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Intradural lumbar disk fragment with ring enhancement on MR
R Wasserstrom1, A C Mamourian, J F Black
1Department of Radiology, Milton S. Hershey Medical Center, Pennsylvania State University Hospital, Hershey 17033.
Abstract:
Intradural extension of a herniated intervertebral disk, an unusual complication of a common disease, may mimic an intradural tumor on MR. A case of a pathologically proved subdural disk fragment is presented; MR findings that suggested the correct diagnosis were: proximity of intervertebral disk disease; whorl-like mixed intensity on T2-weighted images; poor visualization of the mass on unenhanced T1-weighted images; and marked ring enhancement following administration of gadolinium.
Insights
A herniated intervertebral disk can rarely extend intradurally, mimicking a tumor on MRI. Specific MRI features can help differentiate subdural disk fragments from intradural tumors.
Area of Science:
- Neurosurgery
- Neuroradiology
- Spinal Imaging
Background:
- Herniated intervertebral discs are common spinal conditions.
- Intradural disc herniation is an infrequent complication.
- This can present as a diagnostic challenge, mimicking intradural tumors on Magnetic Resonance (MR) imaging.
Observation:
- A case of a pathologically confirmed subdural disc fragment is presented.
- The patient's MR imaging revealed specific findings.
- These findings were crucial for accurate diagnosis.
Findings:
- Key MR findings included: proximity to known intervertebral disc disease.
- Whorl-like mixed signal intensity on T2-weighted images.
- Poor visualization on unenhanced T1-weighted images.
- Marked ring enhancement after gadolinium administration.
Implications:
- Recognizing these specific MR findings aids in differentiating subdural disc fragments from intradural tumors.
- This distinction is critical for appropriate clinical management and surgical planning.
- Improves diagnostic accuracy in challenging spinal imaging cases.