Pediatric Spinal Neoplasia: A Practical Imaging Overview of Intramedullary, Intradural, and Osseous Tumors

Imaging of the pediatric spine can be a daunting task for pediatric radiologists, neuroradiologists, and musculoskeletal imagers alike. This is in large part consequent to multiple differential considerations that are frequently specific to this patient population. Though a definitive diagnosis is not always possible through imaging, determining an appropriate anatomical compartment facilitates a more focused differential list, and therefore provides value to the treating providers. This is typically achieved with magnetic resonance imaging and computed tomography. The purpose of this paper is to equip the radiologist with a useful approach to the imaging of, and creating a practical differential for tumors of the pediatric spine. This includes intramedullary, intradural, and osseous pathology. We focus on the most commonly encountered lesions in each of the above compartments. We discuss less common lesions where appropriate owing to their incidence in the adult spine or pediatric extraspinal locations, and are often included in imaging reports or tumor board discussions. As such, this review offers the radiologist a reasonable and reproducible framework for imaging and diagnosing the vast majority of lesions encountered in the pediatric spine.