PMC5798916_01
Case 1. T2-weighted MRI scan showing a spinal lipoma at the L5 level with a flow void dorsal to the spinal cord
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Fig1
MRI of the spine revealed a spinal lipoma at the L5 level and a flow void dorsal to the spinal cord at approximately the level of the conus medullaris (Fig. 1).
Case 1. MRA image taken with the TRICKS (Time Resolved Imaging of Contrast KineticS) sequence shows tortuous blood vessels (white arrow) at the L5 level. This area is consistent with that of the spinal lipoma shown on T2WI (see Fig. 1)
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Fig2
MRA revealed tortuous blood vessels within the spinal lipoma (Fig. 2).
Case 1. Angiogram showing an abnormal blood vessel, with a shunt within the lipoma fed by the right sacral artery. The feeding artery (thick black arrow) can be seen entering the lipoma from the dorsal side, and passing the shunt(white arrow), and then entering the spinal canal via the juxtamedullary vein (thin black arrow)
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Fig3
The feeding artery entered from the dorsal aspect into the lipoma, and then passed the shun zone, and entered the spinal canal primarily via the juxtamedullary vein (Fig. 3).
Case 1. Angiogram at 2 months after the surgery showing an arteriovenous shunt (white arrow) mediated by a collateral route from the right lateral sacral artery
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Fig4
At 1 month after surgery, his lumbar JOA score had improved to 10/29, but angiography revealed an arteriovenous shunt via a collateral route from the right lateral sacral artery (Fig. 4).
PMC5798916_02
Case 2. T2-weighted MRI scans showing a spinal lipoma at the L2/3 level with a flow void dorsal to the spinal cord
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Fig5
MRI of the spine revealed a spinal lipoma at the L2/3 level and a flow void dorsal to the spinal cord at the level of the conus medullaris (Fig. 5).
Case 2. MRA images taken with the TRICKS sequence shows tortuous blood vessels (white arrows) at the L2/3 level. This area is consistent with where this patient's spinal lipoma was identified on T2WI (see Fig. 5)
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Fig6
MRA revealed tortuous blood vessels within the spinal lipoma, as in Case 1 (Fig. 6).
Case 2 Angiogram showing an abnormal blood vessel with a shunt within the lipoma fed by the right second lumbar artery. The feeding artery (thick black arrow) is entering the lipoma from the ventral side, passing the shunt (white arrow), and then entering the spinal canal as the draining vein (thin black arrow)
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Fig7
A vein from the shunt region drained into the juxtamedullary vein within the spinal canal, and formed a congestion of the venous circulation (Fig. 7).