HEALSME: Differential Diagnosis for Intramedullary Spinal Cord Lesions

Our purpose is to illustrate and review the differential diagnosis for intramedullary spinal cord lesions and masses and to discuss their distinguishing MR imaging features and clinical presentations. An approach to these lesions by using location, signal-intensity characteristics, and patient age significantly narrows the differential diagnosis. The mnemonic HEALSME can help recall a location-based differential diagnosis, accounting for most intramedullary spinal cord lesions, which can be further refined on the basis of patient age, presentation, and imaging features. HEALSME encompasses a variety of intramedullary pathologies, including but not limited to hemangioblastoma, ependymoma, astrocytoma, lymphoma, syrinx, metastasis, MS, and edema. Images of representative entities are presented, and distinguishing imaging features, diagnostic imaging pearls, patient demographics, and prognoses are discussed. Additional less common entities will also be reviewed.