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CORE: Neuro > Spine Tumors > Flashcards

Spine Tumors Flashcards

(46 cards)

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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

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A

external to dura

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

20
Q

vertebral body/epidural mets

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A

breast, lung, prostate mets

T1 focal decrease

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

21
Q

hemangioma

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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

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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

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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

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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
goal of MRI spine
identify surgically correctible lesion or process that can be treated with steroid injection
26
disc bulge/herniation
disc (nucleus pulposus, annulus fibrosis) extends beyond normal margins
27
broad based disc bulge
>180 disc circumference
28
disc herniation
focal disc bulge protrusion: diameter of neck greater than diameter fo dome extrusion: diameter of neck < diameter of dome; saccular aneurysm
29
positions of herniation
central, paracentral, foraminal, far-lateral
30
sequestered disc
protruded disc fragment can migrate inferior or superiorly along posterior longitudinal ligament
31
degenerative changes to disc
disc dessication with T2 shortening (T2 dark) Schmorl's node
32
Modic changes
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
ligamentum flavum infolding/hypertrophy
can narrow posterior aspect of spinal canal >> spinal canal stenosis
34
facet arthropaty
degenerative intervertebral facet joints >> cartilage loss, osteophytosis, sclerosis, subchondral cystic change
35
tarlov cyst
perineural cyst of sacrum; formed within nerve rooth sheath; asymptomatic
36
annular fissure
high intensity zone; T2 bright signal in annulus fibrosis
37
diffuse idiopathic skeletal hyperostosis/DISH
flowing anterior osteophyte exteding 4+ vertebral levels presevation of disc spaces; ossification of PLL
38
ossification of posterior longitudinal ligament
calcification of OPLL which can cause spinal canal stenosis/compression of anterior aspect of cord usually begins in cervical spine
39
postoperative spine
contrast can distinguish between disc disease and scar tissue scar tissue will enhance throughout; disc will only have peripheral enhancement
40
pyogenic discitis/osteomyelitis
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
TB osteomyelitis
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
dAVF in the spine
older males with back pain/progressive myelopathy cognard type V dural AVF flow voids seen surrounding cord; abnormal intramedullary T2 prolongation
43
spinal cord infarction
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
tethered cord syndrome
tethered by thickened filum/lipoma if conus terminates below L2 level back/leg pain, gait spasticity, decreased lower extremitysensation
45
diastematomyelia
congenital split spinal cord which causes scoliosis
46
fatty filum
fat within filum terminale; associated with diastematomyelia, tethered cord; may also be insignificant

CORE: Neuro (21 decks)

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