Naveed Ahmad | RadQuiz.com
1. Transitional Vertebrae
- Description: Developmental anomaly at the lumbosacral junction (lumbarization of S1 or sacralization of L5) occurring in 5% to 10% of patients.
- Imaging Appearance: Small L5–S1 disc and absent normal sacral curvature on sagittal views; articulation or fusion of an enlarged transverse process to the sacrum on CT.
- Radiopaedia: Radiopaedia – Transitional vertebra
2. Congenital Cervical Vertebral Nonsegmentation (Klippel-Feil Variant)
- Description: Single-level congenital fusion of cervical vertebrae predisposing patients to accentuated degenerative changes above and below.
- Imaging Appearance: Smooth inward curvature with a narrowed “waist” in the AP dimension on sagittal views and a small residual vestigial disc.
- Radiopaedia: Radiopaedia – Congenital fusion of cervical vertebrae
3. Os Odontoideum
- Description: Well-corticated ovoid ossicle located superior to a hypoplastic odontoid process, resulting from an unhealed fracture through the C2-odontoid growth plate before age 5 or 6.
- Imaging Appearance: Well-corticated os lying above a hypoplastic odontoid, lacking acute fracture edema on MR, with a hypertrophied, rounded anterior C1 arch.
- Radiopaedia: Radiopaedia – Os odontoideum
4. Limbus Vertebra
- Description: Small, triangular corticated bone fragment at the anterosuperior or anteroinferior corner of a vertebral body resulting from herniation of the nucleus pulposus beneath the apophysis.
- Imaging Appearance: Triangular corticated bone fragment adjacent to the vertebral corner with a sclerotic margin, most commonly in the midlumbar region.
- Radiopaedia: Radiopaedia – Limbus vertebra
5. Conus Lipoma & Fatty Filum Terminale
- Description: Incidental, asymptomatic deposition of mature fat within or adjacent to the filum terminale or conus medullaris.
- Imaging Appearance: Small focal collection or thickening showing high T1 and T2 signal intensity (isointense to fat) with complete signal suppression on fat-saturated post-contrast MR sequences.
- Radiopaedia: Radiopaedia – Fatty filum terminale
6. Conjoined Nerve Roots
- Description: Common lumbosacral nerve root anomaly (1% to 3% incidence) where two roots arise from a single root sleeve before exiting separately.
- Imaging Appearance: Two nerve roots originating from a single conjoined root sleeve that subsequently divides on axial MR/CT sections.
- Radiopaedia: Radiopaedia – Conjoined nerve root
7. Type I Spinal Meningeal Cysts
- Description: Extradural meningeal cysts subdivided into Type IA (extradural arachnoid cysts) and Type IB (sacral meningoceles).
- Imaging Appearance: CSF signal intensity on all MR pulse sequences, located extradurally without nerve root contents (Type IA) or expanding the sacrum (Type IB).
- Radiopaedia: Radiopaedia – Spinal meningeal cyst
8. Type II Spinal Meningeal Cysts (Tarlov Perineural Cysts)
- Description: Very common extradural spinal meningeal cysts containing nerve roots, highly prevalent along sacral nerve roots.
- Imaging Appearance: Frequently large, multiple, and bilateral with CSF signal intensity on all pulse sequences, causing neural foraminal enlargement and posterior scalloping of the vertebral bodies.
- Radiopaedia: Radiopaedia – Tarlov cyst
9. Type III Spinal Meningeal Cysts (Intradural Arachnoid Cysts)
- Description: Intradural-extramedullary arachnoid cysts most frequently located in the thoracic region dorsal to the spinal cord.
- Imaging Appearance: CSF signal intensity on all pulse sequences; causes prominent anterior displacement, flattening, and compression of the spinal cord.
- Radiopaedia: Radiopaedia – Spinal arachnoid cyst
10. Lateral Meningocele
- Description: Lateral protrusion of the dura and arachnoid through an enlarged neural foramen (85% associated with neurofibromatosis type 1).
- Imaging Appearance: Fluid collections with CSF signal intensity on all MR sequences, causing prominent chronic scalloping of the pedicles, laminae, and dorsal vertebral body surface.
- Radiopaedia: Radiopaedia – Lateral thoracic meningocele
11. Congenital Spinal Stenosis
- Description: Developmental narrowing of the spinal canal caused primarily by congenitally shortened pedicles.
