Presentation
Chronic low back pain with no neurological deficit.
Patient Data
Well-defined sausage-shaped intradural extramedullary mass at T12-L1 level lateralized to the right measuring 62 x 22 x 18 mm. It elicits an isosignal to the spinal cord on T1, high signal on T2 and STIR with heterogeneous enhancement on post-contrast sequences. The spinal cord and cauda equina nerve roots are compressed and displaced to the left. No extension into the intervertebral foramina or dural tail sign. Moderate vertebral scalloping is noted.
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Case Discussion
MRI features of intradural extramedullary mass at T12-L1 level compressing and displacing the adjacent segment of the spinal cord with no dural tail sign or extension through the adjacent foramina suggestive of myxopapillary ependymoma.
The main differential diagnosis includes:
- meningioma: dural tail sign, ginkgo leaf sign, homogeneous contrast enhancement
- nerve sheath tumor: nerve root involvement, extradural neural foraminal extension with dumbbell appearance
- paraganglioma: cap sign, cauda equina region with prominent flow voids
For more details, please refer to the article: intradural intramedullary spinal tumors.