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Nonneoplastic Intramedullary Spinal Cord Lesions

In spite of the development of recent imaging technology, it is sometimes difficult to make a diagnosis of intramedullary spinal cord neoplasm. The purpose of this study is to investigate the differentiation of these lesions from nonneoplastic ones. Twelve patients with nonneoplastic intramedullary spinal cord lesions, excluding syringomyelia, who underwent surgery for either partial removal or biopsy were reviewed. Eight lesions were located in the cervical cord, 3 were in the thoracic cord, and 1 was in the thoracolumbar cord. Signs and symptoms were usually referable to the location of the cord lesions, which was not helpful in distinguishing them from intramedullary spinal cord neoplasms. On T1-weighted magnetic resonance imaging, most of signal intensities were iso- or low intense, whereas T2-weighted images showed high signal in all cases. The extent of enhancement with gadolinium (Gd)-DTPA varied from mildly homogeneous to irregular enhancement; however, all lesions showed an ill-defined boundary. Minimal or no spinal cord expansion in spite of the extent of the enhanced mass was the most consistent finding in most of the cases. The pathology of the surgical specimens demonstrated demyelinating lesions in 2 patients, granulomatous disease in 2 patients, vascular disease in 3 patients, inflammatory disease in 3 patients, and other conditions in 2 patients. Even with the advent of diagnostic techniques, it is still sometimes difficult to distinguish nonneoplastic intramedullary spinal cord lesions preoperatively from intramedullary spinal cord neoplasms.