- Imaging Appearance: AP canal dimensions <10\text{ mm} in the cervical region and <12\text{ mm} in the lumbar region, accompanied by canal dimension tapering from upper to lower lumbar levels.
- Radiopaedia: Radiopaedia – Spinal canal stenosis
12. Scoliosis
- Description: Lateral curvature of the spine (90% idiopathic S-shaped curves; 10% congenital, neuromuscular, or posttraumatic).
- Imaging Appearance: Lateral curvature on radiographs and coronal MR; congenital cases reveal vertebral anomalies such as hemivertebrae or butterfly vertebrae.
- Radiopaedia: Radiopaedia – Scoliosis
13. Tethered Cord Syndrome
- Description: Low-lying conus medullaris anchored by a pathological structure (thickened filum terminale, lipomyelomeningocele, or postsurgical scar).
- Imaging Appearance: Spinal cord extending without caliber change into the lumbosacral region, tethered posteriorly with associated dysraphic posterior elements.
- Radiopaedia: Radiopaedia – Tethered cord syndrome
14. Syringohydromyelia
- Description: Encompasses hydromyelia (central canal ependymal-lined dilatation) and syringomyelia (fluid-filled gliotic cavity within the cord parenchyma).
- Imaging Appearance: Well-defined tubular fluid-filled intramedullary cavity showing CSF signal intensity on MR, best delineated on sagittal and axial views.
- Radiopaedia: Radiopaedia – Syringohydromyelia
15. Meningomyelocele and Meningocele (Open Dysraphism)
- Description: Open spinal dysraphism featuring incomplete posterior closure with herniation of neural elements and/or meninges through bony defects.
- Imaging Appearance: Wide posterior dysraphic arch defect communicating with an external CSF-filled sac (exposed neural placode at birth); virtually always accompanied by Chiari II malformation.
- Radiopaedia: Radiopaedia – Meningomyelocele
16. Lipomyelomeningocele and Lipomyelocele (Closed Dysraphism)
- Description: Closed spinal dysraphism characterized by a subcutaneous lipoma attached to the dorsal cord termination extending through a spina bifida defect.
- Imaging Appearance: Spinal cord tethered in the sacral region by an extensive posterior bony defect and a large dorsal lipoma continuous with subcutaneous fat (high T1/T2 fat signal).
- Radiopaedia: Radiopaedia – Lipomyelomeningocele
17. Diastematomyelia
- Description: Congenital splitting of the spinal cord into two hemicords, each invested in pia and containing a central canal.
- Imaging Appearance: Two hemicords visible within single or separate dural sacs on axial/coronal MR, separated by a central fibrous band or osteocartilaginous spur.
- Radiopaedia: Radiopaedia – Diastematomyelia
18. Caudal Regression (Sacral Agenesis)
- Description: Congenital absence of sacrococcygeal vertebrae extending variably into the lumbar spine.
- Imaging Appearance: Partial or complete absence of the sacrum and coccyx on MR/CT, with approximately half of patients exhibiting a blunted, wedge- or hatchetlike conus termination above L1.
- Radiopaedia: Radiopaedia – Caudal regression syndrome
19. Anterior Sacral Meningocele
- Description: Protrusion of dura and leptomeninges anteriorly through a sacral defect via a narrow neck (component of Currarino syndrome triad).
- Imaging Appearance: Presacral CSF collection contiguous with the thecal sac, accompanied by anterior semicircular scalloping of the sacrum yielding a “scimitar” or sickle shape.
- Radiopaedia: Radiopaedia – Anterior sacral meningocele
20. Dorsal Dermal Sinus
- Description: Midline epithelial-lined skin tract extending inward to a variable distance, frequently terminating in an intraspinal dermoid or epidermoid cyst.
- Imaging Appearance: Midline sinus tract extending from a skin dimple/ostium to the spinal canal, often with an associated intramedullary dermoid/epidermoid cyst showing restricted diffusion.
- Radiopaedia: Radiopaedia – Dorsal dermal sinus
21. Intraspinal Enteric Cyst (Neurenteric Cyst)
- Description: Congenital unilocular endodermal-lined cyst typically located ventrally or ventrolateral to the cervical or thoracic spinal cord.
