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J. E. Vandevenne and A. Kastler
ab
Fig. 20.15 (a–c) Plasmacytoma with mini-brain appearance. Example
of a solitary plasmacytoma in a 31-year-old man presenting with low
back pain. The CT image demonstrates an irregular shaped lytic lesion
Table 20.3 Primary benign tumors: CT and MR characteristics and treatment modalities
Tumor type CT features
Osteoma Dense sclerotic, round shape,
sometimes with spicula
Osteoid osteoma (OO) Posterior elements, central nidus
lucent or sclerotic with lucent rim,
broad and dense sclerotic reactive
zone
Osteoblastoma Like osteoid osteoma, osteoid forming
tumor of larger size of nidus: >1.5cm
with variable mineralization
Hemangioma Hypodense with coarse vertical
trabeculae (white polka dots/corduroy
sign)
Aggressive Hemangioma Like hemangioma but with bone
destruction
Fibrous dysplasia Expansile, ground-glass matrix; cystic
areas may appear lytic (rare in spine,
polyostotic)
Osteochondroma Continuity of bony cortex and
medullary space from lesion into
normal bone
Chondroblastoma Osteolytic, thin sclerotic rim, may
involve cortical bone, variable
intralesional calcication (chondroid
matrix)
Simple bone cyst Radiolucent, thin sclerotic rim Fluid signal intensity Not needed
Aneurysmal bone cyst
(ABC)
Benign notochordal
tumor
Giant cell tumor Lytic, expansile, cortical disruption,
Eosinophilic granuloma
(Langerhans
histiocytosis)
Balloon-like expansile, lytic with
bony septa, thin cortical shell may
focally disrupt
Sclerotic, may involve entire vertebra
preserved trabecula, no cortical
destruction
thin/disrupted sclerotic margins and
trabecula, locally aggressive lesion
Lucent lytic lesion, bone destruction
locally aggressive lesion, vertebra
plana
of the vertebral body, with cortical thickening correlating to linear
hypointense struts in T1 and T2 imaging resembling the cortical gyration of a mini-brain
MRI features (high and low refer to signal
intensity) Treatment
Low on all sequences Not needed
Nidus is low on T1 and high on T2, avidly
enhancing; broad, enhancing reactive zone (not
malignant!) nidus easily missed on MRI, CT is
preferred
Low on T1, high on T2, variable enhancement
peritumoral oedema and periosteal reaction
uid-uid levels if associated ABC
Typical (fatty stroma): High on T1, high on T2
atypical (vascular): Iso or low on T1, high on
T2
idem to atypical hemangioma, avid
enhancement, use fat saturation to see
extraosseous extension/cord compression
Low on T1, low to intermediate on T2, cystic
areas are high on T2, enhancement variable
Bone marrow signal, cortical bone signal
cartilage cap (high on T2)
Iso on T1, heterogeneous on T2 and after
contrast lobular matrix, low T1 and T2 rim,
bone marrow and soft tissue edema with
enhancement
Fluid-uid levels (lower layer is low on T2)
solid ABC exist
Hypo or iso, some high foci on T1 (entrapped
fat) high on T2, may sometimes enhance
Soft tissue component, sharp margin, thin
curvilinear bands (residual trabecula) uid-uid
levels if associated ABC
Low or iso on T1, high on T2, diffusely
enhancing
c
Surgical curettage or
percutaneous ablation
Surgery
Not needed
Optional: Embolization,
vertebroplasty, surgery
Not needed
Optional (resection)
Surgery (curettage)
Optional: Biopsy,
surgery, or calcitonin/
corticoid injection
Not needed, MRI
follow-up to exclude
chordoma
Surgery (resection)
Conservative, surgery

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ab
Fig. 20.16 (a–c) Osteoid osteoma in a child with inammatory pain
responding to salicylic acid and non-steroidal anti-inammatory drugs.
