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CORE: Neuro > Spine Tumors > Flashcards

Spine Tumors Flashcards

1
Q

intramedullary lesions

A

ependymoma, astrocytoma, hemangioblastoma, demyelinating lesion

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2
Q

intradural extramedullary lesions

A

schwannoma, neurofibroma, meningioma, myxopapullary ependymoma, epidermoid/dermoid, arachnoiditis

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3
Q

extradural

A

degenerative disease, vertebral neoplasm, epidural mets, hemangioma, epidural lipomastosis

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4
Q

spinal lesion localization areas

A

intramedullary, intradural extramedullary, extradural

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5
Q

intramedullary lesions, most common type

A

deep to pia, typically within the spinal cord

all intramedullary lesions are intradural

cmmonly astrocytoma (kids), ependymoma (adults)

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6
Q

astrocytoma: intramedullary

A

most common intramedullary tumor in kids; typically low grade and can cause fusiform dilation of spinal cord

can cause cystic components/syrinx; enhance and rarely hemorrhage

similar appearing to ependymoma

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7
Q

ependymoma: intramedullary

A

most common itnramedullary tumor in adults; associated with NF2

arises from ependymal cells lining spinal canal

enhance; often hemorrhagic with heterogenous MRI appearance; peripheral hemosiderin deposition with dark T2 rim

causing scalloping of the vertebral bodies

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8
Q

hemangioblastoma: intramedullary

A

associated with VHL

marked enhancement, cyst formation, flow voids; may have intramedullary and intradural-extramedullary components

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9
Q

demyelinating lesion: intramedullary

A

active MS lesions may enhance and mimic spinal tumor; no cord expansion

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10
Q

intradural-extramedullary lesions

A

usually located in subarachnoid space; cSF cleft between lesion/cord

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11
Q

nerve-sheath tumor: intradural-extramedullary tumor

A

most common intradural-extramedullary tumor; schwannoma vs neurofibroma

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12
Q

schwannoma vs neurofibroma

A

schwannoma: more common, older pts
neurofibroma: associated with NF1, younger patients ; lacks capsule

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13
Q

meningioma: intradural-extramedullary tumor

A

older women, benign neoplasm from arachnoid cap cells

broad dural base, calcifications; usually anterior to cord in cerical spine and posterior to cord in thoracic spine

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14
Q

dermoid cyst: intradural-extramedullary tumor

A

macroscopic fat; presents in childhood

hyperintense T1

may rupture and cause fatal meningitis

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15
Q

epidermoid cyst:intradural-extramedullary tumor

A

implantation of skin elements during neonatal spine puncture

simple cystic structure on MR with peripheral rim enhancement; may be proteinaceous

restricts diffusion (unlike arachnoid cysts)

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16
Q

myxopapillary ependymoma: intradural-extramedullary tumor

A

ependymoma exclusively within conus medullaris/filum terminale; arises from ependymal cells

slow growth&raquo_space; vertebral scalopping/spinal canal enlargement

highly vascular, hemorrhagic, lobulated; peripheral hemosiderin; heterogenous appearance

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17
Q

archnoiditis: intradural-extramedullary tumor

A

inflammation of arachnoid surrounding nerve roots with fibrinous exudate and secondary dural adhesions

usually caued by TB/syphilis

displaces nerve roots

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18
Q

imaging patterns fo arachnoiditis

A

group 1: central conglomeration of nerve roots

group 2: peripheral clumping of nerve roots; empty thecal sac sign

group 3: obliteration of subarachnoid space with soft tissue; most severe form

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19
Q

extradural lesions

A

external to dura

include degenerative lesions (herniated discs, osteophytes; mets, infection)

20
Q

vertebral body/epidural mets

A

breast, lung, prostate mets

T1 focal decrease

diffuse T1 decreased signal is nonspecific (leukemia, lymphoma, myelofibrosis, HIV, idiopathic)

21
Q

hemangioma

A

benign lesion of endothelium lined vascular strucures

striated corduroy appearance; T1/2 hyperintense

22
Q

ddx primary osseous vertebral body tumors in older adults

A

chordoma: notocord remnant tumor; sacrococcygeal > clivus > vertebral bodies (cervical); destructive T2 lesion/enhances
plasmocytoma: lytic expansile bony lesion; precursor to MM
chondrosarcoma: low grade malignancy with chondroid rings/arc calcifications; T2 hyperintense