- Imaging Appearance: Well-circumscribed intradural-extramedullary cystic lesion with CSF-like SI, lack of contrast enhancement, focal widening of the bony spinal canal, and vertebral anomalies.
- Radiopaedia: Radiopaedia – Neurenteric cyst
22. Spinal Cord Herniation
- Description: Rare thoracic myelopathy caused by focal prolapse of the spinal cord through an anterior or lateral dural tear.
- Imaging Appearance: Abrupt focal anterior/ventral kinking or deviation of the thoracic cord on sagittal T2 MR, with axial views confirming cord herniation through an anterolateral dural defect.
- Radiopaedia: Radiopaedia – Idiopathic spinal cord herniation
23. Dermoid and Epidermoid Cysts
- Description: Congenital or acquired inclusion cysts lined by squamous epithelium.
- Imaging Appearance: Dermoids show fat high SI on T1; epidermoids mimic CSF on T1/T2 but are distinctly characterized by marked hyperintensity on diffusion-weighted imaging (DWI).
- Radiopaedia: Radiopaedia – Spinal epidermoid cyst
24. Neurofibromatosis Type 1 (NF1)
- Description: Autosomal dominant neurocutaneous disorder characterized by multiple café-au-lait spots, neurofibromas, and skeletal dysplasia.
- Imaging Appearance: Posterior scalloping of vertebral bodies, lateral meningoceles, diffusely enlarged neural foramina, and plexiform neurofibromas showing marked T2 hyperintensity and moderate enhancement.
- Radiopaedia: Radiopaedia – Neurofibromatosis type 1
25. Neurofibromatosis Type 2 (NF2)
- Description: Genetic disorder characterized pathognomonically by bilateral vestibular schwannomas and frequent intraspinal neoplasms.
- Imaging Appearance: Intradural extramedullary schwannomas/meningiomas and intramedullary ependymomas/astrocytomas demonstrating T2 hyperintensity and abnormal contrast enhancement.
- Radiopaedia: Radiopaedia – Neurofibromatosis type 2
26. Klippel-Feil Syndrome
- Description: Congenital syndrome defined by failure of segmentation of two or more cervical vertebrae.
- Imaging Appearance: Hypoplastic, nonsegmented cervical vertebral bodies (most commonly C2–C3 or C5–C6) lacking intervening disc spaces, frequently accompanied by hemivertebrae.
- Radiopaedia: Radiopaedia – Klippel-Feil syndrome
27. Achondroplasia
- Description: Autosomal dominant skeletal dysplasia representing the most common cause of dwarfism.
- Imaging Appearance: Interpedicular distance characteristically decreasing from L1 to L5, congenitally shortened pedicles, and generalized spinal canal stenosis.
- Radiopaedia: Radiopaedia – Achondroplasia
28. Cervical Spine Trauma (Jefferson, Odontoid, Hangman’s, Clay-Shoveler’s, Teardrop, Facet Fractures)
- Description: Acute mechanical skeletal injuries resulting from high-velocity trauma, axial loading, hyperflexion, or hyperextension.
- Imaging Appearance: Specific fracture lines involving C1 rings, dens (Types I–III), C2 pars (Hangman’s), spinous processes, and vertebral body corners.
- Radiopaedia: Radiopaedia – Cervical spine fracture
29. Benign Osteoporotic Compression & Sacral Insufficiency Fractures
- Description: Fragility fractures occurring in elderly osteoporotic patients following minimal trauma.
- Imaging Appearance: Loss of vertebral height with acute marrow edema (low T1, high STIR / fat-suppressed T2 SI) and distinct cortical fracture lines.
- Radiopaedia: Radiopaedia – Osteoporotic compression fracture
30. Spinal Cord Injury (Contusion, Edema, Hemorrhage)
- Description: Acute mechanical trauma leading to cord swelling, microvascular disruption, and necrosis.
- Imaging Appearance: Fusiform cord expansion with T2 hyperintensity (edema) and foci of intramedullary hypointensity on T2* gradient-echo or T1 hyperintensity (methemoglobin).
- Radiopaedia: Radiopaedia – Spinal cord injury
31. Traumatic Disc Herniation
- Description: Acute displacement of intervertebral disc material resulting from mechanical spinal trauma.
