Leukemic infiltration of the spinal cord

Case contributed by Frank Gaillard
Diagnosis almost certain


Known long standing illness. Now rapidly evolving quadriplegia.

Patient Data

Age: Elderly
Gender: Male

Whole cord


The majority of the cord, particularly in the cervical region, is significantly expanded and of increased T2 signal. Following administration of contrast, it demonstrates heterogeneous and diffuse enhancement. 

Best seen on axial T2 images is marked cervical lymph node enlargement. The bone marrow is diffusely abnormally low in signal on T1 weighted images. 

This patient with known long standing previously diagnosed chronic lymphocytic leukemia (CLL) developed an extremely rare complication: extensive infiltration of the entire spinal cord. This was confirmed on CSF cytology demonstrating neoplastic cells. 

Annotated image

The bone marrow is diffusely low in signal (compare vertebral body (yellow square) to muscle (red square)) and there is marked lymph node enlargement ( * ). 

The cord, particularly in the cervical region (green arrows) but also in the upper two thirds of the thoracic region (orange arrows) is enlarged, with high T2 signal with some enhancement. 

Case Discussion

Although the appearance of the spinal cord itself is sometimes non-specific, there are often clues to the diagnosis in the periphery of the images, in this case bone marrow infiltration and lymphadenopathy. 

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