Use of these drugs are a diagnostic test for osteoid osteoma. On MRI, a
hypointense sclerotic center with extensive surrounding inammation
a
b
(reactive zone) on T2WI (a) and strong enhancement after IV contrast
on T1WI with fat suppression (b) is seen. CT to better advantage shows
the typical sclerotic rounded center with a hypodense rim representing
the osteoid nidus (c)
cd
c
Fig. 20.17 (a–d) Benign Notochordal Cell Tumor (BNCT) in an
asymptomatic young adult. Sclerotic lesion on CT involving a large
central area of the L3 body showing visible, undestructed bone trabeculae (a, b). On MRI, the lesion is hypointense on T1WI (c) and hyperin-
tense on T2WI (d). No contrast enhancement (not shown). Incidentally,
a vertebral hemangioma is present in the L4 body, hyperintense on T1
and T2 due to fatty content. Modic type 2 changes are present at level
L4-L5

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Fig. 20.18 (a–d) Giant cell
tumor in the cervical spine of
a young adult. Benign locally
aggressive tumor presenting
as a lytic expansile lesion
with cortical disruption and
soft tissue invasion. CT
demonstrates the osteolysis
but also a thin sclerotic rim in
the vertebral body (narrow
transition zone) and a thin
cortical shell that is rather
eroded and displaced than
destructed: signs of an
expansile erosive lesion but
not permeative (a, b). The
characteristic nding on MRI
is the heterogeneous to low
signal on T2WI representing
hemorrhagic components (c).
The lesion is hypointense on
T1 and avidly enhances after
IV contrast administration (d)
J. E. Vandevenne and A. Kastler
c
d
Table 20.4 Masses in the epidural space
Degenerative Disc herniation, ligamentum avum degeneration
(mucoid and cystic change, calcication,
hypertrophy), facet arthropathy, intraspinal synovial
Infectious Pyogenic abscess, tuberculous abscess, fungal
Neoplastic
benign
Neoplastic
malignant
Congenital Neurenteric cyst (more frequently intradural),
Other Epidural hematoma (spontaneous, post-traumatic,
facet cyst, frictional bursitis de novo in Baastrup,
ossication of posterior longitudinal ligament
(OPLL), retrodental pseudotumor of transverse
ligament
infection
Lipoma/lipomatosis, angiolipoma, cavernous
hemangioma, schwannoma, neurobroma,
meningioma, paraspinal arteriovenous malformation/
stula, arachnoid cyst, dermoid, epidermoid cyst,
extramedullary hematopoiesis
Lymphoma, metastasis, neuroendocrine spinal tumor
(paraganglioma)
meningeal cyst
post-surgery), pseudomeningocele, postoperative
brosis, early postoperative pseudomass (débris),
dilated venous plexus as collateral pathway in
inferior vena cava obstruction, Hirayama’s disease

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ab
Fig. 20.19 (a–c) Epidural lipomatosis on T1WI, often seen in over-
weight patients or secondary to steroids intake. In the thoracic spine,
excessive fat is usually present in the posterior epidural space (a), while
c
in the lumbar spine excessive fat surrounds the thecal sac resulting in a
Y shaped compression (b, c)

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Fig. 20.20 (a–d) Epidural
hematoma can occur after
trauma, secondary to a
vascular abnormality or
anti-coagulant therapy, or
spontaneously as in this case.
Blood signal on MRI will
vary according to age of the
hematoma. An epidural
hematoma posteriorly in the
spinal canal is shown with
intermediary signal on
non-contrast T1WI (a, c) and
typical hypointense signal on
T2WI (b, d). No contrast
enhancement was present (not
shown)
J. E. Vandevenne and A. Kastler
c
d

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311
Fig. 20.21 (a, b). Cavernous
hemangioma is rare in the
epidural space and presents
with typical low signal on T2,
hypo-intense to iso-intense
signal on T1 and with avid
enhancement (a, b). A
specic characteristic of
cavernous hemangioma is the
possible multilevel extension
and the association with an
osseous malformation such as
a vertebral hemangioma (b)
ab
20.5 Concluding Remarks
Important tumoral or infectious lesions may be missed if the
extraspinal soft tissues are not scrutinized by the radiologist.
Once a lesion is detected, the compartment of origin and the
extension to neigboring compartments needs to be determined using established classications. Many lesions can be
correctly diagnosed based on imaging features alone,
however when in doubt follow-up imaging or a biopsy can be
deemed necessary.
