Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
PLoS One. 2020 May 29;15(5):e0233623. doi: 10.1371/journal.pone.0233623. eCollection 2020.
To retrospectively determine the diagnostic ability of MRI in differentiating between intradural extramedullary spinal schwannomas and meningiomas.
A total of 199 patients with spinal intradural extramedullary tumors who underwent preoperative contrast-enhanced MRI between January 2012 and December 2018 were included in this study. Two radiologists independently analyzed the presence of cystic change, dural tail sign, and neural foraminal extension. Clinical and MRI features between the two groups were compared by univariable and multivariable analyses using logistic regression. Interobserver agreements were calculated using kappa statistics.
Patients with schwannoma showed significantly higher frequency of cystic change (96% vs 24%, P < 0.001), neural foraminal extension (29% vs 3%, P = 0.001), and lumbar location (41% vs 5%, P = 0.008). Patients with meningioma showed significantly higher frequency of dural tail sign (64% vs 1%, P < 0.001), thoracic location (75% vs 31%, P = 0.007), older age (59.7 years vs 47.6 years, P < 0.001), higher female predominance (83% vs 50%, P < 0.001), and smaller size (19.8 cm vs 28.8 cm, P < 0.001). Multivariable analysis showed that cystic change (P < 0.001; odds ratio [OR], 0.02), dural tail sign (P < 0.001; OR, 36.23), age (P = 0.032; OR, 1.06), and lumbar location (P = 0.006; OR, 0.02) were independent factors. Interobserver agreements were almost perfect for all analyses.
MRI features were useful in differentiating between intradural extramedullary schwannomas from meningiomas. The presence of cystic change and dural tail sign were independently significant discriminators.
回顾性分析 MRI 对鉴别椎管内髓外硬膜下神经鞘瘤和脑膜瘤的诊断能力。
本研究纳入了 2012 年 1 月至 2018 年 12 月间接受术前增强 MRI 检查的 199 例椎管内髓外硬膜下肿瘤患者。两名放射科医生独立分析了囊变、硬膜尾征和神经孔延伸的存在情况。使用逻辑回归进行单变量和多变量分析比较两组之间的临床和 MRI 特征。使用 Kappa 统计评估观察者间的一致性。
神经鞘瘤患者的囊变（96% vs 24%，P < 0.001）、神经孔延伸（29% vs 3%，P = 0.001）和腰椎位置（41% vs 5%，P = 0.008）的发生率明显更高。脑膜瘤患者的硬膜尾征（64% vs 1%，P < 0.001）、胸椎位置（75% vs 31%，P = 0.007）、年龄较大（59.7 岁 vs 47.6 岁，P < 0.001）、女性比例更高（83% vs 50%，P < 0.001）和肿瘤较小（19.8 cm vs 28.8 cm，P < 0.001）的发生率明显更高。多变量分析显示，囊变（P < 0.001；比值比[OR]，0.02）、硬膜尾征（P < 0.001；OR，36.23）、年龄（P = 0.032；OR，1.06）和腰椎位置（P = 0.006；OR，0.02）是独立的影响因素。所有分析的观察者间一致性均近乎完美。
MRI 特征有助于鉴别椎管内髓外硬膜下神经鞘瘤和脑膜瘤。囊变和硬膜尾征的存在是独立的显著鉴别因素。
