caso clínicos de pacientes com patologia. Identificar a patologia através da visualização das imagens radiológicas.

1. Case 10.1: A young adult with neck pain, numbness, and a weak right arm.
10.1 A
Precontrast sagittal T1 wtd.
MRI of the cervical spine
10.1 B
Post contrast (C+) sagittal T1
wtd. MRI
10.1 C
Sagittal T2 wtd. MRI
10.1 D
Axial T1 wtd. MRI (C+)
DIAGNOSIS
PLEASE …

2. Case 10.2: A middle-aged male with gradual weakness of both arms.
10.2 A
Post contrast (C+)
sagittal T1 wtd. MRI
10.2 C
Axial T1 wtd. MRI (C+)
10.2 B
Sagittal T2 wtd. MR
image of the C-spine
DIAGNOSIS
PLEASE …

3. Name 2 common
intramedullary
tumors involving the
spinal cord.
A. ? B. ?

4. Name 2 common
intramedullary
tumors involving the
spinal cord.
A. Astrocytoma B. Ependymoma

5. Case 10.3: A 50-year-old patient with renal cell carcinoma with back pain and leg
weakness.
10.3 A
Sagittal T1
wtd. MRI
of the lumbar spine
10.3 B
Post contrast (C+)
sagittal T1
wtd. MRI
10.3 C
Sagittal T2
wtd. MRI
DIAGNOSIS
PLEASE …
10.3 D
Axial T1
wtd. MRI (C+)

6. Case 10.4: A 55-year-old lady with gradual lower extremity weakness.
10.4 A
Post contrast (Ct)
sagittal T1 wtd. MRI
DIAGNOSIS
PLEASE …
10.4 B
Sagittal T2 wtd. MRI
of thoracic spine
10.4 C
Precontrast sagittal
T1 wtd. MRI
10.4 D
Axial CT image of
the thoracic spine

7. Case 10.5: A 24-year-old male with neck pain and right arm weakness.
10.5 A
Precontrast sagittal
T1
wtd. MRI of C-
spine
DIAGNOSIS
PLEASE …
10.5 B
Post contrast (C+)
sagittal T1
wtd. MRI
10.5 C
Precontrast axial T1
wtd. MRI
10.5 D
Axial T1
wtd. MRI
(C+)

8. Name 2 common
intradural tumors within
the spinal canal:
A. ?
B. ?

9. Name 2 common
intradural tumors within
the spinal canal:
A. Nerve sheath tumors
(schwannoma, neurofibroma)
B. Meningioma

10. Case 10.6: A 42-year-old patient, developed acute bilateral paraparesis
following placement of an epidural catheter for drug delivery to relive
constant severe back pain.
10.6 A
Post contrast sagittal T1
wtd. MRI of
the thoracic spine
DIAGNOSIS
PLEASE …
10.6 B
Post contrast Axial
T1
wtd. MRI

11. Case 10.7: A 68 yr. Old male with renal cell carcinoma with progressive difficulty in
walking and weakness involving both legs.
10.7 A
Pre-contrast sagittal T1
wtd.
MRI of the thoracic spine
DIAGNOSIS
PLEASE …
10.7 B
Sagittal T2
wtd. MRI
10.7 C
Post contrast sagittal T1
wtd.
MRI
10.7 D
Pre contrast axial T1
wtd. MRI

12. Answers

13. Case 10.1: A young adult with neck pain, numbness, and a weak right arm.
A. B. C.
D.
Findings: : An inhomogeneously enhancing tumor (red arrow in B) is seen
within the upper cervical cord. Large cysts (C) are seen both above and
below the tumor, best seen on T2 wtd. image C. Eccentric location of the
tumor, more to the right of the cervical cord (yellow arrow) is shown on axial
image D.
Diagnosis: Astrocytoma
C
C

14. Astrocytoma of the Spinal Cord
Incidence: Common intramedullary tumor particularly in children
and young adults.
Pathology: Usually low grade
MRI Findings:
• Eccentric location of tumor within the spinal cord
• Multisegmental involvement
• Variable degree of tumoral enhancement
• Cysts are common
• Hemorrhage is rare
Treatment:
• Complete resection of tumor is not possible due to infiltrative
nature.
Radiation therapy is also used for recurrence or growing tumors.

15. Case 10.2: A middle-aged male with gradual weakness of both arms.
10.2 A
Post contrast
(C+) sagittal T1
wtd. MRI
10.2 C
Axial T1 wtd. MRI (C+)
10.2 B
Sagittal T2 wtd.
MR image of
the C-spine
Findings: : A sausage-shaped intensely enhancing tumor (yellow arrow in
A) is seen within the upper cervical cord extending from just above the
cranio-cervical junction with involvement of the dorsal medulla (black arrow
in A) down to C5
level. Small amount of old blood is better seen on T2
wtd.
image as an area of dark signal intensity within the tip of the tumor (white
arrow in B). Central location of tumor (yellow arrows in C) is better
appreciated on axial post contrast image.
Diagnosis: Ependymoma

16. Ependymoma of the Spinal Cord
Incidence: Common intramedullary tumor in adults
Pathology: Cellular tumors that originate from ependymal cells lining the
central canal.
Clinical Symptoms: Nuchal pain/radicular pain, Paresthesia, Motor
weakness
MRI Findings: Moderate to markedly enhancing tumor, Blood products
from hemorrhage within the tumor is common, Tumor can also contain
intrinsic cysts.
Treatment: Surgery. Ependymoma have a well-defined cleavage plane
between the tumor and adjacent spinal cord. Thus, the tumor can be
completely resected with modern neurosurgical techniques with relief of
clinical symptomatology. Recurrence is rare following complete resection.

