Differentiating spinal intradural-extramedullary schwannoma from meningioma using MRI T2 weighted images

Objective: Prior studies advocate the subjective visual differences between meningioma and schwannoma on T-2 weighted images, however objective measurement of signal intensity differences may be useful in certain cases. The aim of this study was to investigate whether an objective evaluation of Sls on T-2 weighted images would be useful to differentiate spinal schwannomas from meningiomas. Methods: The patients with spinal MRIs demonstrating path proven and subsequently treated intradural extramedullary spinal tumors were selected between April 2008 and May 2017. Regions of interest (ROIs) were measured in the tumor and subcutaneous fat on the same image, and we calculated the SI ratio between tumor and fat ROIs. Results: Twenty patients each with meningioma and schwannoma were enrolled. The SI ratios of schwannomas were significantly higher than those of meningiomas (both researcher 1 and 2: p = 0.002). The areas under the curve by researchers 1 and 2 were 0.780. The cutoff value of SI ratio by both of researchers 1 and 2 to differentiate between schwannomas from meningiomas was 0.420 (sensitivity: 80.0%, specificity: 70.0-75.0%). Conclusion: The SI ratio, calculated from the SIs of the tumor and fat on T-2 weighted images, is useful for differentiating spinal schwannomas from meningiomas to obtain an accurate diagnosis. Advances in knowledge: Signal intensity ratio of the spinal tumor and fat on T-2 weighted images is useful for differentiating schwannomas from meningiomas to obtain an accurate diagnosis.