Take-Home Messages
• Beware of satisfaction of search and use your radiological skills to detect extraspinal lesions on every
CT and MRI of the spine you read.
• Add value by correctly grading and characterizing
masses in and around the spine.
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Open Access This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.
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Index
https://t.me/medicina_free
A
Abusive head trauma (AHT), 94
Acute disseminated encephalomyelitis (ADEM), 195, 217, 218, 271
Acute hemorrhagic encephalomyelitis (AHEM), 217
Acute inammatory demyelinating polyneuropathy (AIDP), 280
Acute necrotizing encephalopathy (ANE), 158
Acute viral encephalitis, 212
Adrenomyeloneuropathy (AMN), 130
Alexander disease, 132
Aneurysm, 59
Anoxic brain injury, 220, 221
Anterior longitudinal ligament (ALL), 288
Apparent diffusion coefcient (ADC), 274
Aquaporin-4 (AQP4), 193
Arbovirus, 79, 80
Arterial ischemic stroke (AIS), 206
Arteriovenous malformation, 57, 58
Aspergillosis, 77
Astrocytomas, 44
Autoimmune and limbic encephalitis, 81, 82
Autoimmune CNS vasculitis, 84, 85
B
Bacterial abscess, 119, 126
Baló concentric sclerosis, 192, 193
Behcet’s disease, 119, 125
Benign Notochordal Cell Tumor (BNCT), 307
Blood mimics, 66, 67
Blunt cerebrovascular injury (BCVI), 290, 291
Brain abscess
differential diagnosis, 74
MRI features, 73–75
Brain MRI-based SIH score (bSIH), 15
Burst fracture, 288
C
Carbon monoxide (CO), 161, 162
Carotid artery-cavernous sinus stulas (CCF), 103, 104
Carotid space (CS), 245, 246
Cavernous malformations, 62, 64, 275
Central nervous system (CNS), 86, 211–213
brain abscess
differential diagnosis, 74
MRI features, 73–75
characteristics, 69, 70
HIV infection
aspergillosis, 77
IRIS, 77
toxoplasmosis, 77
tuberculosis, 77–79
inammatory disease, 81–85
meningitis
causes and complications, 71
differential diagnosis, 70
imaging features, 70–73
MRI technique, 70
parasitic diseases, 76
viral infections, 79–81
Central pontine myelinolysis (CPM), 215
Cerebral amyloid angiopathy, 61–63
Cerebral neoplasms
diagnosis, 45
gliomas in children
BRAF mutation, 46
overview, 46
radiological features, 46
gliomatosis cerebri, 45
histone H3-K27 altered tumors, 46
HPC, 47
IDH-mutant gliomas
clinical relevance and prognosis, 42
radiological features, 42, 43
types, 42
multinodular vacuolating neuronal tumor, 47
overview, 42
1p/19q-codeletion
astrocytomas, 44
clinical relevance and prognosis, 44
radiological features, 44, 45
SFT, 47
WHO classication, 41, 42
Cerebral spinal uid (CSF) leak
etiology, 14, 15
imaging, 15–18
TBI, 109
treatment, 17, 18
venous stula, 15
Cerebral venous sinus thrombosis, 58, 59
Cerebrospinal uid (CSF), 159
Cervical lymphadenopathy, 258, 259
Chiasmatic and hypothalamic gliomas, 8, 9
Cholesteatoma, 233
Cholesterol granuloma, 234, 235
Chordoma, 304
Chronic inammatory demyelinating polyneuropathy
(CIDP), 280
Clinically isolated syndrome (CIS), 191–192
Coagulopathy, 66
Combination anti-retroviral therapy (cART), 196
Communicating hydrocephalus, 21, 23, 25
Consciousness, 155
COVID-19 pandemic, 70
© The Editor(s) (if applicable) and The Author(s) 2024
J. Hodler et al. (eds.), Diseases of the Brain, Head and Neck, Spine 2024-2027, IDKD Springer Series,
https://doi.org/10.1007/978-3-031-50675-8
