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Partially cystic/solid lesion is identified at the T3 level. This lesion appears intradural extramedullary on the sagittal sequence (image seven series 13) but appears more intra-medullary on axials appearing to be centered posteriorly within the cord and eccentrically expands the cord at this level.
The lesion extends a vertical length 1 vertebral body height.
Central cystic component measures 1 cm.
The solid component more inferiorly demonstrates diffuse mild homogeneous enhancement. No blood product seen on T2. No flow voids.
Multifocal slightly T1 hyperintense to cord, mildly enhancing soft tissue nodules also extend along the entire length of cord in the subarachnoid space.
There is also diffuse mild leptomeningeal enhancement along the spinal cord. Vertebral bodies demonstrate normal signal and morphology. Visualized paravertebral soft tissue structures within normal limits.
Brain (not shown):
No focal parenchymal lesion is identified.Ventricular size is age-appropriate. There is a FLAIR hyperintense subtly enhancing soft tissue nodule abutting right superior colliculus and posterior thalamus at the right quadrigeminal plate cistern adjacent to the right side of the pineal gland which has a lobular contour measuring up to 8mm. Adjacent pineal gland is separate from this lesion and has a normal appearance. No mass lesion seen in the region of the suprasellar cistern and posterior cranial fossa abnormality. No abnormal meningeal enhancement. Vascular flow voids are preserved.
Appearance is that of "carcinomatous meningitis". If the T3 lesion is intramedullary, then an astrocytoma with a cystic component or syrinx with subarachnoid seeding is favoured over that of an ependymoma or haemangioblastoma. If the T3 lesion is intradural extramedullary, then metastasis from a non-intracerebral source (melanoma?) or lymphoma needs to be considered, although both usually demonstrate more vivid enhancement and a cystic component would be unusual unless it is loculated CSF. A non neoplastic cause such as spinal sarcoidosis is also a possibility.