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Review
. 2024 Feb 29;16(5):1004.
doi: 10.3390/cancers16051004.

It Looks Like a Spinal Cord Tumor but It Is Not

Julien Fournel  1 , Marc Hermier  1 , Anna Martin  1 , Delphine Gamondès  1 , Emanuele Tommasino  1 , Théo Broussolle  2 , Alexis Morgado  2 , Wassim Baassiri  2 , Francois Cotton  3   4 , Yves Berthezène  1   3 , Alexandre Bani-Sadr  1   3
Affiliations
Review

It Looks Like a Spinal Cord Tumor but It Is Not

Julien Fournel et al. Cancers (Basel). .

Abstract

Differentiating neoplastic from non-neoplastic spinal cord pathologies may be challenging due to overlapping clinical and radiological features. Spinal cord tumors, which comprise only 2-4% of central nervous system tumors, are rarer than non-tumoral myelopathies of inflammatory, vascular, or infectious origins. The risk of neurological deterioration and the high rate of false negatives or misdiagnoses associated with spinal cord biopsies require a cautious approach. Facing a spinal cord lesion, prioritizing more common non-surgical myelopathies in differential diagnoses is essential. A comprehensive radiological diagnostic approach is mandatory to identify spinal cord tumor mimics. The diagnostic process involves a multi-step approach: detecting lesions primarily using MRI techniques, precise localization of lesions, assessing lesion signal intensity characteristics, and searching for potentially associated anomalies at spinal cord and cerebral MRI. This review aims to delineate the radiological diagnostic approach for spinal cord lesions that may mimic tumors and briefly highlight the primary pathologies behind these lesions.

