Article Figures & Data
Figures
- Fig 1.
Multiple intramedullary spinal cord metastases in an asymptomatic patient. A 73-year-old man with a history of metastatic lung adenocarcinoma underwent a spine MR imaging after a PET-CT scan had demonstrated multifocal spinal hypermetabolism. He was asymptomatic with regard to the spinal cord. Postcontrast sagittal T1-weighted images of the cervical (A) and thoracic (B) spine are shown. Multiple intramedullary spinal cord metastases are demonstrated at the C2, T4, T4–5, and T11 levels (arrows in A, B). In this series, several other patients were asymptomatic.
- Fig 2.
Typical solitary intramedullary spinal cord metastasis, with visualization of primary tumor. A 66-year-old man presented with 6 weeks of paresthesias, bladder dysfunction, lower extremity weakness, and pain. Thoracic spine sagittal T2-weighted (A), sagittal T1-weighted (B), postcontrast sagittal T1-weighted (C), and axial T1-weighted (D) images are shown. A T2 hyperintense, expansile intramedullary cord lesion (arrow) is associated with a large amount of cord T2 hyperintensity (A). The mass is isointense on T1-weighted images (arrow in B) and enhances heterogeneously (arrow in C). Also noted is a left hilar lung mass (arrows in D), which was further evaluated with chest CT imaging (not shown). This hilar mass was pathologically proved to be a grade 4 undifferentiated small-cell lung carcinoma. Visualization on MR imaging of the primary tumor/non-CNS metastases and/or other spinal/CNS (non–spinal cord) metastases was common in this series.
- Fig 3.
Multiple intramedullary spinal cord metastases, with visualization of other CNS metastases. A 60-year-old woman with a history of small-cell lung carcinoma, diagnosed 6.5 months prior, presented with several days of lower extremity weakness and urinary and stool incontinence. MR images of the cervical and thoracic spine with postcontrast fat-saturated consecutive sagittal T1-weighted images of the thoracic spine (A, B, C) and postcontrast sagittal T1-weighted image of the cervical spine (D) are shown. Several enhancing intramedullary lesions are present (white arrows in A, B, D). There is abnormal leptomeningeal enhancement with several small metastases studding the surface of the cord (arrows in C). Metastases are visualized in the lower pons and cerebellum (thick white arrows in D). Visualization on MR imaging of other CNS or spinal (non-spinal cord) metastases was common in this series, and more common in patients with multiple ISCMs.
- Fig 4.
Atypical intramedullary spinal cord metastasis with central cystic change/necrosis. A 55-year-old man with recent nephrectomy of a renal cell carcinoma presented with 2 weeks of predominantly left upper extremity pain, paresthesias, and weakness, as well as global hyperreflexia. Cervical spine sagittal T2-weighted (A), T1-weighted (B), and postcontrast fat-saturated T1-weighted images (C), and postcontrast axial T1-weighted image are shown. A mass within the cord at the level of C5 has markedly hyperintense central signal on T2-weighted imaging (A) and corresponding T1 hypointensity (B) consistent with central cystic change/necrosis. The sagittal (C) and axial (D) T1-weighted postcontrast images demonstrate the peripheral enhancement with lack of central enhancement corresponding to the region of central cystic/necrotic change. This represents 1 of only 2 cases in the current series of intramedullary spinal cord metastasis demonstrating cystic/necrotic change. The primary tumor type in the other case (not shown) was lung carcinoma.
- Fig 5.
Atypical intramedullary spinal cord metastasis with associated hemorrhage. A 74-year-old man with squamous cell carcinoma of the lung diagnosed 2 years prior presented with 4 weeks of paraplegia. Thoracic spine shown with sagittal T1-weighted (A) and T2-weighted (B) and axial gradient recalled-echo (C) images. Heterogeneous mildly hyperintense central signal is present within the intramedullary spinal cord metastasis on T1-weighted imaging (arrows in A). There is corresponding heterogeneity on T2-weighted imaging (B). The axial gradient recalled-echo image demonstrates corresponding central hypointensity (“blooming,” arrow in C), typical of hemorrhage. This is the only intramedullary spinal cord metastasis in the current series demonstrating signal changes convincing for associated hemorrhage.
