Female, 49 years old, with pure sensory syndrome. Evaluate for cord mass. Thoracic:Alignment is anatomic. Vertebral body height and morphology are within normal limits. Signal related to a benign hemangioma or focal fat is seen in the T3 vertebral body. Otherwise, vertebral body signal characteristics are within normal limits. The visualized spinal cord shows normal signal intensity and morphology throughout. However, prominent vascularity is seen along the surface of the conus and there is enhancement of the cauda equina nerve roots. A small central disc protrusion is present at T8-9 but this causes no significant spinal canal or foraminal compromise. Elsewhere, the intervertebral discs are preserved.Lumbar:As above, the nerve roots of the cauda equina demonstrate diffuse subtle enhancement. They do not appear to be thickened or clumped. No epidural abnormalities are suspected. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No areas of pathologic marrow replacement are seen. Minimal disc bulging is present at L4-5 and L5-S1. No significant spinal canal or foraminal compromise is detected.
Diffuse enhancement of the cauda equina nerve roots is seen. The differential diagnosis is broad and would include infectious or postinfectious/autoimmune phenomenon, as well as nonimmune demyelinating syndromes. Certain collagen vascular disorders such as lupus can also produce similar findings. Although leptomeningeal metastatic disease would technically be in the differential as well, this is considered less likely, particularly if there is no known primary cancer history.