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Spinal Cord Lesions

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Diffusion-Weighted MR Imaging of the Brain, Head and Neck, and Spine

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Abstract

Imaging section: Distinguishing between different types of spinal cord lesions is crucial because the treatments vary greatly: interventional procedures for vascular malformations, decompression surgery for compressive myelopathy, biopsy or resection for neoplasm, and steroids for inflammatory etiologies. However, spinal cord lesions remain a diagnostic challenge due to the wide range of etiologies and nonspecific clinical and imaging presentations. The development of new diffusion-weighted imaging (DWI) techniques with increased resolution and decreased magnetic susceptibility effects, such as BLADE-DWI and multi-shot echo planar DWI, has given radiologists an additional tool to help refine differential diagnoses. Although data is still limited, many investigators believe that DWI in combination with apparent diffusion coefficient (ADC) is more sensitive and specific for cord lesions than T2 weighting since these techniques provide physiologic information. Typically, etiologies that lead to cytotoxic edema (impaired free motion of water molecules), such as cord infarct, will show restricted diffusion (high DWI signal and decreased ADC). Additional etiologies that may show restriction of diffusion include acute demyelination, acute cord contusion, hypercellular tumor, infectious myelitis, and intramedullary abscess. On the other hand, vasogenic/interstitial edema, cystic necrosis, gliosis, fluid collection or increased extracellular matrix (promoting free diffusion of water molecules), such as in subacute to chronic inflammatory or demyelinating lesions, myelomalacia, compressive myelopathy, pre-syrinx/syrinx, hypocellular neoplasm tend to show increased ADC values.

Treatment section: Imaging is paramount in identifying intradural from extradural spinal tumors. Current MRI techniques are quite accurate in separating gliomas from meningiomas, nerve sheath tumors, cavernomas, or hemangioblastomas. Diagnosis of intramedullary tumors can often be suspected from imaging, but confirmation demands surgery. Our review of 30 gliomas referred to our institution revealed that distinguishing astrocytoma from ependymoma was not consistent, and both diagnoses were often listed as possible. A syrinx cavity was, however, more often associated with ependymoma compared to astrocytoma. Surgery remains the mainstay of treating symptomatic intramedullary lesions.

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Acknowledgement

The authors acknowledge the invaluable assistance of Faith Vaughn in the editing and submission of this manuscript.

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Authors and Affiliations

  1. Division of Neuroradiology, University of Michigan, Ann Arbor, MI, USA

    John Kim & Toshio Moritani

  2. Riverside Community Hospital, UC Riverside, Riverside, CA, USA

    Duy Q. Bui

  3. University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Patrick W. Hitchon

  4. Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Royce W. Woodroffe

  5. Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Jennifer L. Noeller

  6. University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Kirill V. Nourski

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  1. Professor of Radiology, Director of Clinical Neuroradiology Research, Division of Neuroradiology, University of Michigan, Ann Arbor, MI, USA

    Toshio Moritani

  2. Associate Professor of Radiology, Division of Neuroradiology, University of Michigan, Ann Arbor, MI, USA

    Aristides A. Capizzano

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Kim, J. et al. (2021). Spinal Cord Lesions. In: Moritani, T., Capizzano, A.A. (eds) Diffusion-Weighted MR Imaging of the Brain, Head and Neck, and Spine. Springer, Cham. https://doi.org/10.1007/978-3-030-62120-9_23

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