Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299, Qingyang Road, Wuxi, 214000, Jiangsu Province, China.
Department of Ophthalmology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299, Qingyang Road, Wuxi, 214000, Jiangsu Province, China.
Radiol Med. 2019 Jun;124(6):510-521. doi: 10.1007/s11547-019-00988-z. Epub 2019 Jan 25.
To retrospectively review the MRI characteristics and clinic features and evaluate the effectiveness of MR imaging in differentiating intraspinal schwannomas and meningiomas, with the excised histopathologic findings as the reference standard.
One hundred and four schwannomas (M/F, 57:47) and 53 meningiomas (M/F, 13:40) underwent MR examinations before surgical treatment. Simple clinic data and imaging findings were considered:(a) location (craniocaudal and axial), (b) size, (c) morphology, (d) dural contact, (e) signal characteristics, (f) enhancement degree and patterns. The usefulness of the algorithm for differential diagnosis was examined between the two tumors.
Interobserver agreement was good (κ = 0.7-0.9). Ten cases meningiomas demonstrated multiple lesions. There was a female predominance in the meningiomas (P < 0.001). Meningiomas predominantly were located in the ventral or anterolateral areas of thoracic regions, while schwannomas in the posterolateral areas of the thoracic and the lumbar regions (P < 0.001). Mean size of the lesions was 1.47 ± 0.36 cm for meningioma, and 2.02 ± 1.13 cm for schwannoma (P < 0.001). A dumbbell shape with intervertebral foramen widening could detect schwannomas, while the "dural tail sign" did meningiomas (P < 0.001). Hypointense and miscellaneous signal implied meningioma on TWIs (P < 0.001). Isointense was more frequently observed in the meningiomas, while the fluid signal intensity and miscellaneous signal in the schwannomas on TWIs (P < 0.001). Schwannomas usually manifested rim enhancement, while meningiomas diffuse enhancement (P = 0.005). There were six variables including the logistic equation (age, size, dural tail sign, morphology, TWI, and axial location). The accuracy of the algorithm in diagnosis of schwannomas was 87.1%.
Combination of clinic data and MRI performs significantly for differentiating between intraspinal meningiomas and schwannomas.
回顾性分析脊髓内神经鞘瘤和脑膜瘤的 MRI 特征和临床特征，并评估 MRI 在鉴别诊断中的作用，以手术病理结果为参考标准。
104 例神经鞘瘤（男/女，57:47）和 53 例脑膜瘤（男/女，13:40）患者在手术治疗前均行 MRI 检查。分析简单的临床资料和影像学表现：（a）部位（颅尾和轴位），（b）大小，（c）形态，（d）硬脑膜接触，（e）信号特征，（f）强化程度和模式。检验两种肿瘤鉴别诊断算法的有效性。
观察者间一致性良好（κ=0.7-0.9）。10 例脑膜瘤表现为多发病变。脑膜瘤以女性为主（P<0.001）。脑膜瘤主要位于胸区腹侧或前外侧，而神经鞘瘤位于胸、腰区的后外侧（P<0.001）。脑膜瘤病变的平均大小为 1.47±0.36cm，神经鞘瘤为 2.02±1.13cm（P<0.001）。椎间孔扩大的哑铃形可检测神经鞘瘤，而“硬膜尾征”则提示脑膜瘤（P<0.001）。T1WI 低信号和混杂信号提示脑膜瘤（P<0.001）。等信号在脑膜瘤中更常见，而在神经鞘瘤中则为液体信号强度和混杂信号（P<0.001）。神经鞘瘤通常表现为边缘强化，而脑膜瘤则为弥漫性强化（P=0.005）。有 6 个变量包括 logistic 方程（年龄、大小、硬膜尾征、形态、T1WI 和轴位）。该算法对神经鞘瘤的诊断准确率为 87.1%。
结合临床资料和 MRI 对鉴别脊髓内脑膜瘤和神经鞘瘤具有重要意义。
