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Bruno Cunha1,2, Alexandra Rodrigues1,2,3, João Gonçalves1,2,3, Carla Conceição1

1 - Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
2 - NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
3 - Unidade de Neurorradiologia, Hospital Central do Funchal, Funchal, Portugal

- J Neuroimaging. 2022;1–18. DOI: 10.1111/jon.13037

Several distinct conditions present as cystic or pseudocystic lesions within the spinal canal. Some of the most common spinal cystic lesions include spinal meningeal cysts, juxtafacet cysts, dermoid/epidermoid cysts, nerve sheath tumors, and syringohydromyelia. Clinical presentation is usually nonspecific and imaging characteristics are frequently overlapping, which may pose a challenging presurgical diagnosis.We provide a pictorial review of cystic intraspinal lesions and discuss the main imaging features that can aid the neuroradiologist in the differential diagnosis. First, we propose a categorization  of the lesions according to their location as extradural, intradural extramedullary, and intramedullary. This is a crucial initial step in the diagnostic workup and surgical planning. Second, for each of these locations, we organize the lesions according to their etiology: congenital and developmental disorders, degenerative disorders, traumatic or postsurgical collections, infectious conditions, neoplastic lesions, and othermiscellaneous disorders. Finally, we summarize the clinical highlights and MR features that provide important insights for the differential diagnosis.MR is the technique of choice in presurgical evaluation and postsurgery follow-up. It provides accurate lesion localization and characterization and, most of the times, it will allow a confident differential diagnosis. High-resolution three-dimensional T2-weighted sequences and diffusion-weighted imaging can provide important hints in specific cases. Signal correlation with T1-weighted and fat-saturated sequences allows to differentiate true cystic lesions from hemorrhage or fat tissue.

Keywords: extradural spinal lesions, intradural extramedullary lesions, intramedullary lesions, MR imaging, neuroradiology, spine