Differential diagnosis of cervical spinal cord demyelinating diseases and cervical intramedullary gliomas

Abstract

Objective To analyze the imaging characteristics of cervical spinal cord demyelinating diseases and cervical intramedullary gliomas, so as to improve the differential diagnosis between them.  Methods A retrospective analysis was conducted using clinical and MRI data from 22 cases of cervical spinal cord demyelinating diseases and 16 cases of cervical intramedullary gliomas.  Results Clinical features in both groups included paresthesia [77.27% (17/22), 12/16], weakness of limbs [72.73% (16/22), 10/16], and dysfunction of autonomic nerve [45.45% (10/22), 4/16]. In cervical MRI, the lesions involving more than 3 vertebras were 63.64% (14/22) in demyelinating group and 15/16 in glioma group, and the average lengths of lesions were (3.41 ± 1.74) and (3.59 ± 1.28) vertebras in 2 groups. The lesions showed long T₁ signal [68.18% (15/22), 7/16], equisignal T₁ [31.82% (7/22), 6/16] and long T₂ signal [100% (22/22), 8/15] in 2 groups. Mixed T₁ and T₂ signals (3/16, 6/15) could be seen in glioma group. Demyelinating lesions had unclear boundary [90.91% (20/22)] with patchy and ribbon-like enhancement (13/16). Limited enlargement of spinal cord (15/16) and thickening spinal meninges (14/16) were more common in glioma group, usually with block and circular enhancement (12/16). Spinal cord involvement around central canal could be seen (14/15), and the cysts or central canal enlargement, hemorrhage and "cap sign" were showed frequently (7/16, 5/16 and 4/16).  Conclusions Although none of one single clinical or MRI feature was sufficient enough to identify cervical spinal demyelinating diseases from cervical glioma, the comprehensive analysis of multiple features could help to make differential diagnosis of these diseases.

doi: 10.3969/j.issn.1672-6731.2014.09.008