Learning objectives
Differentiating solitary intramedullary lesions on MRI is difficult and poses a diagnostic challenge especially in delineating Ependymoma and Hemangioblastoma.1 This case report demonstrates intralesional arteriovenous shunting which has previously been described in Hemangioblastomas.1,2
Background
68yo female presented with symptomatic conus lesion. This was evaluated with CT/CTA/MRI/MRI+C/MRA preoperatively. Radiological findings favoured Myxopapillary Ependymoma because of its location with associated arteriovenous shunting. Final histology was consistent with Hemangioblastoma.
Imaging findings OR Procedure details
The MRI showed a 3.6cm heterogeneously enhancing intramedullary conus mass lesion with intratumoural T2WI-hyperintense cyst. [Fig 1] [Fig 2] [Fig 3] No cord signal change, syrinx/syringomyelia or hemosiderin deposition were seen. [Fig 4] CTA and MRA showed predominant feeders from lumbar arteries and a prominent draining vein. [Fig 5] There was no calcification on CT.
Intramedullary tumours
60% of spinal cord tumours (SCT) in adults are Ependymomas.1 Myxopapillary Ependymoma (ME) is a subtype of Ependymoma that exhibits a certain predilection for conus medullaris, filum-terminale and...
Conclusion
Spinal Ependymomas and Hemangioblastomas may be indistinguishable on MRI. Presence of prominent vessels can only pose further diagnostic challenge to exclude DAVF but enhancing mass with vasculature and lack of cord edema should favour Hemangioblastoma.
References
Ross JS, Moore KR. Diagnostic Imaging: Spine. 4th Philadelphia: Elsevier; 2020.
Wong GK, Zhu XL, Ng HK, Mak H, Yu SC, Wong JK, Poon WS. Hemangioblastoma of filum terminale associated with arteriovenous shunting. Surg Neurol. 2007 Aug; 68(2):211-214
Healy V, O'Halloran PJ, Husien MB, Bolger C, Farrell M. Intermixed arteriovenous malformation and hemangioblastoma: case report and literature review. CNS Oncol. 2020 Dec 1; 9(4):CNS66
Eun NL, Ahn SJ, Chung TS, Cho YE, Kim KS, Kuh SU, Suh SH. Intramedullary Spinal Lesions Involving the Conus Medullaris:...