Tables
Feature Prevalence Sex Female 26 (53%) Primary malignancy Lung carcinoma 24 (49%) Breast carcinoma 7 (14%) Melanoma 5 (10%) CNS origin 4 (8%) Renal cell carcinoma 3 (6%) Other 6 (12%) Timing of primary tumor diagnosis ISCM presentation preceded primary tumor diagnosis 10 (20%) ISCM diagnosis preceded primary tumor diagnosis 5 (10%) Dominant presenting symptoms Weakness 28 (57%) Sensory symptoms 8 (16%) Bowel and/or bladder dysfunction 5 (10%) Pain 4 (8%) Asymptomatic 4 (8%) Time interval, median (range) Duration of symptoms at clinical presentation (n = 44) 2 weeks (0.1–32) Primary tumor diagnosis to ISCM presentation (n = 38) 1.8 years (0–19.3) Primary tumor diagnosis to ISCM diagnosis (n = 44) 1.6 years (0–19.5) Feature Prevalence Location (n = 70) Cervical 16 (23%) Cervicothoracic 2 (3%) Thoracic 40 (57%) Thoracic-conus 1 (1%) Conus 11 (16%) Position (n = 62) Central 23 (37%) Eccentric 35 (56%) Exophytic 4 (6%) Morphology (n = 66) Well-circumscribed 64 (97%) Ill-defined 2 (3%) Cord expansion (n = 70) Present 44 (63%) Absent 26 (37%) Enhancement (n = 64) Present 63 (98%) Absent 1 (2%) Enhancement pattern (n = 63) Homogeneous 31 (49%) Heterogeneous 31 (49%) Peripheral (ring) 1 (2%) Size of enhancing lesion, mm, mean (range) Anterior-posterior (n = 63) 6.5 (1–16) Transverse (n = 53) 7.3 (2–23) Superior-inferior (n = 63) 19.9 (2–114) Longitudinal extent, No. of vertebral segments, mean (range) Length of enhancement (n = 63) 1.4 (1–8) Length of cord T2 signal hyperintensity (n = 69) 4.5 (1–15) Ratio, T2 signal/enhancement (n = 63) 3.6 (1–14) T2 signal intensity (n = 70) Hyperintense 55 (79%) Hypointense 1 (1%) Isointense 14 (20%) T1 signal intensity (n = 63) Hyperintense 10 (16%) Hypointense 5 (8%) Isointense 48 (76%) Cystic change (n = 70) Intratumoral 2 (3%) Peritumoral 0 (0%) Intratumoral hemorrhage (n = 70) 1 (1%) - Table 3:
Additional MRI features of ISCMs on reference MRI, per-patient basis (n = 49 patients)
Feature Prevalence Solitary ISCM 39 (80%) Multiple ISCMs 10 (20%) Non-cord CNS and/or spinal metastasis 29 (59%) Leptomeningeal metastasis 18 (37%) Primary tumor and/or non-CNS metastasis 29 (59%) Non-cord CNS/spinal metastasis OR primary tumor/non-CNS metastasis 43 (88%) Both non-cord CNS/spinal metastasis AND primary tumor/non-CNS metastasis 15 (31%)
Jump to section
Related Articles
Cited By...
- [18F]FDG-PET Evaluation of Spinal Pathology in Patients in Oncology: Pearls and Pitfalls for the Neuroradiologist
- Combined intramedullary and intradural extramedullary spinal metastases in malignant melanoma
- Intramedullary Spinal Cord Metastases: Prognostic Value of MRI and Clinical Features from a 13-Year Institutional Case Series
- Clinical Reasoning: An unusual cause of transverse myelitis?
- Clinical Reasoning: An unusual cause of transverse myelitis?
- Intramedullary Spinal Cord Metastases: Visibility on PET and Correlation with MRI Features