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Lipoma vs. Fatty Infiltration of the Filum

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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.

Report

Description

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Spine

Pediatrics

Neuroradiology

Musculoskeletal (MSK)

MRI

Congenital

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