- Imaging Appearance: Focal anterior or paracentral epidural soft tissue mass contiguous with the disc space, causing localized cord/thecal sac deformation.
- Radiopaedia: Radiopaedia – Traumatic disc herniation
32. Spinal Epidural Hematoma
- Description: Spontaneous or posttraumatic collection of blood within the spinal epidural space causing rapid cord compression.
- Imaging Appearance: Extradural fluid collection extending over several segments, tapering smoothly in the lumbar region; hyperintense on T1-weighted scans.
- Radiopaedia: Radiopaedia – Spinal epidural haematoma
33. Brachial Plexus Injury
- Description: High-velocity trauma affecting the roots and trunks of the brachial plexus (C5–T1).
- Imaging Appearance: Preganglionic avulsion injuries demonstrate CSF-filled pseudomeningoceles; postganglionic stretch injuries show nerve thickening and T2 hyperintensity.
- Radiopaedia: Radiopaedia – Brachial plexus injury
34. Degenerative Spinal Stenosis
- Description: Acquired narrowing of the central spinal canal, lateral recesses, and neural foramina resulting from multi-factorial degenerative disease.
- Imaging Appearance: Combined spinal canal narrowing driven by anterior disc-osteophyte complexes, ligamentum flavum hypertrophy/buckling, and facet joint osteoarthritis.
- Radiopaedia: Radiopaedia – Lumbar spinal stenosis
35. Disc Herniation (Protrusion, Extrusion, Sequestered Fragment)
- Description: Displacement of intervertebral disc nuclear material beyond the disk space margins.
- Imaging Appearance: Bulges (>180^\circ circumferential), protrusions (focal base), extrusions (narrower base than dome), and sequestered free fragments.
- Radiopaedia: Radiopaedia – Intervertebral disc herniation
36. Modic Endplate Changes (Types 1, 2, and 3)
- Description: MRI signal abnormalities in vertebral endplates adjacent to degenerated discs reflecting histological marrow changes.
- Imaging Appearance: Type 1 (Low T1, High T2 edema), Type 2 (High T1 fatty replacement), Type 3 (Low T1, Low T2 sclerosis).
- Radiopaedia: Radiopaedia – Modic changes
37. Spondylolisthesis and Spondylolysis
- Description: Forward slippage of a vertebral body (spondylolisthesis) frequently resulting from pars interarticularis fatigue fracture (spondylolysis).
- Imaging Appearance: Anterolisthesis graded I to IV; spondylolysis appears as a pars interarticularis discontinuity on sagittal/axial CT.
- Radiopaedia: Radiopaedia – Spondylolisthesis
38. Retrolisthesis
- Description: Posterior subluxation of a vertebral body relative to the subjacent vertebra, typically secondary to advanced disc degeneration.
- Imaging Appearance: Posterior displacement of a vertebral body on sagittal MR/CT accompanied by neural foraminal narrowing.
- Radiopaedia: Radiopaedia – Retrolisthesis
39. Diffuse Idiopathic Skeletal Hyperostosis (DISH)
- Description: Non-inflammatory ossification disorder of the spine primarily affecting elderly individuals.
- Imaging Appearance: Exuberant flowing anterior and anterolateral ossification along \ge 4 contiguous thoracic vertebrae with preserved disc heights.
- Radiopaedia: Radiopaedia – Diffuse idiopathic skeletal hyperostosis
40. Ankylosing Spondylitis
- Description: Seronegative inflammatory spondyloarthropathy characterized by inflammation progressing to bony ankylosis.
- Imaging Appearance: Early bilateral sacroiliitis, vertical syndesmophytes, vertebral body squaring, and “bamboo spine” ankylosis.
- Radiopaedia: Radiopaedia – Ankylosing spondylitis
41. Rheumatoid Arthritis
- Description: Chronic systemic inflammatory synovitis frequently targeting the craniocervical junction.
- Imaging Appearance: Atlantoaxial subluxation with increased ADI distance, dens erosion, and retroodontoid inflammatory pannus.
- Radiopaedia: Radiopaedia – Rheumatoid arthritis (spine)
42. Spinal Dural Arteriovenous Fistula (DAVF)
- Description: Direct vascular shunt between a radiculomeningeal artery and a radicular vein leading to venous hypertension and cord hypoxia.
