31.1 Case Presentation

A 16-year-old female patient with history of a motor vehicular collision presents with complaint of neck pain and thoracic region back pain.

31.2 Imaging Analysis

Spine MRI from a 16-year-old female patient with sagittal T2-wighted (T2w; ▶ Fig. 31.1a), sagittal T1-weighted (T1w; ▶ Fig. 31.1b), and axial T2w (▶ Fig. 31.1c) images. A slightly enlarged central canal is noticed (arrows); however, there are no additional abnormalities of the spinal cord in course, overall diameter, or surrounding parenchymal signal intensity.

31.3 Differential Diagnosis

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  Prominent central canal:

  
  
  
  
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    This refers to a slightly expanded central canal filled with cerebrospinal fluid (CSF) without any spinal cord signal abnormality or enhancement.

  
  
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  Cystic spinal cord neoplasm:

  
  
  
  
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    The imaging hallmarks are cord signal abnormality, mass effect, contrast enhancement, and associated with neurological symptoms. ¹

  
  
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  Syringohydromyelia:

  
  
  
  
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    Cystic dilatation of the central canal that could be isolated or associated with congenital anomalies in up to 30% of cases. ¹

    
    
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    The entire spine MRI should be performed to rule out low-lying cerebellar tonsils (Chiari I malformation) as well as low-lying conus with or without fatty filum (tethered cord).

  
  
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  Myelomalacia:

  
  
  
  
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    Cord atrophy secondary to previous vascular, traumatic, or other injury.