MRI
Sagittal T2
Sagittal STIR
Sagittal T1
Sagittal T1 C+
Axial T2
Axial T1
Axial T1 C+
What is the differential?
Ependymoma or haemangioblastoma are most likely. Astrocytoma including pilocytic astrocytoma should be considered. Cord metastasis is unlikely as they are rare, especially in young patients.
What finding dorsal to the lesion is helpful in suggesting a haemangioblastoma over an ependymoma as the most likely histology?
Posterior to the lesion a number of serpentine flow voids are noted, typical of haemangioblastomas but unusual in ependymomas.
An enhancing nodule is present within the cord at the level of C5 with adjacent peritumoural cysts and extensive cord oedema. Posterior to the lesion a number of serpentine flow voids are noted. The mass has evidence of blood products (previous haemorrhage) and vivid enhancement.