IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Spinal cord astrocytoma - conus

Case contributed by Frank Gaillard

Presentation

Gradual bilateral leg weakness.

Patient Data

Age: 40 years
Gender: Male

The whole of the thoracic cord from the level of the C7/T1 disc through to the conus is slightly expanded and displays abnormal signal within the grey matter.  The central canal is slightly dilated up to a maximum of 3 mm in diameter in the mid thoracic cord.  No abnormal vessels are detected.  Post contrast views show slight, diffuse contrast enhancement, maximal in the conus and lower thoracic cord. The conus terminates opposite L2. 

This patient's symptoms had been gradual and progressive. There was no history of preceding infection or illness, and CSF was bland. The lesion did not resolve on follow up imaging and a biopsy of the conus confirmed a diffuse WHO II astrocytoma. 

Annotated image

Enhancement is usually present but can be subtle and careful side by side comparison of pre and post contrast images may be required to detect faint diffuse enhancement. 

Note how at the L5/S1 level the apparent region of intradural enhancement (blue arrow) has a similar appearance on pre contrast and is attributable to bulging epidural fat (yellow arrow). 

Case Discussion

This case illustrates how diffuse a diffuse spinal cord astrocytoma can be, and one can easily understand why they are difficult to diagnose without the aid of MRI. 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.