[Radiological evaluation of non-neoplastic intramedullary lesions of the spinal cord]

Radiological evaluation of the non-neoplastic intramedullary lesions of the spinal cord includes lesion detection and characterization in order to make definitive diagnosis or to narrow differential diagnoses. Radiologist may be able to guide clinicians as to next diagnostic step when definitive diagnosis cannot be made. Treatment effect can be also assessed. Among other radiological modalities, MRI plays the most important role in the evaluation of the spinal lesions, particularly of the intramedullary lesions. MRI findings of intramedullary lesions can be divided into morphological and signal abnormalities. Morphological abnormalities include presence of an abnormal structure, deviation or deformity of normal structures, and enlargement or atrophy of the spinal cord. Signal abnormalities include T2 prolongation (often associated with T1 prolongation), T1 and T2 shortening, and abnormal contrast enhancement. There may be only one finding, or multiple findings may be present in combination. Signal changes and abnormal contrast enhancement with or without cord enlargement are the most common but important findings. There are a few disease entities with pathognomonic MRI findings, but it is often difficult to make definitive diagnosis based on MRI findings alone. It is imperative not only to have thorough knowledge of imaging findings various diseases, but also to pursuit radiological evaluation correlating with clinical and laboratory findings.