Two spinal lesions: schwannoma and meningioma


  • A 21 years old lady
  • Previously healthy
  • Presented with low back pain, right lower limb pain, shooting upward for few months.
  • Later also developed numbness of right lower limb.
  • Normal neurological assessment.
MRI of whole spine in sagittal plane
MRI spine in pre and post contrast images
MRI spine pre and post contrast.

MRI findings:

  • There are two lesions seen within the spinal canal.
  • The upper lesion located at T3 level is isointense on T1 and slightly hyperintense on T2WI compared to the cord
  • The lower lesion at L3-L4 levels is isointense on T1 and hypointense on T2WI compared to the cord.
  • Both lesions show marked enhancement post contrast
  • The lesions are intradural and extramedullary
  • No expansion of the neural foramina.
  • Compression and distortion of the spinal cord is seen. No abnormal signal intensity within the cord itself.

HPE findings: Upper lesion (Psammomatous meningioma, WHO Grade 1) and lower lesion (schwannoma).


  • Schwannoma and meningioma are common differential diagnoses for intradural extramedullary spinal tumours. Other include neurofibroma and ependymoma.
  • Half of cervical tumours were schwannomas, 72% thoracic lesions were meningiomas and all lumbar tumours are schwannomas
  • Meningiomas were significantly located at the upper and mid-thoracic levels and schwannomas in lumbar area
  • T1WI; no statistical difference. T2WI; schwannomas hyperintense and heterogenous.
  • Post contrast: Schwannomas intense and heterogenous, Meningioma : moderate and homogenous.
  • Meningioma: Dural tail sign, bone sclerosis.
  • Schwannoma: neural foraminal extension and foraminal widening


Author: radhianahassan