Board Review 2 – Case 16

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows a mass within the spinal canal of the upper thoracic spine. For any spinal canal mass, your first step is to determine if it is:

• intramedullary (in the spinal cord)
• intradural extramedullary (inside the dura, but outside the spinal cord)
• extradural

This mass appears to be extramedullary but intradural. The main differential considerations are meningioma, nerve sheath tumor/schwannoma, or metastasis. This mass has a relatively benign appearance and enhances avidly and homogenously.

The diagnosis is: meningioma

Spinal meningiomas are extramedullary masses that share an imaging appearance with intracranial meningiomas. They are often homogenous and enhance avidly. They can have calcification. The treatment, if symptomatic, is surgical resection.

Board Review 2 – Case 15

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows a trauma patient who had a significant fall and now has lower extremity symptoms. On the MRI, there are a few compression fractures that you can see, but in addition there is T1 hyperintense fluid in the dorsal epidural space. In the setting of trauma, this is likely to be an epidural hematoma.

The diagnosis is: fracture with spinal epidural hematoma

Epidural hematoma is a dreaded complication of spine trauma that can cause worsening cord injury. It requires close monitoring and possibly surgical drainage if this may improve the symptoms. Look for intraspinal fluid collections after trauma, as they can be hard to identify.

Board Review 2 – Case 13

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows an aggressive lesion of the upper thoracic spine in a relatively young patient. It appears to be centered in the posterior elements of the upper thoracic spine. There is central osseous matrix formation as well as a surrounding soft tissue mass with adjacent bone destruction. This is causing significant narrowing of the spinal canal.

The diagnosis is: osteosarcoma

In this case, you know you are dealing with an aggressive mass because of the soft tissue component and bone destruction. The differential includes primary bone lesions, metastatic disease, and lymphoma, but because of the new bone formation (osteoid matrix), it suggests osteosarcoma.

Board Review 2 – Case 12

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows multiple images throughout the body, with initial emphasis on the lumbar spine, where there is destruction of a lumbar vertebral body and surrounding abscess and inflammatory changes of the adjacent disc. There is relative sparing of the lumbar discs.

There is also disease elsewhere in the body, including an osseous lesion in a left-sided rib, ground glass and tree-in-bud nodules in the lungs, and nodular enhancing lesions in the brain. This makes you think about some sort of systemic process.

The diagnosis is: spinal tuberculosis

Spinal tuberculosis is a serious disease which can cause a discitis-osteomyelitis. The classic teaching, although it may not be true, is that the disease will spare the intervertebral discs. Other things to consider in the differential are metastatic disease and other infections.