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Case Challenge: Spine MRI Cases


Spine MRI Case Challenge Pre-Course Activities
2 topics

5b - Answer: Cervical spine mass

David Yousem MBA, MD
David M Yousem, MBA, MD
Professor of Radiology, Vice Chairman and Associate Dean
Includes DICOM files

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Case Report

HISTORY: Cervical spine mass

PROCEDURE: Multiplanar, multisequence MR images of the cervical spine with and without intravenous contrast were submitted.

FINDINGS:

There is an extramedullary, intradural, dural-based, avidly enhancing mass centered along the left anterior aspect of the thecal sac at the C2-C3 level. The mass is relatively T2 hypointense and demonstrates what appears to be a thin dural tail coursing cranially, as seen for instance on slice 5 from series 10. The mass deforms the left ventral and lateral
spinal cord at this level without definite intramedullary signal changes. The mass approaches but does not appear to extend into the left C2-C3 neural foramen.

The patient is status post anterior C5-C6 fusion with vertebral body screws and plate as well as discectomy at the same level.

The visualized portions of the posterior fossa and cervicomedullary junction are unremarkable.

At C3-C4, there is mild uncovertebral hypertrophy and facet degenerative changes resulting in mild narrowing of the left neural foramen. The spinal canal and right neural foramen are patent.

At C4-C5, there are mild facet degenerative changes. The spinal canal and neural foramina are patent.

At C5-C6, there is a small residual or recurrent central disc protrusion as seen on slice 31 from series 8 and slice 24 from series 6. This results in mild narrowing of the spinal canal. There is encephalomalacia within the spinal cord bilaterally presumably as a result of prior compressive myelopathy.

At C6-C7, the spinal canal and neural foramina are patent.

At C7-T1, the spinal canal and neural foramina are patent.

The visualized structures of the neck are unremarkable.

There is trace mucosal thickening within the anterior-superior aspect of the right maxillary sinus as seen on the sagittal STIR sequences.

IMPRESSIONS:  

  1. Outside images submitted for second opinion consultation.
  2. Intradural, extramedullary, dural-based mass along the left anterior aspect of the spinal canal at the C2-C3 level, most suspicious for a meningioma. The mass indents and deforms the left ventral and lateral aspects of the spinal cord at this level without evident intramedullary signal changes.
  3. Postsurgical changes following C5-C6 anterior cervical spinal fusion and discectomy with a small residual or recurrent central disc protrusion mildly narrowing the spinal canal at this level. There is focal encephalomalacia at the same level presumably from prior compressive myelopathy.

LESSON 2, TOPIC 15

Case Challenge: Spine MRI Cases

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