This is a rare benign tumor. The configuration is fairly characteristics - thoracic, posterior epidural, multiple levels, extends from left to right foramina, bony canal widening.

A pre-operative diagnosis, apart from relying on its shape and location, is possible if there is significant amount of fatty content. But if the tumor is highly vascular,  the fat may not be as obvious, and tumor looks more like a nonspecific soft tissue tumor.  As the vessels are of low flow characteristics, flow void is not commonly seen; but will be a helpful hint if present.

Features against other epidural lesions are:

1. Not typical shape for meningioma or schwannoma; although the T2 characteristics, in this case, looks almost like mix zones of Antoni A and B fibers.
2. Not enough fatty tissue to be lipoma or low-grade liposarcoma. High-grade liposarcoma is unlikely given the long history and bony remodeling.
3. Not typical appearance for vascular malformation or bony lesions with extraosseous soft tissue mass.