MRI of Intramedullary Spinal Cord Hemangioblastoma

General Findings

  • Average size of the tumor is 1 cm or less.
  • Extension to pia: The solid portion of the tumor will typically extend to the pia with  majority going to dorsal surface (5).
  • Cysts are present in more than 50% of patients with these tumors.  When present, the solid portion of the tumor will be a nodule coming off the cyst wall.
  • Flow voids are commonly seen in tumors that are larger than 1.5 cm.

T1-Weighted Sequence

  • Iso-, hypo- or mixed-intensity.
  • Blurred margins due to infiltrative nature of tumor.
  • Gadolinium enhances: The solid portion of the tumor will vividly enhance in a homogeneous manor if the tumor is less than 1 cm in diameter.  When the tumor is larger, the enhancement will be heterogeneous.
T1-weighted MRI with gadolinium enhancement of an intramedullary hemangioblastoma:

 

T2-Weighted Sequence

  • Hypointense: Hemangioblastomas will appear hypointense on T2-weighted sequences and commonly there will be a surrounding hyperintensity due to the edema in the cord.
T2-weighted MRI of an intramedullary hemangioblastoma: