Differentiation between Spinal Intramedullary Astrocytoma and Spinal Multiple Sclerosis Using Clinical and Radiologic Factors

Abstract

Objective: Both spinal multiple sclerosis (SMS) and spinal intramedullary astrocytoma (SIA) are rare space-occupying lesions in the spinal cord and clinically show various myelopathy symptoms. Both clinical and imaging findings are similar and are easily misdiagnosed. This study is to clarify clinical and radiographic finding that could be helpful to differentiate SMS from SIA.Methods: We compared the demographic, clinical, and radiographic characteristics between the SIA and SMS groups. The SIA group (n=13) was diagnosed postoperatively with pathologic confirmation, and the SMS group (n=25) was composed of patients who have a lesion in the spinal cord and met the McDonald criteria for the diagnosis of multiple sclerosis (criteria revised in 2010).Results: Clinically, patients with SIA had a significantly longer symptom duration before the first visit than SMS (4.9±4.4 vs. 2.1±3.6 months, p=0.008). All persons with SIA showed progressive disease course, whereas 95.8% of persons with SMS showed remission (p<0.001). In contrast to SMS, the involvement of both halves of the spinal cord was more frequently observed in patients with SIA (p<0.001). In addition, fusiform dilation in the sagittal plane (p<0.001) or tumoral cyst (p=0.001) also significantly suggested SIA rather than SMS.Conclusion: Despite many limitations of this study, the present data demonstrated the clinical and imaging features helpful in distinguishing SIA from SMS. As with most tumors, SIA tends to show a slowly progressive clinical course without remission. Occupation of both halves of the spinal cord, fusiform dilation, or cysts was favoring radiographic factor for the SIA.