0:00

This was a 27-year-old who had acute onset

0:06

of neck pain after weightlifting.

0:11

On the T1-weighted scan,

0:14

we don't see very much at all.

0:17

However, on T2-weighted imaging,

0:20

we see an area of dark signal intensity within the

0:23

spinal cord with a small area

0:25

of bright signal intensity.

0:27

This lesion does not show any cord edema,

0:29

and if anything,

0:30

the cord caliber is small at

0:34

the level of the lesion.

0:35

So let's just really magnify this up so that

0:38

way we can see it to best advantage.

0:41

It looks like there's a little peripheral

0:43

area of bright signal intensity,

0:45

but mostly what we're seeing is dark signal in the

0:48

spinal cord, which represents hemosiderin.

0:50

And this is verified on the STIR image as well,

0:54

where we see that prominent dark signal

0:59

intensity of hemosiderin.

1:00

Now, I might be able to convince you that there is a

1:03

little low signal intensity all the way around the

1:05

periphery of this lesion, which is eccentric.

1:08

The key here in looking and identifying and

1:11

verifying that this represents hemosiderin,

1:14

which is a superparamagnetic substance,

1:17

is to compare the signal intensity on the fast

1:20

spin echo with the signal intensity on the

1:23

gradient echo. On the fast spin echo,

1:28

we would expect the blood products to be this

1:31

prominent, whereas on the gradient echo,

1:34

there should be some blooming.

1:36

So a nice gradient echo scan showing the

1:39

central gray matter of the spinal cord,

1:42

the posterior columns,

1:43

the lateral spinothalamic tract,

1:46

lateral corticospinal tract,

1:47

and the anterior corticospinal track.

1:50

So as we scroll down to the lesion,

1:54

we notice the dark signal intensity

1:57

both on the fast spin echo,

1:59

as well as nicely demonstrated

2:01

on the gradient echo.

2:03

And this peripheral area of methemoglobin is

2:09

not so bright on the gradient echo scan,

2:13

which is secondary to the presence of

2:16

superimposed hemosiderin, as well.

2:19

The cord is not expanded by the lesion.

2:22

So, this was an example of a cavernoma.

2:24

And on the post-contrast scan, as I've mentioned,

2:29

the cavernoma enhancement is either going

2:31

to be very faint or not at all.

2:34

Let's see whether we can get in line here.

2:37

So, very faint or not at all in the lesion.

2:42

So, spinal cord cavernoma,

2:44

the most common of the vascular malformations

2:47

of the spinal cord.