Astrocytoma, upper spinal cord
Findings:
Multiple MR images demonstrate postoperative findings of multilevel upper cervical laminectomy. An expansile lesion involves the upper cervical cord extending to the mid C3 level, associated with heterogeneous internal enhancement.
Differential Diagnosis:
Astrocytoma, Ependymoma, Hemangioblastoma, metastasis
Discussion:
Some overlap exists between the imaging appearance of spinal cord astrocytoma and ependymoma, and the absence of enhancement should suggest an alternate diagnosis even if the syrinx is otherwise very complex. Nonenhancing spinal cord astrocytoma is rare, but may occur in the lower brainstem and upper cord. Astrocytoma is typically an infiltrating expansile enhancing lesion involving 4 or less segments of the cord. It is the most common intramedullary tumor in children and young adults, but ependymoma is more common in older adults. Most tumors are slow growing and the prognosis depends on the histologic grade and ability to resect the lesion. Preoperative deficits generally dictate the expected postoperative function. There is no evidence that XRT/chemo improves outcome. Ependymomas and helpful distinguishers are discussed in the ependymoma cases on this site.