Weekly Image Challenge – April 2, 2023

What is the most likely diagnosis for this 30-year-old male patient who had presented with neck pain and bilateral upper extremity numbness and motor weakness?

  1. Ependymoma
  2. Astrocytoma
  3. Schwannoma
  4. Meningioma
  5. Metastasis


Congratulations to all who selected Ependymoma. It is an intramedullary lesion, which is well-circumscribed. It is iso- to hypo-intense on T1, and hyper-intense on T2, and shows contrast enhancement. There is a hypo-intense cap sign (hemosiderin rim) which signifies associated hemorrhage. The T2-weighted image shows surrounding edema and syringomyelia.

Astrocytoma was a close differential. It is often ill-defined and not well-circumscribed, heterogenously enhances on contrast, and usually does not have associated hemorrhage.

Spinal metastasis is rarely intramedullary and is often dural-based.

Spinal schwannoma and meningioma are are extra-medullary tumors, and often show homogenous enhancement.