Interactive Transcript
0:01
Let's start with our first case,
0:03
and this is a patient who had back pain.
0:06
These are the pulse sequences that I mentioned that we
0:09
typically perform as part of our routine
0:12
for evaluation of spinal lesions.
0:15
What you're seeing here is the sagittal T1-weighted
0:18
scan, the sagittal T2-weighted scan, and the STIR image.
0:22
And remember that the STIR image is the one that has
0:26
some application of a suppressor technique for the fat,
0:30
as opposed to the traditional T2-weighted scan,
0:33
and it gives you a wider range for the contrast.
0:37
In this examination,
0:38
we see that there is a mass at the
0:40
L4 level within the thecal sac.
0:43
This is nicely demonstrated on the T2-weighted scan,
0:47
in that we can actually see the edges of the dura here,
0:51
identifying this as an intradural lesion.
0:53
Then we make the distinction that this
0:55
is not within the spinal cord,
0:57
which ends up here at...
0:58
around the L1 level.
1:00
So, therefore, it's intradural but extramedullary.
1:03
We are in the lumbar region.
1:05
We are looking at a cystic lesion in the lumbar region.
1:09
Cystic lesion, lumbar region, intradural extramedullary,
1:12
far and away, we're going to say that this is most likely
1:15
going to be a Schwannoma.
1:17
However, we want to see the post-gadolinium enhanced
1:19
sequences to ensure that it will enhance.
1:23
Almost all Schwannomas will enhance except
1:26
for those that are completely cystic.
1:28
This one does have some solid portions that we would
1:31
expect would demonstrate contrast enhancement.
1:34
The additional sequences that we're going to look at
1:37
will be our T2-weighted axial scan and our sagittal
1:42
post-gadolinium enhanced scan and our axial post-gadolinium
1:46
enhanced scan. As we scroll through the images,
1:50
we come upon the lesion,
1:52
which again is demonstrated to be within the thecal sac,
1:56
showing both cystic, as well as solid portions.
1:59
Note that there are these bright areas on the T2-weighted scan,
2:03
which are usually going to be ascribed to
2:05
cystic portions. And then we have our darker area,
2:08
which is going to be more solid.
2:10
As we scroll through the T1-weighted
2:13
sequences, after gadolinium,
2:15
we see that this lesion does indeed show contrast
2:18
enhancement with a more solid posterior component
2:23
and with the more cystic areas above and below.
2:27
On the axial scans, we see, as we scroll toward the edges
2:32
of the lesion, the more cystic component you see above,
2:36
coming into the more solid component centrally.
2:39
And then as we go further inferiorly,
2:41
we come into the more cystic component.
2:44
So our summary of this case would be a solitary,
2:47
intradural, extramedullary, partially cystic,
2:50
partially solid mass,
2:52
most likely representing a Schwannoma.
2:56
I would probably not include anything else in
2:59
the differential diagnosis for this case.
© 2024 Medality. All Rights Reserved.