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Spine and Back Health

MRI findings

11/05/2008

Question:

MRI last week: findngs: 1 cm extradural common intramedullary mass in the right side of the thecal sac at the inferior L1 level. Differential diagnosis includes meningioma, schwannoma/neurofibroma, and metastatic diseases including CNS drop nets. Low grade enhancement is also present on the surface of the conus medullaris and visualized inferior thoracic cord. Grade I spondylolisthesis at L2-L3 with approximately 3 mm of postetior translocation of L2 compared to L3

Within the right lateral aspect of the thecal sac at the inferior L1 level is an ovoid approximately 1 cm extramedullary intradural mass. This is hypointense on T1 sequences, slightly higher in signal intensity than CSF. STIR sequences demonstrate signal intensity slightly higher than that of CSF. Postgadolinium images demonstrate low grade diffuse pathologic contrast enhancement slightly greater around the rim of the mass. THe right sided intrathecal nerve roots at this level are displaced medially. Differential diagnosis includesmenigioma, schwannoma/neurofibroma, and metastatic disease including CNS drop metastis. Additonally the external surface of the conus medullaris and visualized anterior thoracic cord also demonstrates subtle contrast enhancement. this maybe reactive or neoplastic in nature. recomment neurosurgical consultation and correlation with CSF analysis. the cnus medullarsi termates at the L1 level.. no intramedullary masses.

I do have a consult next week.. i did see a neurosurgeon about a year and a half ago before this mri . i had another one but not as agressive as this one.. he told me to come back in ten years because i have a large area for the tumor to grow..i will not see that doctor this time thank you i am just wondering by the sounds of this that the chance of this being cancer is a good diagnosis.. thank you

Answer:

Thank you for visiting NetWellness. On this site, we try to answer general questions about healthbut cannot diagnose or recommend treatment. You appear to have some very, very specific questions about your condition, which can only be answered properly by a physician who is familiar with your history, physical exam, and test results. Your questions about the testing results you've been given or the risks, benefits, and alternatives for proposed treatments of this condition need to be directed to your treating physician(s). You should insist that they answer these questions in a way that you are able to understand before consenting to any treatment. If your physician is unable to help you understand these issues, you should get a second opinion. Take care.

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Response by:

David J Hart, MD David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University