17. Case 10.3: A 50-year-old patient with renal cell carcinoma with back pain and leg
weakness.
10.3 A
Sagittal T1
wtd. MRI
of the lumbar spine
10.3 B
Post contrast (C+)
sagittal T1
wtd. MRI
10.3 C
Sagittal T2
wtd. MRI
10.3 D
Axial T1
wtd. MRI (C+)
Findings: : Bony metastasis (yellow arrow in A, B, C) is seen involving the
T12
vertebral body. Intramedullary location of metastasis within the distal
thoracic cord, is verified on post contrast sagittal image (red arrow in B) and
axial image (red arrow in D). Edema (green arrow in C) within the thoracic
cord is best shown on T2
wtd. image C.
Diagnosis: Bony Metastasis and metastasis to the Spinal Cord

18. Metastasis to the Spinal Cord
Incidence: Rare
Primary Sites:
•Lung
•Breast
•Melanoma
•Kidney
•Lymphoma/Leukemia
Intracerebral Tumors:
•Medulloblastoma
•Ependymoma
•Glioblastoma
•Germ Cell Tumor
Route of Spread: Arterial seeding, Batson’s venous plexus, Drop
metastasis (from intracerebral tumor)

19. Case 10.4: A 55-year-old lady with gradual lower extremity weakness.
10.4 A
Post contrast (C+)
sagittal T1 wtd. MRI
10.4 B
Sagittal T2 wtd. MRI
of thoracic spine
10.4 C
Precontrast sagittal
T1 wtd. MRI
10.4 D
Axial CT image of
the thoracic spine
Findings: : An intradural enhancing meningioma (arrow in A), the ventrally
located tumor has produced cord compression and with displacement of the
thoracic cord (red arrow in D) to the right side. Calcified nature of the tumor
is identified on sagittal T2
wtd. image as an area of dark signal intensity
(yellow arrow in B) and confirmed by CT imaging (yellow arrow in D) as an
area of high attenuation density.
Diagnosis: Classic example of calcified intradural meningioma

20. Intraspinal Meningioma
Incidence:
• Second common intradural tumor
• Middle-aged females (80%)
• Thoracic spine (80%), cervical spine (15%)
MRI Findings:
• Intensely enhancing intradural tumor
• Calcification, when seen, clinches the diagnosis
Treatment:
• Surgery

21. Case 10.5: A 24-year-old male with neck pain and right arm weakness.
10.5 A
Precontrast sagittal
T1
wtd. MRI of
C.spine
10.5 B
Post contrast (C+)
sagittal T1
wtd. MRI
10.5 C
Precontrast axial T1
wtd. MRI
10.5 D
Axial T1
wtd. MRI
(C+)
Findings: An enhancing intradural nerve sheath tumor (Schwannoma) is
shown (red arrow in B and D). Dumbbell shape of tumor with intraspinal
component (red arrow in D) producing cord compression (yellow arrow in D)
and paraspinal tumor extension through an enlarged neural foramen (green
arrow in C & D) following the exiting nerve root is best shown on axial post
contrast image D.
Diagnosis: Schwannoma arising from the spinal nerve root

22. Intraspinal Nerve Sheath Tumors
Incidence: Most common intradural tumor
• Solitary nerve sheath tumor is usually Schwannoma and commonly
seen in adults.
• Multiple nerve sheath tumors are usually neurofibromas and
commonly seen in the pediatric age group with neurofibromatosis
MRI Findings:
• Dumbbell shaped enhancing intradural tumor with paraspinal
extension through enlarged neural foramen is a characteristic feature of
nerve sheath tumor.
• Can cause cord compression.
Treatment: Surgrey

23. Case 10.6: A 42-year-old patient, developed acute bilateral paraparesis following
placement of an epidural catheter for drug delivery to relive constant severe back pain.
10.6 A
Post contrast sagittal T1
wtd. MRI of
the thoracic spine
10.6 B
Post contrast Axial
T1
wtd. MRI
Findings: The central portion of the midthoracic cord is compressed and
displaced anteriorly (red arrows in A outline the thoracic cord both above
and below the level of cord compression) by an epidural abscess (yellow
arrows in A, B). The capsule of the abscess enhances intensely with central
low signal intensity produced by pus. Figure B demonstrates ventrally
displaced thoracic cord (red arrow) by dorsally located epidural abscess
(yellow arrows).
Diagnosis: Epidural abscess
Treatment: Surgical drainage and antibiotics.

24. Case 10.7: A 68 yr. Old male with renal cell carcinoma with progressive difficulty in
walking and weakness involving both legs.
10.7 A
Pre-contrast
sagittal T1
wtd. MRI
of the thoracic
spine
10.7 B
Sagittal T2
wtd.
MRI
10.7 C
Post contrast sagittal
T1
wtd. MRI
10.7 D
Pre contrast axial T1
wtd. MRI
Findings: Bony metastasis involving the T8 vertebral body, right
pedicle/transverse process and spinous process (arrow in A,B,C,D) with
epidural tumor producing marked degree of cord compression (red arrow).
Diagnosis: Bony metastasis from renal cell carcinoma with epidural tumor
producing cord compression