Radiological manifestation of spinal cord tumor

Cho, O K; Park, C Y; Choi, B S; Oh, K K

Abstract

Since 60-85% of spinal cord tumors are benign and potentially curable when surgery was done beforeirreversible pressure changes have occurredin the cord and nerves, early diagnosis of spinal cord tumor is veryimportant. There are many radiological diagnostic methods such as plain film, myelogram and angiogram using eithercontrast media or radioisotope. High reliability of precise myelographic localization of spinal cord tumor hasbeen stressed by Camp (1934), and Traub (1972) said that myelogram can furnish the information not only about theexact tumor localization but the presence of other lesions such as disk or arachnoiditis and existence of multipletumors. DiChiro (1957) described angiographic findings of hemangioblastoma and that was the initial attempt ofangiography for the spinal cord tumor diagnosis. Previously they said that angiogram is not useful in spinal cordtumor except arteriovenous malformation, however Herdt et al (1972) reported angiographic criteria fordifferentiation of intra and extramedullary vascular tumor. This paper is a study of confirmed 108 cases of spinalcord tumor in respect to clinical features and pathologic findings. In this analysis, special attention was givento the 86 plain film and myelogram for differentiation of exact tumor localization in relation to spinal cord anddura. 5 cases of angiography was reviewed. The results are : 1. 69% of patients were in the fourth and fifthdecade and occured more frequently in the male. 2. Patient's chief complaint was pain with motor and sensorychange. Mean average duration of symptoms was 17 months. 3. 56 of 60 cases (93.3%) show spinal fluid protein levelabove 50mg%. Queckenstedt test was positive in 80% of patient with partial or complete obstruction. 4. Intraduralextramedullary tumors ae more frequent (50 cases, 46.3%) than extradural tumors (43 cases, 39.9%) and thoracicspine was the most frequently involved site (43.5%) 5. Benign tumors were 72 cases (66.7%) that is doubleincidence of malignant tumor. Most frequent tumor was neurofibroma (54 cases) that occurs at any site, howevermajorities intradural extramedullary tumor. Metastatic carcinoma was most common tumor of extramedullary lesion(30.2%) and astrocytoma (36.4%) at intradural lesion. 6. 38 of 86 cases (44.1%) show bone changes on plain filmsof spine and among them extradural tumor was 21cases. Most common findings of plain film change was pedicleerosion that noted on 28 cases (73.7%) 7. myelographic observationsin the extradural tumor show displacement ofthe opaque column from the inner aspect of the bony spinal canal (75.5%), and other useful sign was appearancetransverse serrated block (43.2%). Majority of intradural tumors caused displacement of the spinal cord (67.6%),clearly outlined concave defect (81%), and narrow distance from dye column pedicle (70.3%). Characteristicfindings of intramedullary tumor was fusiform enlargement spinal cord (75%) and streaks of contrast mediumdiverging upward laterally around the expensile mass. 8. 3 of 5 cases of angiogram were extradural arteriovenousmalformation that show abnormal tortuous hypertrophied vessel and i case was extradural metastatic Ca. withabnormal neovasculization.