Imaging of Intramedullary Spinal Cord Lesions Neuroradiologic and Advanced Imaging Perspectives for Surgical Decision-Making.

Intramedullary spinal cord lesions represent a rare, clinically consequential group of pathologies where imaging plays a decisive role in diagnosis, operative planning, and longitudinal management. MRI remains the cornerstone of evaluation, providing critical information regarding lesion localization, extent, internal composition, and relationship to functional spinal cord pathways. Advanced MRI techniques including diffusion tensor imaging, susceptibility-weighted imaging, and intraoperative ultrasound have expanded the neuroradiologic toolkit but have limitations, particularly in pediatric patients. This review focuses on the neuroradiologic evaluation of intramedullary spinal cord lesions, imaging technical considerations, pattern recognition, and practical pearls relevant to neurosurgeons and neuroradiologists managing these challenging entities.