IMAGING OF SPINAL-CORD HEMANGIOBLASTOMAS

Hemangioblastomas, which are associated with von Hippel-Lindau disease, represent the third most common type of intramedullary spinal cord tumour. The authors reviewed the radiologic findings in five cases of surgically proven spinal cord hemangioblastoma. Magnetic resonance imaging (MRI) could be used to differentiate the various components of these tumours, including the tumour nodule, edema, cysts and syringomyelia. The tumour nodule could be identified as an isointense area surrounded by edema, a cyst or syringomyelia, or as an area adjacent to a signal void (which represented feeding and draining vessels). Tumour nodules demonstrated intense enhancement when gadolinium diethylenetriaminepenta-acetic acid was administered. Edema appeared as an ill-defined region of moderately low signal intensity in T1-weighted images and moderately high signal intensity in T2-weighted images. Cysts and syringomyelia appeared as well-defined regions of low signal intensity in T1-weighted images and high signal intensity in T2-weighted images. MRI allows the radiologist to assist the surgeon in determining preoperatively the level of laminectomy appropriate to resect the tumour. Preoperative embolization of the posterior spinal arteries, facilitated by angiography, can be important in reducing perioperative hemorrhage.