Figure 1
Calcified mass in the spinal canal
Unenhanced CT shows a calcified mass in the thoracic spinal canal. No mediastinal mass is seen.
Meningioma of the Thoracic Spine
SectionNeuroradiology
Case TypeClinical Cases
AuthorsHughes D, Day N, Healy A, Aw Yeang HW, Vasireddy N
Connected authors
71 years, female
Clinical History
Asymptomatic patient underwent chest CT for follow-up of a mediastinal sarcoma.
Imaging Findings
Asymptomatic patient underwent chest CT for follow-up of a successfully treated mediastinal sarcoma. A calcified mass in the spinal canal was incidentally noted. No neurological abnormality was found on examination of the lower limbs. An MRI of the thoracic spine was performed to further assess the lesion. This showed an intradural extramedullary mass, which enhanced with gadolinium, and displaced and compressed the thoracic spinal cord.
Discussion
Intradural, extramedullary lesions are located outside the spinal cord but within the thecal sac. The two most common lesions in this group are nerve sheath tumours (schwannomas and neurofibromas) and meningiomas. Less common lesions include arachnoid cysts, drop metastases, vascular malformations, lipomas and subdural haematomas.
Meningiomas account for 15 to 45% of spinal cord tumors. They have a 6:1 female to male preponderance. Although the vast majority are intradural, extramedullary, some may be extradural, or even a mixture of both.
They are generally benign and slow-growing tumours. Because they are slow growing, marked cord compression may exist by the time they are discovered.
MR findings include a well-circumscribed mass that is isointense to cord on T1. On T2, they are isointense to slightly hyperintense to cord, silhouetted by the bright signal of CSF. Intense, homogeneous enhancement is usual, unless there is dense calcification, in which case heterogeneous appearances may occur. If a meningioma is small and asymptomatic in a person over 65, it may just be observed. Observation usually involves annual CT or MRI. Larger tumors, those with symptoms or those that show progressive growth should be treated. Treatment options include surgery and radiation therapy. Research into medical therapy for meningiomas is ongoing and maybe a treatment option in the future.
Meningiomas account for 15 to 45% of spinal cord tumors. They have a 6:1 female to male preponderance. Although the vast majority are intradural, extramedullary, some may be extradural, or even a mixture of both.
They are generally benign and slow-growing tumours. Because they are slow growing, marked cord compression may exist by the time they are discovered.
MR findings include a well-circumscribed mass that is isointense to cord on T1. On T2, they are isointense to slightly hyperintense to cord, silhouetted by the bright signal of CSF. Intense, homogeneous enhancement is usual, unless there is dense calcification, in which case heterogeneous appearances may occur. If a meningioma is small and asymptomatic in a person over 65, it may just be observed. Observation usually involves annual CT or MRI. Larger tumors, those with symptoms or those that show progressive growth should be treated. Treatment options include surgery and radiation therapy. Research into medical therapy for meningiomas is ongoing and maybe a treatment option in the future.
Differential Diagnosis List
Meningioma of the thoracic spine
Final Diagnosis
Meningioma of the thoracic spine
References
[1]
Gelabert Gonzalez M, Garcia Pravos A, Fernandez Villa JM.
Spinal meningiomas.
Neurologia 2000 Feb;15(2):58-62. (PMID: 10769533)
[2]
Gezen F, Kahraman S, Canakci Z, Beduk A.
Review of 36 cases of spinal cord meningioma.
Spine 2000 Mar 15;25(6):727-31. (PMID: 10752106)
[3] Zimmerman RA, Gibby WA, Carmody RF<br>Neuroimaging. Clinical and physical principles.<br>Springer-Verlag, New York (2000).
Case information
| URL: | https://www.eurorad.org/case/2321 |
| DOI: | 10.1594/EURORAD/CASE.2321 |
| ISSN: | 1563-4086 |
Figure 2
Intradural, extramedullary mass
T2 weighted sagittal section showing an Intradural, extramedullary mass which is displacing and compressing the thoracic spinal cord.
Figure 3
Intradural, extramedullary mass
T1 weighted gadolinium enhanced sagittal section showing an enhancing intradural, extramedullary mass which is displacing and compressing the thoracic spinal cord.
Figure 4
Intradural, extramedullary mass
T1 weighted gadolinium enhanced axial section showing an enhancing intradural, extramedullary mass which is displacing and compressing the thoracic spinal cord. The enhancement is more intense peripherally, as there is dense calcification centrally. There is enhancement of the dura peripheral to the tumour, producing the "dural tail" sign.
Calcified mass in the spinal canal
Unenhanced CT shows a calcified mass in the thoracic spinal canal. No mediastinal mass is seen.
Intradural, extramedullary mass
T2 weighted sagittal section showing an Intradural, extramedullary mass which is displacing and compressing the thoracic spinal cord.
Intradural, extramedullary mass
T1 weighted gadolinium enhanced sagittal section showing an enhancing intradural, extramedullary mass which is displacing and compressing the thoracic spinal cord.
Intradural, extramedullary mass
T1 weighted gadolinium enhanced axial section showing an enhancing intradural, extramedullary mass which is displacing and compressing the thoracic spinal cord. The enhancement is more intense peripherally, as there is dense calcification centrally. There is enhancement of the dura peripheral to the tumour, producing the "dural tail" sign.