What spinal abnormalities include mature fatty tissue?
Mature fatty tissue within the spinal dura can be seen in a number of entities: lipomyelomeningocele (most common), lipoma of the filum terminale (most common incidental finding), intradural lipoma.
What is the treatment for these lesions?
Asymptomatic lesions can be safely ignored. If symptomatic the treatment of choice is surgical resection. As lipomas adhere closely to the adjacent spinal parenchyma, they generally cannot be entirely resected and the aim of surgery is decompression. Because these lesions are typically very slow growing, a very satisfactory and long-lasting clinical effect may be obtained after achieving a subtotal excision.
A spindle shaped intradural extramedullary mass (yellow arrows) is located posterior to the cord. The mass follows fat on all sequences, including T2 STIR and T1 fat saturated sequences (orange arrows) confirming it is made of fat. On sagittal T2 images a prominent chemical shift artefact is also visible (white line behind the mass (green arrow), black line infront of the mass (blue arrow)).
Bone marrow oedema is seen involving T5 and T8 (red arrows).