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Index
Cranial nerves (CNs)
anatomy, 168, 169
extracranial lesions
demyelinating diseases, 182
facial lesions, 180
granulomatous diseases, 182
Graves’ disease, 182
infectious diseases, 181, 182
muscle atrophy/dystrophy, 180
nerve sheath tumours, 183
orbital diseases, 180
orbital pseudotumor, 182
primary nerve lesions, 182, 183
secondary nerve involvement, 183, 184
suprahyoid level, 180
trauma, 184, 185
upper mediastinum, 185
vascular lesions, 181
imaging technique, 169–172
intraaxial lesions, 173
demyelinating disease, 172, 173
infectious diseases, 173
ischemic stroke, 172, 173
overview, 172
trauma, 172
vascular malformations, 172, 173
intracranial extraaxial lesions
aneurysm, 176
arterial dissection, 176
dermoid cysts, lipomas and neurenteric cysts, 176
epidermoid cysts, 175, 176
infectious diseases, 176, 177
meningiomas, 175
nerve sheath tumours, 174, 175
non-infectious inammatory diseases, 177
NVCS, 176
overview, 174
pineal tumours and cysts, 176
pituitary adenomas, 176
subarachnoid CSF encapsulation, 176
trauma, 177
skull base lesions
cavernous sinus, 179, 180
contrast enhanced 3D BB images, 178
foramina, ssures and canals, 177
infections and tumours, 178, 179
neuritis, 178
trauma, 178
Craniocervical junction (CCJ), 288
Craniopharyngiomas, 7
D
Degenerative cervical myelopathy (DCM), 268
Demyelinating disease, 172, 173, 182
Denver grading scale, 291
Diabetes insipidus (DI), 109
Diabetic ketoacidosis (DKA), 215
Diffuse axonal injury (DAI), 97, 99, 101, 103
Diffuse large B-cell lymphoma, 305
Drowning, 220, 221
Drug-induced encephalopathy, 135
Dural arteriovenous stulae (dAVF), 61
E
Encephalitis, 214, 215
Encephalomalacia, 109
Endovascular therapy (EVT), 30
Enlarged vestibular aqueduct syndrome (EVA), 232
Enteroviruses, 272
Ependymoma, 279, 280
Epidermoid cysts, 175, 176
Epidural blood patch (EBP), 17, 18
Epidural hematoma (EDH), 91–93
Epidural Spinal Cord Compression (ESCC) score, 299, 300
Epilepsy
denition, 137
epileptogenic tumors, 147–149
etiology, 137
focal epilepsy, 149–151
image indication, 138–141
MCD, 143–147
MTS, 141–143
Epileptogenic tumors, 147–149
Ethylene glycol poisoning, 161, 162
External auditory canal (EAC), 228
Extranodal extension (ENE), 253
Extrapontine myelinolysis (EPM), 215
F
Fabry disease, 132
Facial nerve palsy (FNP), 218, 219
Flaviviruses, 272
G
Galactocerebrosidase deciency, 132
GBMs, 119, 121
Giant cell tumor, 308
Gliomas
BRAF mutation, 46
overview, 46
radiological features, 46
Gliomatosis cerebri, 45
Globoid cell leukodystrophy (GLD), 130, 131
Glomus tympanicum, 233, 234
Granulomatous diseases, 182
Graves’ disease, 182
Guillain-Barré syndrome, 280
Gunshot wound, 107, 108
H
Head and neck spaces
carotid space, 245, 246
infrahyoid neck, 243–245
PVS, 247
RPS, 246, 247
suprahyoid neck
masticator space, 240
parotid space, 240, 241
PMS, 238, 239
PPS, 239
SLS, 242, 243
SMS, 242, 243
Head and neck squamous cell cancer (HNSCC)

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315
cervical lymphadenopathy, 258, 259
hypopharynx/larynx SCC, 257, 258
imaging methods
computed tomography, 252
magnetic resonance imaging, 252
MR/PET, 253
PET/CT, 252
ultrasound, 253
morbidity and mortality rates, 251
NCUP, 261, 262
NPC, 254
OCSCC, 255, 256
