【临床病史】：患者，男性，48岁，背痛数年，伴有步态障碍及下肢无力。48-year-old male admitted with complaints of mid back pain for several years with associated gait disturbance and weakness of the lower extremities
【影像图片】MRI图像
【影像表现】：Figure 1: Intramedullary mass at the T9-T10 level with hyperintense signal on T1-weighted sequence (orange arrow).图1：T9-T10水平髓内肿块，T1序列亦呈高信号。
Figure 2: Intramedullary mass at the T9-T10 level with hyperintense signal on the T2 -weighted sequence (orange arrow).图2：T9-T10水平髓内肿块，T2序列呈高信号
Figure 3: Fat suppression on the STIR image (orange arrow).图3：Stir序列上脂肪被抑制
Figure 4and Figure 5: Fat saturation on the T1 fat saturated post contrast images and no enhancement of the lesion. There also is splaying of the spinal cord at this level (orange arrow). 图4和图5：T1压脂增强扫描，病变无明显强化。
【影像诊断】：髓内脂肪瘤.Surgically proven intramedullary lipoma
【诊断要点】：
Intramedullary lipoma of the spinal cord is a rare tumor comprising about 1 % of intramedullary tumors. 髓内脂肪瘤是一种少见的肿瘤，约占髓内肿瘤的1％
MRI is diagnostic. MRI是首选的诊断方式
Intraspinal lipomas can be a lipomyelomeningocele, a filum terminale lipoma or an intradural intramedullary lipoma. All these have a high association with dysraphism. 髓内脂肪瘤可以是脂肪瘤型脊膜膨出、终丝脂肪瘤或髓内硬膜下脂肪瘤。这些都与神经根闭合不全高度相关。
Treatment of intramedullary lipomas is controversial. Some advocate early decompression before onset of symptoms because once symptoms set in there is a high chance of residual deficits after surgery.髓内脂肪瘤的脂肪瘤是有争议的。一些人主张在症状出现前早期减压，因为一旦症状出现后再行手术有很高的几率出现后遗症。
【讨论】：99% of intramedullary lipomas are associated with spinal dysraphism. Most tumors occur in the dorsal cervical and thoracic cord.
99％的髓内脂肪瘤是与椎管闭合不全相关的。大多数的肿瘤发生在颈胸部背侧脊髓。
Intramedullary lipomas are rare. These comprise 1-2 % of intramedullary tumors. Multiple noncontiguous intramedullary lipomas are even rarer. These affect both sexes equally. Most patients present with symptoms during the first 2 -3 decades of life. Most have a slow progression of neurological deterioration. Sensory disturbances, pain, ataxia and lower extremity weakness are the most common presenting complaints. Urinary and bowel incontinence present later. CT can show a fatty lesion and MRI is diagnostic. They have a short T1 relaxation time and are bright on T1 weighted images and also bright on T2 weighted images following signal intensity of subcutaneous fat. There is very little enhancement. Treatment is still controversial and some physicians advocate early decompression before onset of symptoms because of significant residual deficits after surgery in symptomatic patients. Complete resection is not possible in intramedullary lipomas.
髓内淋巴瘤少见，仅占髓内肿瘤的1-2％。多发性非连续性的髓内脂肪瘤更为少见。无性别差异。大多数病人在20-30岁的时候出现症状。多数病人有缓慢进展的神经学退变。感觉异常、疼痛、共济失调和下肢无力也是最常见的临床主诉。晚期可以出现尿失禁和肠失禁。CT可以显示脂性病变，但MRI是确诊的方法。表现为短T1长T2信号，类似于皮下脂肪的信号强度。几乎没有强化。治疗方式尚有争议，一些医生提倡在症状出现前早期减压，因为一旦症状出现后再行手术有很高的几率出现后遗症。髓内脂肪瘤完全切除是不可能的。