yao MS, Chu JS, Chan WP. MRI of hemangioblastoma in the conus medullaris. Comput Med Imaging Graph 2008;32:78-81   DOI
5 Welling LC, Zanellato C, Tessari M, Mendes V, Figueiredo EG, Teixeira MJ. Hemangioblastoma of the conus medullaris. Br J Neurosurg 2012;26:296-297   DOI
6 Shimosawa H, Matsumoto M, Yabe H, Mukai M, Toyama Y, Morioka H. Primary primitive neuroectodermal tumor of the conus medullaris in an elderly patient: a case report and review of the literature. Case Rep Oncol 2011;4:267-274   DOI
7 Sanborn MR, Pramick M, Brooks J, Welch WC. Glioblastoma multiforme in the adult conus medullaris. J Clin Neurosci 2011;18:842-843   DOI
8 Jaiswal AK, Jaiswal S, Gupta SK, Singh Gautam VK, Kumar S. Intramedullary tuberculoma of the conus. J Clin Neurosci 2006;13:870-872   DOI
9 Kahilogullari G, Erdem A, Heper AO, Erden E. Intramedullary mature cystic teratoma of the conus medullaris. A case report. J Neurosurg Sci 2006;50:55-58
10 Gallia GL, Burger PC, Suk I, et al. Concomitant conus medullaris ependymoma and filum terminale lipoma: case report. Neurosurgery 2006;58:E1214   DOI
11 Srivatanakul K, Songsaeng D, Ozanne A, Toulgoat F, Lasjaunias P. Spinal arteriovenous malformation associated with syringomyelia. J Neurosurg Spine 2009;10:436-442   DOI   ScienceOn
12 Oh MC, Kim JM, Kaur G, et al. Prognosis by tumor location in adults with spinal ependymomas. J Neurosurg Spine 2013;18:226-235   DOI
13 Kim DH, Kim JH, Choi SH, et al. Differentiation between intramedullary spinal ependymoma and astrocytoma: comparative MRI analysis. Clin Radiol 2014;69:29-35   DOI
14 Goy AM, Pinto RS, Raghavendra BN, Epstein FJ, Kricheff II. Intramedullary spinal cord tumors: MR imaging, with emphasis on associated cysts. Radiology 1986;161:381-386   DOI
15 Sun B, Wang C, Wang J, Liu A. MRI features of intramedullary spinal cord ependymomas. J Neuroimaging 2003;13:346-351   DOI
16 Koeller KK, Rosenblum RS, Morrison AL. Neoplasms of the spinal cord and filum terminale: radiologic-pathologic correlation. Radiographics 2000;20:1721-1749   DOI
17 Epstein FJ, Farmer JP, Freed D. Adult intramedullary spinal cord ependymomas: the result of surgery in 38 patients. J Neurosurg 1993;79:204-209   DOI   ScienceOn
18 Kahan H, Sklar EM, Post MJ, Bruce JH. MR characteristics of histopathologic subtypes of spinal ependymoma. AJNR Am J Neuroradiol 1996;17:143-150
19 Baker KB, Moran CJ, Wippold FJ, 2nd et al. MR imaging of spinal hemangioblastoma. AJR Am J Roentgenol 2000;174:377-382   DOI
20 Browne TR, Adams RD, Roberson GH. Hemangioblastoma of the spinal cord. Review and report of five cases. Arch Neurol 1976;33:435-441   DOI   ScienceOn
21 Park CH, Lee CH, Hyun SJ, Jahng TA, Kim HJ, Kim KJ. Surgical outcome of spinal cord hemangioblastomas. J Korean Neurosurg Soc 2012;52:221-227   DOI
22 Murota T, Symon L. Surgical management of hemangioblastoma of the spinal cord: a report of 18 cases. Neurosurgery 1989;25:699-707   DOI
23 Fine MJ, Kricheff II, Freed D, Epstein FJ. Spinal cord ependymomas: MR imaging features. Radiology 1995;197:655-658   DOI
24 Yoshii S, Shimizu K, Ido K, Nakamura T. Ependymoma of the spinal cord and the cauda equina region. J Spinal Disord 1999;12:157-161
