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Calcified Meningioma

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This was a case of a patient who was being evaluated

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for a thoracic aortic aneurysm study,

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and this was a CTA that was being done.

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However,

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the body CT people identified that there was an

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abnormality in the thoracic spinal column.

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And we see that within the intradural

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extramedullary space,

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we have a mass which is rounded and appears to

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be eccentric or outside the spinal cord.

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So, again, intradural but extramedullary.

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How do we know that this is not arising

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from the bone? On the sagittal scan,

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it actually looks like it could be

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a lesion of the spinous process,

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in which case it would probably be called an extradural

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lesion. For this reason, an MRI was requested.

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Here is the MRI scan that was performed after

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the CTA identified the abnormality. And when

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we look at the MRI scan on the T1-weighted

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and T2-weighted scan,

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I think we're more comfortable in saying that this

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is indeed an intradural extramedullary lesion.

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How so? On this example,

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you see that there is a meniscus sign.

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So the CSF space is widened at the level of the lesion

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above and below the lesion, and therefore,

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this must be intradural extramedullary.

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If it really was arising from the spinous process,

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as we were concerned about with the CT scan,

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it would lead to narrowing of the CSF

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space at the level of the lesion.

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So this is indeed a calcified intradural

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extramedullary lesion. And with that,

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we would say this is most likely a meningioma.

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We'd want to look at the post gadolinium-enhanced scans

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because meningiomas do show typically

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uniform enhancement. Now, this is a little bit tricky because

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this lesion was calcified,

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and calcification generally does not show enhancement.

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But let's let's look at it nonetheless.

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So let's pull down the post gadolinium-enhanced scans,

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and I will then magnify this for you and

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bring it up a little bit into our area.

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So there we go. So, on this pair of scans,

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we have the non-contrast scan on the right and the

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post-contrast T1-weighted scan on the left.

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And what you see is indeed an enhancing lesion that is

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in the intradural extramedullary compartment in the thoracic

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spine, which showed calcification. This is a meningioma.

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Absolutely.

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Move on to the next case.

Report

Description

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Spine

Neuroradiology

Neoplastic

Musculoskeletal (MSK)

MRI

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