[Vascular mass lesions of the spinal cord : Cavernous malformations, spinal arteriovenous malformations and...

In a narrow neuroradiological sense, vascular mass lesions of the spinal cord primarily comprise intramedullary cavernous malformations, spinal arteriovenous malformations (AVMs) with an intramedullary or pial nidus, and hemangioblastomas. Cavernous malformations typically present as small eccentric lesions with a mixed internal signal pattern and a hemosiderin rim; contrast enhancement is usually absent or only minimal. Spinal AVMs are characterized by a nidus with intra- and perimedullary flow voids; hemorrhagic stigmata may be present, and angiography demonstrates early venous drainage. Hemangioblastomas typically appear as avidly enhancing nodules, usually located superficially or subpially, often with a syrinx that is disproportionately large relative to tumor size. Magnetic resonance imaging (MRI) is the first-line imaging modality; when a shunt lesion is suspected, digital subtraction angiography (DSA) remains indispensable. The spinal dural arteriovenous fistula (SDAVF) is presented as the most important differential diagnosis; its appearance of a venous congestive myelopathy distinguishes it from the aforementioned mass lesions.