PMC7579400_01
Sagittal (a,c) and transverse (b,d) images of the lumbar spinal cord. (a,b) There is a partial loss of the hyperintense signal of the L5-L6 IVD nucleus pulposus. (a) Overlying the L5-L6 IVD, a focal heterogenous spinal cord lesion, containing a linear hyperintense band, bordered by hypointense signal, extends from the dorsal aspect of the L5-L6 annulus fibrosus to the dorsal aspect of the spinal cord (white arrow). This vertical tract appears hypointense on the T1-WI transverse images [(d), yellow arrows] and extends from the left aspect of the IVD space within the overlying spinal cord. Cranially, an ill-defined spinal cord hyperintense lesion and mild spinal swelling is observed, extending from mid L5 to L5-L6 IVD space (a,b). (c) Mild contrast enhancement of the vertical intramedullary linear tract, meninges overlying L5-L6 IVD and adjacent to the area of spinal cord swelling can be observed a swell.
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F1
On the sagittal T2-WI, there was partial reduction in volume of the L5-L6 nucleus pulposus (Figure 1a). Dorsal to this intervertebral disk (IVD) space, a focal relatively well-defined intramedullary heterogeneous lesion was observed on the T2-WI sequences (Figures 1a,b), partially correlated to a voluminous strongly hypointense rim surrounding a focal dorsal right-sided intramedullary hyperintensity on the transverse MERGE-WI (Figure 2). A vertical linear tract was also observed intralesionally, T2-WI hyperintense, T1-WI hypointense, extending within the spinal cord parenchyma from the dorsal L5-L6 annulus fibrosus (Figures 1a-d). Mild spinal cord swelling was also present, from the mid-vertebral body of L5 to the L5-L6 intervertebral disk space (Figure 1a). After intravenous administration of Gadodiamide2 (0.05 mmol/mL, dose of 0.2 mL/kg), mild perilesional enhancement was noted around the vertical intramedullary linear tract, associated with focal L5-L6 meningeal enhancement (Figure 1c).
Transverse image of the lumbar spinal cord at the level of L5 (Gradient-echo sequence). A voluminous strongly hypointense rim surrounding a focal dorsal right intramedullary hyperintensity is observed, compatible with heterogeneous intramedullary hemorrhagic or mineralized lesion.
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F2
Dorsal to this intervertebral disk (IVD) space, a focal relatively well-defined intramedullary heterogeneous lesion was observed on the T2-WI sequences (Figures 1a,b), partially correlated to a voluminous strongly hypointense rim surrounding a focal dorsal right-sided intramedullary hyperintensity on the transverse MERGE-WI (Figure 2).
CT transverse (a) and sagittal (c) images of the lumbar spinal cord (acquired in a bone algorithm, and displayed in a bone window) and MRI gradient-echo transverse image (b) of the lumbar spinal cord. A right focal hyperattenuating intramedullary lesion with a CT number of 266 HU is observed at the dorsal aspect of the L5-L6 intervertebral space. The L5-L6 intervertebral disc space is partially collapsed compared to the adjacent intervertebral disk spaces.
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F3
A faint hyperattenuating intramedullary focus was noted overlying the narrowed L5-L6 IVD space, most likely compatible with a focus of mineralization (266 Hounsfied Unit) (Figure 3).
Intramedullary tissue surgically removed. A solid white material mixed with hematoma is observed. (b,c) Histological appearance of the material. Fragments of degenerate cartilaginous tissue (black arrows) consistent with cartilaginous metaplastic degeneration of IVD nucleus pulposus. Adjacent abondant fibrinohemorragic material (yellow stars). Haematoxylin and eosin stain. (a) x5. (b) x20.
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F4
Parts of hematoma were gently removed and solid white material mixed with hemorrhage was observed (Figure 4a), within the spinal cord parenchyma, that appeared soft and discolored.