- Imaging Appearance: Extensive central gray matter cord edema (“H-shaped” on axial T2) and prominent perimedullary flow voids.
- Radiopaedia: Radiopaedia – Spinal dural arteriovenous fistula
43. Spinal Cord Arteriovenous Malformation (AVM)
- Description: Congenital vascular malformation presenting in younger individuals with hemorrhage or myelopathy.
- Imaging Appearance: Dilated intramedullary and perimedullary vessels, cord swelling, and T2 hyperintensity from edema and venous congestion.
- Radiopaedia: Radiopaedia – Spinal arteriovenous malformation
44. Spinal Cord Arterial Ischemia / Infarction
- Description: Vascular occlusion of radicular/intercostal arteries or intrinsic cord vessels.
- Imaging Appearance: Symmetric T2 hyperintensity involving the anterior two-thirds of the spinal cord (anterior spinal artery territory) with acute focal cord expansion.
- Radiopaedia: Radiopaedia – Spinal cord infarction
45. Cavernous Malformation (Cavernoma)
- Description: Angiographically occult vascular hamartoma of the spinal cord containing sinusoidal vascular spaces.
- Imaging Appearance: Small well-marginated intramedullary lesion with a central mixed-intensity core and a dark peripheral rim of hemosiderin/ferritin (markedly hypointense on T2/T2*).
- Radiopaedia: Radiopaedia – Spinal cord cavernous malformation
46. Spondylodiscitis (Pyogenic Disc Space Infection)
- Description: Hematogenous or postoperative infection originating in subchondral bone or disc space.
- Imaging Appearance: Narrowed irregular disc space with high T2 fluid signal, endplate destruction, horizontal Modic-like marrow edema, and enhancing paraspinal soft tissue.
- Radiopaedia: Radiopaedia – Spondylodiscitis
47. Tuberculous Spondylitis (Pott’s Disease)
- Description: Indolent granulomatous infection caused by Mycobacterium tuberculosis.
- Imaging Appearance: Involvement of multiple contiguous vertebral bodies with large paraspinal abscesses and relative sparing of the intervertebral disc space early in the disease process.
- Radiopaedia: Radiopaedia – Tuberculous spondylitis
48. Spinal Epidural Abscess
- Description: Purulent infection within the epidural space resulting from hematogenous spread or direct extension.
- Imaging Appearance: Extradural fluid collection showing peripheral rim enhancement and marked central hyperintensity on diffusion-weighted imaging (DWI).
- Radiopaedia: Radiopaedia – Spinal epidural abscess
49. Meningitis and Myelitis
- Description: Inflammatory/infectious involvement of the meninges and spinal cord parenchyma.
- Imaging Appearance: Diffuse leptomeningeal contrast enhancement of nerve roots, cord swelling, and T2 hyperintensity accompanying myelitis.
- Radiopaedia: Radiopaedia – Spinal meningitis
50. Arachnoiditis
- Description: Fibrous thickening and adherence of arachnoid and nerve roots caused by infection, surgery, or hemorrhage.
- Imaging Appearance: Clumped, thickened nerve roots adhering to the periphery of the thecal sac (“empty” sac) or forming a central nodular mass with abnormal enhancement.
- Radiopaedia: Radiopaedia – Arachnoiditis ossificans
51. Guillain-Barré Syndrome
- Description: Immune-mediated demyelinating polyradiculoneuropathy presenting with progressive motor paralysis.
- Imaging Appearance: Smooth mild thickening and prominent contrast enhancement of cauda equina nerve roots, with preferential enhancement of anterior (motor) roots.
- Radiopaedia: Radiopaedia – Guillain-Barré syndrome
52. Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
- Description: Chronic immune-mediated demyelinating disorder causing peripheral nerve and nerve root hypertrophy.
- Imaging Appearance: Marked enlargement and T2 hyperintensity of cauda equina nerve roots, dorsal root ganglia, and exiting spinal nerves.
- Radiopaedia: Radiopaedia – Chronic inflammatory demyelinating polyneuropathy
53. Sarcoidosis
- Description: Noncaseating granulomatous inflammatory disease affecting the central nervous system.
- Imaging Appearance: Fusiform spinal cord enlargement with abnormal T2 hyperintensity and patchy leptomeningeal/cord contrast enhancement.