OPSCC, 256, 257
PNS, 259, 260
surveillance, 260, 261
TNM staging, 253
Hearing loss
anatomy, 228, 229
causes, 228
computed tomography, 229, 230
magnetic resonance imaging, 230
with mass
cholesteatoma, 233
cholesterol granuloma, 234, 235
glomus tympanicum, 233, 234
vestibular schwannomas, 232, 233
without mass
EVA, 232
labyrinthitis ossicans, 231
otospongiosis, 230, 231
superior semicircular canal dehiscence, 231, 232
Hemangioblastomas, 279
Hemangiopericytoma (HPC), 47
Hemorrhagic contusion, 289, 290
Hemorrhagic encephalitis, 66
Hepatic encephalopathy (HE), 133, 134, 197
Herniation syndrome, 159, 160
Herpes simplex virus, 79, 80
Herpes simplex virus (HSV) type 1, 212
Herpes simplex virus (HSV) type 2, 212, 213
HIV-associated neuron-cognitive disorder (HAND), 196
Human Immunodeciency Virus (HIV), 196, 273
Human papillomavirus (HPV), 251
Hydrocephalus, 219, 220
assessment, 19
brain CT, 19
cardiac-gated phase contrast MRI (PC-MRI), 19
causes, 19, 20
communicating hydrocephalus, 21, 23, 25
denition, 19
non-communicating (obstructive) hydrocephalus, 21, 23, 24
protocol recommendations, 20, 21
radiological ndings, 20, 22
Hyperextension, 288
Hyperexion injuries, 287
Hyperglycemic encephalopathy, 135
Hypertensive hemorrhage, 62, 63
Hypoglycemic encephalopathy, 134, 135
Hypoperfusion injury, 157
Hypopharynx/larynx SCC, 257, 258
Hypoxic-ischemic encephalopathy (HIE), 135
I
Idiopathic (iNPH), 23
IgG4-related disease, 82, 83
Immune reconstitution inammatory syndrome (IRIS), 77, 196
Infectious diseases, 173
Instability, 287
Internal auditory canal (IAC), 229
Intracranial hemorrhages (ICH), 208, 209, 216
Intracranial hypertension, 105, 106
Intracranial masses
extraaxial neoplasms, 114, 118, 119
intraaxial neoplasms, 114
bacterial abscess, 119, 126
Behcet’s disease, 119, 125
features, 119
GBMs, 119, 121
giant cavernoma, 119, 125
giant thrombosed aneurysm, 119, 124
lymphoma, 119, 122
neurocytomas, 119, 122
oligodendrogliomas, 119, 121
sarcoidosis, 119, 125
subacute stroke, 119, 123
T2/FLAIR mismatch, 119, 120
toxoplasmosis, 119, 126
metastatic disease, 117
multiple lesions, 116
neoplastic vs. non-neoplastic disease, 114–116
pattern recognition, 114
single lesions, 116, 117
time course of disease, 113, 114
Intracranial pressure (ICP), 159, 160
Intraparenchymal hemorrhage
aneurysm, 59
arteriovenous malformation, 57, 58
cavernous malformations, 62, 64
cerebral amyloid angiopathy, 61–63
cerebral venous sinus thrombosis, 58, 59
coagulopathy, 66
dAVF, 61
etiology, 55–57
hemorrhagic encephalitis, 66
hemorrhagic transformation, 59
hypertensive hemorrhage, 62, 63
imaging features, 55
intracranial infections, 60
intratumoral/peritumoral hemorrhage, 65
moyamoya disease, 59, 60
overview, 54, 55
PRES, 61
primary CNS vasculitis, 61
prognostic factors, 55
reversible cerebral vasoconstriction syndrome, 59, 60
Intratumoral/peritumoral hemorrhage, 65
Intraventricular hemorrhage (IVH), 95–97
Ischemic stroke, 59, 172, 173
K
Krabbe disease, 130, 131
L
Labyrinthitis ossicans, 231
Large vessel occlusion (LVO), 30
Leucine-rich glioma inactivated 1 (LGI1) antibody, 81, 82
Levator palatini muscle, 254
Ligamentous injury, 288, 289
Long-term epilepsy associated tumors (LEAT), 147
Lumbar puncture (LP), 70
Lumbar spine, 288
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