Ginkgo leaf sign: a highly predictive imaging feature of spinal meningioma

Yamaguchi, Satoshi; Takeda, Masaaki; Takahashi, Toshiyuki; Yamahata, Hitoshi; Mitsuhara, Takafumi; Niiro, Tadaaki; Hanakita, Junya; Hida, Kazutoshi; Arita, Kazunori; Kurisu, Kaoru

doi:10.3171/2015.3.spine1598

Cited by 25 publications

(14 citation statements)

References 12 publications

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“…By contrast, schwannomas generally originate from the dorsal rootlets and are usually found in the dorsal or dorsolateral side to the spinal cord. 13) In the present case, T2-weighted MR images depicted the extradural part as mixed signal intensity and the intradural component as low signal intensity. Retrospectively, these differences in the signal intensity suggested that the extra- and intradural components had discrete histology.…”

Section: Discussionsupporting

confidence: 46%

Concurrent Schwannoma and Meningioma Arising in the Same Spinal Level: A Report of Two Cases

Matsuda

Kajihara²,

Abiko

et al. 2018

NMC Case Report Journal

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Concurrent multiple tumors developing in the spinal cord are rare, except for in genetic disorders, such as neurofibromatosis and von Hippel-Lindau disease. Furthermore, concurrent tumors arising in the same spinal level with discrete histopathology are much rarer. We report two such cases. Case 1: A 53-year-old man presented with intracranial hemorrhage that manifested as disturbed consciousness and right hemiparesis. Magnetic resonance (MR) angiography demonstrated severe stenosis of the terminal portion of the bilateral internal carotid arteries, implying Moyamoya disease. Cranial MR images showed a hematoma in the left basal ganglia perforating into the lateral ventricle, which was incidentally detected as a spinal tumor compressing the cervical cord at the C2 level. After conservative management for cerebral hemorrhage, the patient underwent total removal of the spinal tumor. Surgical findings showed that the tumor consisted of extra- and intradural components. Histopathological findings showed that the extra- and intradural components were schwannoma and meningioma, respectively. Case 2: A 70-year-old man presented with progressive left hemiparesis and numbness in both lower extremities. Craniocervical MR images demonstrated a paraspinal tumor compressing the spinal cord at C2 level. Surgical findings disclosed that the tumor consisted of major extradural- and minor intradural components. Histopathological study showed that these components had discrete histological findings: extradural lesion was schwannoma and intradural lesion was meningioma. Concurrent tumors with discrete histopathology should be considered in tumors with extra- and intradural components, particularly, when they are located in the high cervical spine.

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Section: Discussionsupporting

confidence: 46%

Concurrent Schwannoma and Meningioma Arising in the Same Spinal Level: A Report of Two Cases

Matsuda

Kajihara²,

Abiko

et al. 2018

NMC Case Report Journal

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“…[15,17] There are some diagnostic features for typical meningioma that can facilitate the diagnosis of spinal meningiomas on MRI; they are well-circumscribed lesions which have broad-based dural attachment, dural tail sign (60%-70%), and ginkgo leaf sign in meningiomas arising lateral or ventrolateral to the medulla spinalis. [15,20] Occasionally, densely calcified spinal meningiomas are hypointense on T1WI and T2WI sequences, as well as calcified spinal meningiomas show only minimal contrast enhancement. [15,18] We did not have calcified spinal meningiomas in our series.…”

Section: Discussionmentioning

confidence: 99%

Radiologic–Histopathologic correlation of adult spinal tumors: A retrospective study

2020

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Aim: Preoperatively performed magnetic resonance images (MRIs) are essential before treating spinal tumors surgically. This study aims to investigate the compatibility of MRI preliminary diagnosis and proven histopathologic diagnosis of consecutively operated 96 spinal tumors. Material and Methods: Medical records were retrospectively reviewed for all spinal tumors operated at our institute during a period of 6 years. One hundred and ten spinal tumors were detected. Fourteen tumors were excluded because they were not met our study criteria. Results: Ninety-six cases of spinal tumors were detected in 46 female and 50 male patients. The mean age was 49.3 ± 22.7 years. The most common symptom was radicular pain (88.6%). Histopathologic diagnoses were metastasis (n = 26), meningioma (n = 16), schwannoma (n = 15), ependymoma (n = 9), astrocytoma (n = 6), chronic nonspecific granulomatous infection (n = 4), lymphoma (n = 3), lipoma (n = 3), epidural tuberculosis abscess (Pott's disease) (n = 3), and other pathologies in 11 cases. Cervical spine was the less spinal region affected with metastases (P < 0.05). Thoracic spine was the most affected spinal region from meningioma (P < 0.05). Preoperatively, preliminary diagnosis on MRIs was proven with histopathologic examinations in 22 metastasis, 14 meningioma, 11 schwannoma, and all epidermoid cyst and lipoma cases. Despite the fact that MRI cannot diagnose all cases of spinal tumors, MRIs had a high accurate rate to diagnose the most common spinal neoplasms (69.8%). Conclusions: Metastases rarely occurred in cervical spine, whereas meningiomas were most likely to occur in thoracic spine. MRIs can help diagnose metastases and spinal benign lesions, whereas they failed to distinguish astrocytomas and lymphomas. Further prospective studies with large size are needed to support our results.

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“…Yamaguchi et al (23) reported a specific MRI feature related to fan-shaped deformity of the spinal cord from a spinal meningioma along its lateral or ventrolateral margin. The deformity is created by tethering of the tumor to the dura and a stretched dentate ligament.…”

Section: Meningiomamentioning

confidence: 99%