23
Q

ddx primary osseous vertebral body tumors in adolescents/young adults

A

ABC: benign destructive lesion with fluid levels on MRI

chondroblastoma: vertebral column; benign; secondary aneurysmal bone cyst may be present

osteoid osteoma: benign sclerotic lesion of vertebral posterior elements; nocturnal pain relieved by NSAIDS; central radiolucent nidus (vascular fibrous connecting tissue)

osteosarcoma: malignant tumor with osteoid matrix

24
Q

epidural lipomatosis

A

rare overgrowth of fat in extradural space; most sevre can cause cauda equina

may be caused by exogenous steroid administration, Cushing syndrome; morbid obesity

25
Q

goal of MRI spine

A

identify surgically correctible lesion or process that can be treated with steroid injection

26
Q

disc bulge/herniation

A

disc (nucleus pulposus, annulus fibrosis) extends beyond normal margins

27
Q

broad based disc bulge

A

> 180 disc circumference

28
Q

disc herniation

A

focal disc bulge

protrusion: diameter of neck greater than diameter fo dome
extrusion: diameter of neck < diameter of dome; saccular aneurysm

29
Q

positions of herniation

A

central, paracentral, foraminal, far-lateral

30
Q

sequestered disc

A

protruded disc fragment can migrate inferior or superiorly along posterior longitudinal ligament

31
Q

degenerative changes to disc

A

disc dessication with T2 shortening (T2 dark)

Schmorl’s node

32
Q

Modic changes

A

type 1: T1 dark/T2 bright; bone marrow edema/inflammation; active symptoms

type 2: T1/2 bright; fatty proliferation with affected marrow; chronic marrow ischemia

type 3: T1/2 hypointense; sclerosis

33
Q

ligamentum flavum infolding/hypertrophy

A

can narrow posterior aspect of spinal canal&raquo_space; spinal canal stenosis

34
Q

facet arthropaty

A

degenerative intervertebral facet joints&raquo_space; cartilage loss, osteophytosis, sclerosis, subchondral cystic change

35
Q

tarlov cyst

A

perineural cyst of sacrum; formed within nerve rooth sheath; asymptomatic

36
Q

annular fissure

A

high intensity zone; T2 bright signal in annulus fibrosis

37
Q

diffuse idiopathic skeletal hyperostosis/DISH

A

flowing anterior osteophyte exteding 4+ vertebral levels

presevation of disc spaces; ossification of PLL

38
Q

ossification of posterior longitudinal ligament

A

calcification of OPLL which can cause spinal canal stenosis/compression of anterior aspect of cord

usually begins in cervical spine

39
Q

postoperative spine

A

contrast can distinguish between disc disease and scar tissue

scar tissue will enhance throughout; disc will only have peripheral enhancement

40
Q

pyogenic discitis/osteomyelitis

A

infection of disc/adjacent vertebrae, usually from S. aureus

adults: vascular subchondral bone is site
children: intervertebral disc is normally site

T1 dark on both sides of disc, T2 hyperintense; loss of endplate definition and disc height; soft tissue infection may be present

41
Q

TB osteomyelitis

A

Pott disease; disc spared since they cannot break down disc substance

wedge shaped compression of anterior aspect of vertebral body; gibbus deformity (acutely angled kyphosis)

may also have pulmonary TB

42
Q

dAVF in the spine

A

older males with back pain/progressive myelopathy

cognard type V dural AVF

flow voids seen surrounding cord; abnormal intramedullary T2 prolongation

43
Q

spinal cord infarction

A

upper thoracic/thoracolumbar spine due to artery of Adamkiewicz infarct

loss of bowel/bladder control, perineural sensation, motor/sensory imparment

causes: aortic surgery, AAA, arteritis, sickle cell, vascular malformation, disc herniation

T2 hyperintense/enlarged; restricts diffusion; vertebral body infarction may be present

44
Q

tethered cord syndrome

A

tethered by thickened filum/lipoma if conus terminates below L2 level

back/leg pain, gait spasticity, decreased lower extremitysensation

45
Q

diastematomyelia

A

congenital split spinal cord which causes scoliosis

46
Q

fatty filum

A

fat within filum terminale; associated with diastematomyelia, tethered cord; may also be insignificant

CORE: Neuro (21 decks)

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