intradural spinal tumors

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1、MehulBhatt,HMSIIIGillianLieberman,M.D.BIDMCDepartmentofRadiologyAugust24,2009°OurPatient°SpinalAnatomy°DifferentialDiagnosis°MenuofTests°IntraduralSpinalTumors°Summary21.Learnthegeneralanatomyofthespine2.Learntheclinicalpresentationanddifferentialdiagnosisofspinallesions3.Understandther

2、adiologicalteststousetoevaluatespinallesions4.Developanunderstandingofthedifferenttypesofintraduralspinallesionsandtheirradiologicalpresentations3°Ms.Sisa57yearoldwomanwhopresentedtoherprimarycarephysiciancomplainingofepisodicleftlowerbackpainradiatingtoherleftgroin.Thepainhadbeenincrea

3、singinseverityforthepastfewmonths°PMH/PSH:Unremarkable°PhysicalExamwaspositiveforleftflankpain°Urineanalysiswasunremarkable4°31pairsofspinalnerves▪8Cervical▪12Thoracic▪5Lumbar▪5Sacral▪1Coccygeal°ConusMedullarisatL1,L2Imageadaptedfromfrom:AndrewL.Chen,MD;http://www.nlm.nih.gov/MEDLINEPLU

4、S/ency/imagepages/1116.htm5AxialCTLumbarVertebraLumbarVertebraTrabecularBoneCortexPedicleTransverseProcessImageadaptedfrom:ShelerudR.AtlasofPACSBIDMCRheumatology.EditedbyGeneHunder,GeneG.SpinousHunder.©2005CurrentMedicineGroupLLCProcess6SpinalCordVentralRootNervoussystemcelltypes:•Neuro

5、nalCells•Astrocytes(CNS)DorsalRoot•Oligodendrocytes(CNS)•Schwanncells(PNS)•Ependymalcells(CNS)Imageadaptedfrom:M.Headwouth,MayfieldClinic;http://www.mayfieldclinic.com/Images/PE-AnatSpine_Figure8.jpg7CSFislocatedinsubarachnoidspacePiaMaterArachnoidMaterDuraMaterImageadaptedfrom:M.Headwo

6、uth,MayfieldClinic;http://www.mayfieldclinic.com/Images/PE-AnatSpine_Figure8.jpg8L1,L2area•Dermatomesspecifythespinallevelsupplyingthesensorynerveforeachareaoftheskin.•Ms.SseemedtobeaffectedalongtheL1,L2dermatomeNetter’sAnatomy,4thEd.9www.netteranatomy.com1.Renal:4.Infectious▪KidneySton

7、econditions:▪Viral,bacterial,2.Degenerativeorparasitic▪Abscessconditions:▪Tuberculosis▪Discherniation5.Vascular3.Inflammatoryconditions:conditions:▪Guillain–Barré▪CordInfarction▪MultipleSclerosis▪TransverseMyelitis6.Neoplasms:▪Sarcoidosis▪SpinalTumors101.Renal:4.InfectiousNotli