Keywords: inflammatory pseudotumor; magnetic resonance imaging; myelopathy; neoplasms; spinal cord.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Multiple sclerosis myelitis. (A) Sagittal T2-weighted MRI of the cervical spine. (B) Sagittal post-contrast T1-weighted MRI of the cervical spine. (C) Axial T2-weighted MRI of the cervical spine. (D) Fluid-attenuated inversion recovery-weighted MRI of the brain. The figure illustrates multiple short intramedullary myelitis (A), including one lesion showing enhancement (B) and selectively affecting the right lateral cord (C). Brain MRI (D) reveals multiple short and ovoid associated lesions in the periventricular and subcortical regions. The imaging data meet the criteria for temporal and spatial dissemination of multiple sclerosis.
Figure 2
Figure 2
Neuromyelitis optica spectrum disorder positive for aquaporin-4 antibody myelitis. (A) Sagittal T2-weighted MRI of the cervical spine. (B) Sagittal post-contrast T1-weighted MRI post-injection of the cervical spine. (C) Axial T2-weighted MRI of the cervical spine. (D–F) Fluid-attenuated inversion recovery-weighted MRI of the brain. This figure depicts longitudinally extensive myelitis (A) with leptomeningeal enhancement (B). Axial images reveal extensive transverse involvement of both white and gray matter with T2 signal lesions as intense as cerebrospinal fluid (bright spotty lesions) (C). Brain MRI shows involvement of the area postrema and the optic chiasm (D–F).
Figure 3
Figure 3
Myelin-oligodendrocyte glycoprotein associated disorder myelitis. (A) Sagittal T2-weighted MRI of the thoraco-lumbar spine. (B) Sagittal T1-weighted MRI of the thoraco-lumbar spine. (C) Sagittal post-contrast T1-weighted MRI of the thoraco-lumbar spine. (D) T2-weighted MRI of the thoraco-lumbar spine in sagittal sections. This figure illustrates a longitudinally extensive myelitis of the conus medullaris (A), without enhancement (B,C). On axial images, a transverse myelitis affecting both white and grey matter and a pseudodilatation of the ependymal canal are observed (D).
Figure 4
Figure 4
Neurosarcoidosis myelitis. (A) Sagittal T2-weighted MRI of the cervical spine. (B) Sagittal T1-weighted MRI post-injection of the cervical spine. (C) Axial post-contrast T1-weighted MRI of the cervical spine. This figure shows a longitudinally extensive cervical myelitis (A) with dorsal enhancement and leptomeningeal enhancement (B). The axial images (C) demonstrate enhancement of lesions in the posterior subpial white matter.
Figure 5
Figure 5
Acute demyelinating encephalomyelitis. (A) Sagittal T2-weighted MRI of the spine. (B) Sagittal post-contrast T1-weighted MRI of the spine. (C,D) Fluid-attenuated inversion recovery-weighted MRI of the brain. This figure illustrates multiple short myelitis at the level of the cervical and thoracic spinal cord (A), of similar age (not enhanced) (B) associated with demyelinating-like lesions of the posterior cranial fossa and periventricular regions (C,D).
Figure 6
Figure 6
Neuro-Behçet’s myelitis. (A) Sagittal T2-weighted MRI of the thoraco-lumbar spine. (B) Sagittal T1-weighted MRI of the thoraco-lumbar spine. (C) Sagittal post-contrast T1-weighted MRI of the thoraco-lumbar spine. This figure illustrates a myelitis of the conus medullaris (A), characterized by ring enhancement and leptomeningeal enhancement (B,C).
Figure 7
Figure 7
Degenerative compressive myelopathy. (A) Sagittal T2-weighted MRI of the cervical spine. (B) Sagittal T1-weighted MRI post-injection of the cervical spine. (C) Sagittal T2-weighted MRI of the cervical spine in axial sections. This figure illustrates a short myelitis centered on a posterior disc herniation at the level of C5–C6 (A) with linear “pancake-like” enhancement at the site of the maximum canal stenosis (B). Axial images (C) show lesions predominantly affecting gray matter resulting in an H-shaped appearance.
Figure 8
Figure 8
Subacute spinal cord infarction. (A) Sagittal T2-weighted MRI of the cervical spine. (B) Sagittal T2-weighted MRI of the cervical spine. This figure depicts two spinal cord lesions (one cervical and one thoracic) that are edematous and slightly swollen (A), predominantly affecting the gray matter (B).
Figure 9
Figure 9
Acute spinal cord infarction. (A) Sagittal T2-weighted MRI of the cervical spine. (B) Sagittal diffusion-weighted MRI of the cervical spine. (C) Sagittal apparent diffusion coefficient map of the cervical spine. (D) Axial T2-weighted MRI of the cervical spine. This figure displays a cervical spinal cord lesion (A), exhibiting cytotoxic edema (B,C) and predominantly affecting the gray matter of the left hemicord (D).
Figure 10
Figure 10
Spinal dural arteriovenous fistula. (A) Sagittal T2-weighted MRI of the thoraco-lumbar spine. (B) Sagittal post-contrast T1-weighted MRI of the thoraco-lumbar spine. This figure illustrates a longitudinally extensive and swollen edematous lesion of the conus medullaris (A) associated with tortuous and dilated perimedullary vessels (A).
Figure 11
Figure 11
Spinal cavernous malformation. (A) Sagittal T1-weighted MRI of the cervical spine. (B,C) Sagittal T2-weighted MRI of the cervical spinal. (C) Axial gradient-recalled echo T2*-weighted imaging of the cervical spine. This figure depicts a moderately swollen, well-defined oval intramedullary lesion with multiple compartments showing variable T1 and T2 signal intensities, resembling a mulberry appearance (A,B), surrounded by a peripheral hemosiderin rim (C). The axial images reveal a blooming artifact on the magnetic susceptibility sequence (D).
Figure 12
Figure 12
Chronic hematomyelia. (A) Sagittal T1-weighted MRI of the cervical spine. (B) Sagittal T2-weighted MRI of the cervical spinal. (C) Axial T2-weighted MRI of the cervical spinal. This figure displays an intramedullary lesion moderately expanding the spinal cord, appearing isointense on T1-weighted images (A) and centrally hyperintense on T2-weighted images (B), surrounded by a peripheral ring of hyperintensity on T1 and hypointensity on T2 (C).
Figure 13
Figure 13
Bacterial Myelitis. (A) Sagittal T1-weighted MRI of the cervical spine. (B) Sagittal fat-saturated T2-weighted MRI of the cervical spine. (C) Sagittal post-contrast T1-weighted MRI of the cervical spinal. (D) Axial T2-weighted MRI of the cervical spine. (E) Axial diffusion-weighted MRI of the brain. (F) Axial apparent diffusion coefficient map of the brain. (G) Axial fluid-attenuated inversion recovery-weighted MRI of the brain. (H) Axial post-contrast T1-weighted MRI of the brain. This figure illustrates a moderately swollen, longitudinally extensive cervical myelitis (A,B) with a lesion showing annular enhancement suggestive of an ongoing collection (C). Axial images reveal involvement of both white and grey matter (D). Cerebral MRI reveals a left frontal lesion with purulent content (E,F), surrounded by a vasogenic edema zone (G), and exhibiting annular enhancement (H), indicating an intracerebral abscess.
Figure 14
Figure 14
Spinal schistosomiasis. (A) Sagittal T2-weighted MRI of the thoraco-lumbar spine. (B) Sagittal post-contrast T1-weighted MRI of the thoraco-lumbar spine. This figure depicts a longitudinally extensive myelitis of the conus medullaris (A) with patchy and confluent enhancement (B).
Figure 15
Figure 15
Subacute combined degeneration of the spinal cord. (A) Sagittal T2-weighted MRI of the cervical spine. (B) Sagittal post-contrast T1-weighted MRI of the cervical spine. (C) Axial T2-weighted MRI of the cervical spine. This figure depicts a longitudinally extensive cervical myelitis (A) with mild enhancement (B) and predominantly involving dorsal columns (C).
Figure 16
Figure 16
Intra-medullary lipoma. (A) Sagittal T1-weighted MRI of the thoraco-lumbar spine. (B) Sagittal T2-weighted MRI of the thoraco-lumbar spine. (C) Sagittal fat-saturated T1-weighted MRI of the thoraco-lumbar in sagittal section. This figure illustrates an intramedullary lesion, a well-defined lesion exhibiting a fatty signal (A–C).
Figure 17
Figure 17
Intra-medullary dermoid cyst. (A) Sagittal T1-weighted MRI of the thoraco-lumbar spine. (B) Sagittal T2-weighted MRI of the thoraco-lumbar spine. (C) Sagittal fat-saturated T1-weighted MRI of the thoraco-lumbar spine. (D) Sagittal post-contrast T1-weighted MRI of the thoraco-lumbar spine. This figure shows an intramedullary lesion in the conus region with a cystic appearance containing mixed contents, including a fatty component (A–C). Note the presence of punctate T1 (A) and T2 (B) hyperintense signals around the spinal cord, indicating a ruptured dermoid cyst.
Figure 18
Figure 18
This figure summarizes the main diagnostic ranges to consider when faced with a medullary pseudotumor.
See this image and copyright information in PMC

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