Transcript Differentiation of Spinal Schwannomas And meningiomas on

DIFFERENTIATION OF SPINAL
SCHWANNOMAS AND MENINGIOMAS ON
MAGNETIC RESONANCE IMAGING
Abstract Id: IRIA- 1035
INTRODUCTION
 Spinal Schwannomas and Meningiomas are
the most common intradural extramedullary
lesion and account for 45% of primary Spinal
Neoplasms.
 The clinical futures are usually Myelopathy
and/or radiculopathy
 Depending on the type of tumour, different
surgical techniques may be planned.
OBJECTIVE
 To evaluate the effectiveness of MRI in
differentiating intradural extramedullary
spinal schwannomas and meningiomas.
 To analyze tumour location, morphologic
characteristics and enhancement pattern.
MATERIALS AND MEATHODS
 Inclusion criteria:- All patients who are
surgically treated and histopathologically
proven as Schwannomas and meningiomas at
our institution were included. Tumours with
extra spinal extension such as dumbbell
Schwannomas were excluded.
 Exclusion criteria:- Paediatric with age less
than 18 years were excluded from the study.
 Study period:- Two years from February 2012
till January 2014.
MATERIALS AND MEATHODS
Study Design:- Retrospective study.
Sample Size:- 40 patients.
Study Equipment:- MRI by 1.5 Tesla GE Signa
HDe MRI machine.
Protocol for MRI:- Axial T2 FLAIR, Axial T2
propeller, T2 sagittal T1
sequences.
Data Collection:- A study was conducted on 40
patients with spinal
Schwannomas and meningiomas,
which were histopathologically
proven after surgery.
MATERIALS AND MEATHODS
Study Analysis:- Data Analysis was done using
rates, ratios and percentages.
Ethical clearance from our Institutional Ethics
committee has been obtained.
RESULTS
RESULTS ANALYSIS
Frequency in %
25
20
15
Frequency in %
10
5
0
MALE
FEMALE
SCHWANNOMAS
MALE
FEMALE
MENINGIOMAS
Average Age
Average age is 54 years (Range 20 to 80 years)
MENINGIOMAS
FREQUENCY IN %
80
70
60
50
40
FREQUENCY IN %
30
20
10
0
CERVICAL
THORACIC
SCARAL
SCHWANNOMA
LUMBAR
CERVICAL
THORACIC
SCARAL
MENINGIOMA
LUMBAR
TUMOUR DEVIATION
Frequency in %
80
70
60
50
40
Frequency in %
30
20
10
0
CENTRAL
ECCENTRIC
SCHWANNOMAS
CENTRAL
ECCENTRIC
MENINGIOMAS
MENINGIOMAS
Frequency in %
70
60
50
40
Frequency in %
30
20
10
0
< 10mm
10 to 12 mm
20 to 30 mm
SCHWANNOMAS
>30 mm
< 10mm
10 to 12 mm
20 to 30 mm
MENINGIOMAS
>30 mm
ISOINTENCITY on T1 WEIGHTED
IMAGE
Frequency in %
120
100
80
60
Frequency in %
40
20
0
ISOINTENSITY on T1
ISOINTENSITY on T1
SCHWANNOMAS
MENINGIOMAS
DEGREE OF ENHANSEMENT ON T1
WEIGHTED IMAGE
Frequency in %
120
100
80
60
Frequency in %
40
20
0
STRONG
STRONG
SCHWANNOMAS
MENINGIOMAS
CONTRAST ENHANCEMENT PATTERN
ON T1 IMAGE
Frequency in %
120
100
80
60
Frequency in %
40
20
0
SCHWANNOMAS
MENINGIOMAS
DIFFUSE
SCHWANNOMAS
MENINGIOMAS
RIM
CONTRAST ENHANSEMENT PATTEREN
ON T1 WEIGHTED IMAGE
Frequency in %
120
100
80
60
Frequency in %
40
20
0
SCHWANNOMAS
MENINGIOMAS
HETEROGENOUS
SCHWANNOMAS
MENINGIOMAS
HOMOGENOUS
HETEROGENOUS ENHANCEMENT
STRONG, HOMOGENOUS & DEFFUSE
EHHANCEMENT
ENHANCEMENT
DURAL TAIL SIGN
COMPARISION
Lui WC et al
De Verdelhan et al
Female sex for Meningiomas
80.6
Lumbar location for Schwannomas
53.3
100%
Thoracic location for Meningiomas
80%
72%
Fluid signal intensity on T2- Weighted MRI
for Schwannomas
55.4%
Rim Enhancement for Schwannomas
58.7%
Dural tail sign for Meningiomas
58.3%
67%
CONCLUSION
 Certain MR findings are useful for the differentiation
of Schwannomas from Meningiomas of the spine.
 All parameters provide statistical significance;
however tumours with lumbar locations, winding of
neutral foramen, fluid signal intensity on T2weighted images, RIM enhancement on MR provide
statistically significant as predictors of
Schwannomas.
 While tumours Located at a thoracic lesion in
females and dural tail provide statistically significant
predictors of Meningioma.
 The differential diagnosis of spinal Schwannomas
and Meningiomas on MRI can be narrowed.
LIMITATIONS
 The limitation of the study is that it is
retrospective. The reviewers are familiar with the
cases of Schwannomas or Meningiomas and this
may have affected the increased sensitivity
setting of the MR imaging for differentiating
Schwannomas from Meningiomas .
 Second selection bias may have existed because
of the procurement of patients through the
radiology report database. Selection bias may
also be a serious consideration.
REFERENCES
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Intraduralspinal tumours current classification and MRI futures.
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 Gebauer GP, Farjoodi P, SciubbaDM, Gokaslan ZL, Rilley LH 3rd,
Wasserman BA, Khanna AJ (2008), Magnetic resonance imaging
of spinal tumours: Classification, differential diagnosis and
Spectrum of deceases. J Bone Jnt Surg Am 90: 146-162.
 Schroth G, Thron A, Guhl L, Voigt K, Niendorf HP, Gr]arces
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