25 Han IH, Kuh SU, Chin DK, Kim KS, Jin BH, Cho YE. Surgical treatment of primary spinal tumors in the conus medullaris. J Korean Neurosurg Soc 2008;44:72-77   DOI
26 Lowe GM. Magnetic resonance imaging of intramedullary spinal cord tumors. J Neurooncol 2000;47:195-210   DOI
27 Bostrom A, Hans FJ, Reinacher PC, et al. Intramedullary hemangioblastomas: timing of surgery, microsurgical technique and follow-up in 23 patients. Eur Spine J 2008;17:882-886   DOI   ScienceOn
28 Xu QW, Bao WM, Mao RL, Yang GY. Magnetic resonance imaging and microsurgical treatment of intramedullary hemangioblastoma of the spinal cord. Neurosurgery 1994;35:671-675   DOI   ScienceOn
29 Samii M, Klekamp J. Surgical results of 100 intramedullary tumors in relation to accompanying syringomyelia. Neurosurgery 1994;35:865-873   DOI   ScienceOn
30 Brisman JL, Borges LF, Ogilvy CS. Extramedullary hemangioblastoma of the conus medullaris. Acta Neurochir (Wien) 2000;142:1059-1062   DOI   ScienceOn
31 Liccardo G, Ruggeri F, De Cerchio L, Floris R, Lunardi P. Fifth ventricle: an unusual cystic lesion of the conus medullaris. Spinal Cord 2005;43:381-384   DOI   ScienceOn
32 Sigal R, Denys A, Halimi P, Shapeero L, Doyon D, Boudghene F. Ventriculus terminalis of the conus medullaris: MR imaging in four patients with congenital dilatation. AJNR Am J Neuroradiol 1991;12:733-737
33 Matsubayashi R, Uchino A, Kato A, Kudo S, Sakai S, Murata S. Cystic dilatation of ventriculus terminalis in adults: MRI. Neuroradiology 1998;40:45-47   DOI   ScienceOn
34 Dullerud R, Server A, Berg-Johnsen J. MR imaging of ventriculus terminalis of the conus medullaris. A report of two operated patients and a review of the literature. Acta Radiol 2003;44:444-446
35 Brisman JL, Li M, Hamilton D, Mayberg MR, Newell DW. Cystic dilation of the conus ventriculus terminalis presenting as an acute cauda equina syndrome relieved by decompression and cyst drainage: case report. Neurosurgery 2006;58:E585   DOI
36 Sansur CA, Sheehan JP, Sherman JH, Jane JA. Ventriculus terminalis causing back pain and urinary retention. Acta Neurochir (Wien) 2006;148:919-920   DOI
37 Ciappetta P, D'Urso P I, Luzzi S, Ingravallo G, Cimmino A, Resta L. Cystic dilation of the ventriculus terminalis in adults. J Neurosurg Spine 2008;8:92-99   DOI   ScienceOn
38 Dhillon RS, McKelvie PA, Wang YY, Han T, Murphy M. Cystic lesion of the ventriculus terminalis in an adult. J Clin Neurosci 2010;17:1601-1603   DOI
39 van Aalst J, Hoekstra F, Beuls EA, et al. Intraspinal dermoid and epidermoid tumors: report of 18 cases and reappraisal of the literature. Pediatr Neurosurg 2009;45:281-290   DOI
40 Graham DV, Tampieri D, Villemure JG. Intramedullary dermoid tumor diagnosed with the assistance of magnetic resonance imaging. Neurosurgery 1988;23:765-767   DOI
41 Muthukumar N, Srisaravanan J. Intramedullary dermoid in a low lying conus tethered by a fatty filum - embryological implications. Acta Neurochir (Wien) 2007;149:1173-1175   DOI
42 Patankar AP, Sheth JH. Dermoid cyst: a rare intramedullary inclusion cyst. Asian J Neurosurg 2012;7:81-83   DOI
43 Krishna KK, Agarwal PA, Agarwal SI, Jain MM. Dermoid of the conus medullaris. J Clin Neurosci 2004;11:796-797   DOI