Interactive Transcript
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I did want to compare and contrast two different
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entities, the lipoma of the filum terminale
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and the fatty infiltration of the filum.
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The fatty infiltration of the filum is considered a
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normal variant and is usually not symptomatic and is
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not associated with tethering of the spinal cord.
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Lipomas of the filum,
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or the conus medullaris are often associated
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with tethering of the spinal cord.
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So, let me show the difference here.
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These are both children.
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This is the first case where we have a patient
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who has a lipoma, which is associated with
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the termination of the spinal cord
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here at the L3 level,
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the cord is a little bit low.
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This is a mass, and as you can see,
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there is some bulk to this lesion associated
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with the of the conus medullaris.
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So, low conus ending here at about L3,
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and a bulky lesion in the thecal sac.
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Let's compare that with the fatty infiltration
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of the filum case, which is seen here.
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So here we have...
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the abnormality is, again, at the L3 level.
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However,
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we note that the cord has ended at the
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appropriate T12-L1 level.
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So, this is in a lower location without
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tethering of the spinal cord.
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And although it's bright in signal intensity,
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it is small in size.
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And this is what we would use the term
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fatty infiltration of the filum.
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Why are we using that term?
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So, the difference is that someone hears lipoma,
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they think, oh,
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I've got a fatty tumor of the spinal cord or of
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the filum, and are more worried about it,
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and it's associated with tethering.
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By saying the term fatty infiltration of the filum,
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we're essentially calling it a normal variant.
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Both of these are going to show suppression
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on the STIR imaging,
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and you would see it as the darker signal intensity,
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whether it's the infiltration of the filum,
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or in the example of a patient who has a lipoma,
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which also, because of the fat, will
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suppress on the STIR imaging.
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So two different cases, a lipoma at the conus
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medullaris and filum with associated low spinal
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cord or tethering, versus the kind of normal
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variation of fatty infiltration of the filum.
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