Findings
Sagittal T1, T2, axial T2, coronal STIR, post contrast T1 sagittal, coronal and axial MRI images reveal a well-defined heterogeneously enhancing T2 hyperintense, T1 iso to hypointense intradural extramedullary lesion in left side of spinal canal extending from the level of L2 till L3 vertebra, causing compression, right lateral displacement of conus medullaris and cauda equina nerve roots. No bony erosions or neural foraminal extension of the lesion noted.
Diagnosis
Nerve sheath tumor
Summary
Spinal nerve sheath tumors include Shwannoma, Neurofibroma and Ganglioneuroma. Schwannomas are usually round, shows heterogenous signal intensity due to hemorrhage, vascular changes, cyst formation and degeneration. A T2 hyperintense rim and central area of low signal (Target Sign) may be seen in Neurofibromas and occasionally in Schwannomas. At present, no single imaging feature or reproducible criteria, or a combination, can differentiate reliably between a neurofibroma and a schwannoma or discriminate with certainty between benign and malignant neurogenic tumors. Differentials include Meningioma, Paraganglioma and Metastases.
Further reads
Tagliafico, A. S., Isaac, A., Bignotti, B., Rossi, F., Zaottini, F., & Martinoli, C. (2019). Nerve Tumors: What the MSK Radiologist Should Know. Seminars in musculoskeletal radiology, 23(1), 76–84. https://doi.org/10.1055/s-0038-1676290
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