- Radiopaedia: Radiopaedia – Neurosarcoidosis
54. Multiple Sclerosis (Spinal Cord Plaques)
- Description: Central nervous system demyelinating disease involving the spinal cord.
- Imaging Appearance: Well-circumscribed focal T2/STIR hyperintense plaques not respecting gray-white boundaries, elongated craniocaudally, with variable contrast enhancement.
- Radiopaedia: Radiopaedia – Multiple sclerosis (spinal cord)
55. Neuromyelitis Optica (Devic Disease)
- Description: Inflammatory demyelinating disorder affecting optic nerves and spinal cord.
- Imaging Appearance: Extensive longitudinal transverse myelitis (cord lesions spanning \ge 3 vertebral segments) with T2 hyperintensity.
- Radiopaedia: Radiopaedia – Neuromyelitis optica
56. Acute Transverse Myelitis
- Description: Acute idiopathic or autoimmune inflammatory myelopathy.
- Imaging Appearance: Focal or extensive T2 hyperintensity involving the majority of cord cross-section over multiple segments, with fusiform swelling.
- Radiopaedia: Radiopaedia – Transverse myelitis
57. Vitamin B12 Deficiency (Subacute Combined Degeneration)
- Description: Metabolic neuropathy resulting from vitamin B12 malabsorption or deficiency.
- Imaging Appearance: Characteristic symmetric T2 hyperintensity restricted to the dorsal columns, forming an “inverted-V” appearance extending over multiple segments.
- Radiopaedia: Radiopaedia – Subacute combined degeneration of the spinal cord
58. Paget Disease
- Description: Chronic metabolic bone remodeling disorder characterized by abnormal bone resorption and formation.
- Imaging Appearance: Bony expansion of single or multiple vertebrae with accentuated coarse trabeculae, thickened cortices, and “picture frame” appearance.
- Radiopaedia: Radiopaedia – Paget disease of bone (spine)
59. Nerve Sheath Tumors (Schwannoma and Neurofibroma)
- Description: Benign peripheral nerve sheath neoplasms (most common primary intraspinal/intradural-extramedullary tumors).
- Imaging Appearance: Schwannomas show well-encapsulated avid enhancement with cystic changes; neurofibromas show non-encapsulated fusiform nerve enlargement (dumbbell shape).
- Radiopaedia: Radiopaedia – Spinal schwannoma / Neurofibroma
60. Meningioma
- Description: Benign slow-growing dural-based tumor (second most common intraspinal tumor).
- Imaging Appearance: Well-delineated intradural-extramedullary mass with broad dural base, avid homogeneous enhancement, and sometimes internal calcifications.
- Radiopaedia: Radiopaedia – Spinal meningioma
61. Ependymoma
- Description: Neuroepithelial intramedullary tumor arising from ependymal cells of the central canal (most common adult cord tumor).
- Imaging Appearance: Well-circumscribed intramedullary mass spanning 2–3 segments with avid enhancement, reactive polar cysts, and possible hemorrhage/hemosiderosis.
- Radiopaedia: Radiopaedia – Spinal ependymoma
62. Astrocytoma
- Description: Infiltrative glial neoplasm of the spinal cord (more common in children).
- Imaging Appearance: Long-segment cord expansion spanning multiple vertebral segments with poorly defined margins, T1 hypointensity, T2 hyperintensity, and variable enhancement.
- Radiopaedia: Radiopaedia – Spinal astrocytoma
63. Hemangioblastoma
- Description: Highly vascular benign intramedullary neoplasm associated with von Hippel-Lindau disease.
- Imaging Appearance: Small intensely enhancing intramedullary nodule associated with a large polar cyst and prominent serpentine perilesional flow voids.
- Radiopaedia: Radiopaedia – Spinal hemangioblastoma
64. Leptomeningeal and Spinal Cord Metastases
- Description: Disseminated metastatic seeding of the leptomeninges, subarachnoid space, or spinal cord parenchyma.
- Imaging Appearance: “Icing-like” pial coating, clumped/beaded enhancing nodules coating cauda equina nerve roots, or focal intramedullary enhancing masses.
- Radiopaedia: Radiopaedia – Leptomeningeal carcinomatosis
65. Vertebral Body Hemangioma
- Description: Very common benign vascular incidental finding composed of cavernous sinuses and fatty stroma.
