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Lumbar Spine Solid Schwanoma vs. Meningioma

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This is another patient who presented with low

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back pain but had an element of fecal and

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urinary incontinence associated with it.

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We have the T1-weighted scan to the left,

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the T2-weighted scan centrally,

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and the STIR image on the right-hand side.

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It's pretty clear that we have this mass that

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is centered at the L1-L2 disc level.

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We would describe this lesion as being intradural

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extramedullary because it does indeed have

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that meniscus sign of CSF above and below it.

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That is the widening of the CSF space.

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We also know that this is intradural extramedullary

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because we are at a level where we

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are below the spinal cord termination,

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generally at the L1 level or L2 level,

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and therefore this is going to be in

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the intradural extramedullary space.

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This is a purely solid lesion.

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In this location,

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we have a differential diagnosis which would

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include either a meningioma or a schwannoma.

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But just looking at the numbers in the lumbar

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level, schwannomas outnumber Meningiomas,

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this lesion does have a basis that it is along

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the posterior dura and therefore it could have

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arised from this posterior dura and could be a

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meningioma. Let's look at the axial scans.

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I'm just going to window these a little

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bit better for the audience.

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And here we have the mass on the T2-weighted

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axial scan. And it is, as you can see,

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intradural within the thecal sac,

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but outside the spinal cord,

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which is demonstrated above the lesion.

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So here's the termination of the spinal cord,

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the so called conus medullaris,

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and then we rise with this mass.

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So the post-gadolinium-enhanced scans,

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which were not performed since this was

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done as a DJD low back pain protocol,

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might help us in distinguishing between a

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schwannoma versus a meningioma, in that

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meningiomas tend to have a dural

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based tail as opposed to schwannomas,

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which do not have that dural enhancement

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associated with it. In this case,

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just based on the numbers,

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we would say schwannoma favored over meningioma.

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Recommend gadolinium-enhanced pulse sequences

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for further evaluation.

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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