The possible causes of a round-like T2WI high signal shadow seen in the spinal canal at the sacral 2-3 level include hemorrhage, inflammation, and tumor. In magnetic resonance examination of the sacrococcygeal region, because of the low water content of normal bone, it shows low signal in T2WI, and the higher water content often shows high signal. 1. When sacral fracture caused by trauma results in intradural hemorrhage, because of the high water content of the blood, and more confined may show T2WI rounded high signal shadow. 2. When an infection occurs in the spinal canal, causing edema, which is more confined, there is also a certain possibility that it may be manifested as a T2WI-like rounded high signal shadow. 3. Because the tumor cells grow to the surrounding area, forming a cystic mass, which can be manifested as a T2WI rounded high signal shadow in MRI. Commonly, there are neurofibromas, teratomas, intravertebral metastases and so on. As for whether it is a benign or malignant tumor, further examination and pathological biopsy are needed to clarify. There are many causes of round-like T2WI high signal shadow in the spinal canal at the sacral 2-3 level, so it is recommended to clarify the cause and carry out targeted treatment under the guidance of a doctor.