- Imaging Appearance: Well-circumscribed focal lesion with high T1 and T2 SI interspersed with thick vertical striations (“polka-dot” appearance).
- Radiopaedia: Radiopaedia – Vertebral haemangioma
66. Aneurysmal Bone Cyst (ABC)
- Description: Benign expansile vascular bone lesion predominantly affecting posterior elements in patients under 20.
- Imaging Appearance: Lytic, multilocular, expansile, lobular mass with fluid-fluid levels and enhancing solid septal components.
- Radiopaedia: Radiopaedia – Aneurysmal bone cyst (spine)
67. Osteoid Osteoma
- Description: Benign bone tumor composed of vascular fibrous connective tissue with a central nidus (<2\text{ cm}).
- Imaging Appearance: Small lytic nidus with central calcification, prominent surrounding reactive bony sclerosis, and extensive marrow edema.
- Radiopaedia: Radiopaedia – Osteoid osteoma (spine)
68. Osteochondroma
- Description: Osteocartilaginous exostosis with a cortex and medullary cavity contiguous with parent bone.
- Imaging Appearance: Bony protuberance covered by a cartilaginous cap maintaining direct continuity with the parent bone’s medullary cavity.
- Radiopaedia: Radiopaedia – Osteochondroma (spine)
69. Giant Cell Tumor
- Description: Locally aggressive low-grade vascular tumor, most frequently occurring in the sacrum.
- Imaging Appearance: Expansile, lytic, non-sclerotic vascular bone mass with intermediate-to-low T1 SI, intermediate-to-high T2 SI, and heterogeneous enhancement.
- Radiopaedia: Radiopaedia – Giant cell tumour of bone (spine)
70. Chordoma
- Description: Midline, locally invasive, destructive malignant neoplasm arising from notochordal remnants.
- Imaging Appearance: Large destructive lytic midline mass involving multiple vertebral segments, containing intratumoral calcifications and high T2 SI.
- Radiopaedia: Radiopaedia – Chordoma
71. Sacrococcygeal Teratoma
- Description: Rare congenital germ cell tumor representing the most common presacral mass in children.
- Imaging Appearance: Lobulated, sharply demarcated presacral mass with heterogeneous cystic and solid components containing fat, soft tissue, and fluid elements.
- Radiopaedia: Radiopaedia – Sacrococcygeal teratoma
72. Focal Vertebral Body Metastatic Disease & Pathologic Compression Fractures
- Description: Secondary skeletal malignancy from systemic primaries (lung, breast, prostate, renal cell).
- Imaging Appearance: Focal replacement of high-SI fatty marrow by low T1 SI lesions; lytic metastases show high STIR/T2-FS signal; blastic metastases show profound low T1/T2 SI.
- Radiopaedia: Radiopaedia – Spinal metastases
73. Langerhans Cell Histiocytosis
- Description: Benign proliferative disease of children characterized in the spine by severe vertebral collapse.
- Imaging Appearance: “Vertebra plana” (near-complete uniform loss of vertebral body height with preserved adjacent intervertebral discs and posterior elements).
- Radiopaedia: Radiopaedia – Vertebra plana
74. Diffuse Marrow Disease (Leukemia, Lymphoma, Multiple Myeloma)
- Description: Generalized systemic marrow infiltration by hematopoietic or plasma cell malignancies.
- Imaging Appearance: Diffuse homogenous low T1 signal intensity of vertebral bodies (isointense or hypointense relative to adjacent intervertebral discs).
- Radiopaedia: Radiopaedia – Diffuse bone marrow infiltration
75. Spinal Lymphoma
- Description: Non-Hodgkin lymphoma involving paravertebral, epidural, and vertebral compartments.
- Imaging Appearance: Infiltrative soft tissue masses showing homogeneous contrast enhancement and diffuse marrow low T1 SI.
- Radiopaedia: Radiopaedia – Spinal lymphoma
76. Multiple Myeloma
- Description: Malignant plasma cell neoplasm causing focal or diffuse skeletal destruction.
- Imaging Appearance: Multiple lytic “punched-out” lesions, diffuse homogenous marrow replacement, or focal plasmacytomas with epidural soft tissue extension.
- Radiopaedia: Radiopaedia – Multiple myeloma (spine)