Q. MRI spine showed intramedullary mass at T4. Is it a cyst or malignancy?

Answered by
Dr. Sharoff Lokesh Mohan
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 22, 2018 and last reviewed on: Nov 29, 2022

Hello doctor,

I had an MRI of the thoracic spine and it showed an intramedullar mass at level T4. I was told it is likely to be a cyst and is not malignant. However, everything I have read online says that intramedullar lesions are almost always malignant and cysts are rare or maybe evidence of MS, which my uncle had, so now I am worried. The reports says it is a fusiform mass with hypersignal intensity at T2W1 and hyposignal intensity at T1W1.

Kindly advise.



Welcome to

Can you attach the MRI images and upload it so that I can review them?

Thank you doctor,

I have attached the files. Please have a look.



Welcome back to

I have seen your MRI scans (attachment removed to protect patient identity). The lesion is cystic but it can be benign or malignant. Cystic lesions does not mean that it can only be benign. It can be a benign focal syrinx or an ependymoma which can either be benign or malignant, or locally aggressive cystic lesions. Mostly ependymomas require removal surgically with or without radiation therapy. Recurrences are common if the cyst is not removed surgically.

Is there weakness of the lower limbs or urinary or bowel problems? Can you detail the symptoms the patient has? And also the duration of symptoms?

I hope this helps.

Take care.

Hi doctor,

That is helpful to know, thank you. So how can I tell which type it is? Only by removing? My symptom has been pain around my right side on my ribs for nearly a year. I am not sure if this would be the cause. No lower limb weakness is there.



Welcome back to

Yes, surgical excision and histopathology testing will help in knowing the type of lesion. The neuro or spine surgeon will take the final decision after clinically examining you. Pretty difficult to exactly say the type of lesion by MRI according to me.

I hope this helps.

Thank you.

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