Preliminary algorithm for differential diagnosis between spinal meningioma and schwannoma using plain magnetic resonance imaging

Differentiating between spinal schwannomas and meningiomas using MRI: A focus on cystic change

“…[1][2][3] Among them, meningiomas and schwannomas are the two most common histologic subtypes, which comprise 55-90% of all intradural extramedullary spinal tumors. [4,5] Although both tumors are mostly benign, there is a substantial difference between the surgical techniques for removing each. [6,7] Since spinal meningiomas have a tendency to recur, complete tumor resection with dural excision is recommended whenever practicable to lower the recurrence rate.…”

“…[1,7,13,14] Besides locating the tumor, dural tail sign or neural foraminal extension was suggested as a useful imaging feature in differentiating between the two histologic subtypes. [4,7,13,14] Signal intensity of the tumor on T2-weighted image was also shown to be helpful for the differentiation; schwannomas have a tendency to show a hyperintense signal while a substantial portion of meningiomas shows an isointense signal compared to that of the spinal cord. [7,13,14] However, most of the reported studies involve few cases, and the discriminating ability of each sign varies among studies.…”

“…[7,13,14] However, most of the reported studies involve few cases, and the discriminating ability of each sign varies among studies. [1,4,7,13,14] Thus, there is room for further investigation to identify other and better imaging features that could help in easily differentiating between subtypes of intradural extramedullary spinal tumors.…”

Clinical Significance of Pain in Differential Diagnosis between Spinal Meningioma and Schwannoma

“…Schwannomas demonstrate typical MRI features of T 1 iso-to-hypointensity, T 2 hyperintensity, or fluid signal intensity [4]. In the presented case, fluid signal intensity on T 2 -weighted images and isointensive signal on T1-weighted images might indicate meningioma or schwannoma [2,5]. Meningiomas homogeneously enhance after contrast administration; however, in schwannomas, enhancement upon contrast application is variable [4].…”

“…Approximately 75% of all patients with peripheral nerve sheath tumors have pain in some settings. The distinction of the pain at rest versus other pain characteristics seems to be crucial for the diagnosis: the rest pain is reported only by 5% of patients with schwannomas while the pain induced by pressure is observed in 95% of patients with benign nerve sheath tumors [ 5 ]. Pain appearing during physical activity seems to be also an important symptom of spinal schwannoma.…”