Male, 21 years old, with right upper extremity plegia. Evaluate C1-C5 intramedullary lesion. An expansile, heterogeneously T2 hyperintense lesion is present within the spinal cord. This lesion expands the cord such that it fills the spinal canal. The lesion appears to extend from the C1-C5 level and measures at least 68 mm in craniocaudal length and 17 x 12 mm in maximal transaxial dimension. Less intense tapering T2 signal abnormality extending superiorly and inferiorly from the lesion may represent edema.The internal texture of the lesion suggests areas of heterogeneous tissue potentially with some foci of liquefaction or cyst formation. On postcontrast images, faint rim enhancement is seen along the lesion's superior aspect. On gradient echo images, there is the suggestion of susceptibility effect at the inferior pole of the lesion which may represent a hemosiderin cap.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow signal or enhancement is seen. The intervertebral discs are preserved. No areas of extrinsic spinal canal or neuroforaminal encroachment are seen.
An expansile masslike lesion is evident within the cervical spinal cord. The core of the lesion appears to extend from C1 down to C5, with tapering signal abnormality above and below the lesion potentially representing edema.The differential diagnosis would include a primary tumor of the spinal cord. The imaging features of the lesion and the age of the patient favor ependymoma, though astrocytoma would still be in the differential diagnosis. An inflammatory or demyelinating process is considered unlikely. However, imaging of the brain and the remainder of the spine may provide additional information.