0:01

This was a case of a patient who was being evaluated

0:04

for a thoracic aortic aneurysm study,

0:08

and this was a CTA that was being done.

0:11

However,

0:11

the body CT people identified that there was an

0:15

abnormality in the thoracic spinal column.

0:19

And we see that within the intradural

0:22

extramedullary space,

0:23

we have a mass which is rounded and appears to

0:27

be eccentric or outside the spinal cord.

0:30

So, again, intradural but extramedullary.

0:33

How do we know that this is not arising

0:36

from the bone? On the sagittal scan,

0:38

it actually looks like it could be

0:40

a lesion of the spinous process,

0:43

in which case it would probably be called an extradural

0:46

lesion. For this reason, an MRI was requested.

0:50

Here is the MRI scan that was performed after

0:55

the CTA identified the abnormality. And when

1:00

we look at the MRI scan on the T1-weighted

1:03

and T2-weighted scan,

1:04

I think we're more comfortable in saying that this

1:07

is indeed an intradural extramedullary lesion.

1:11

How so? On this example,

1:14

you see that there is a meniscus sign.

1:17

So the CSF space is widened at the level of the lesion

1:22

above and below the lesion, and therefore,

1:26

this must be intradural extramedullary.

1:30

If it really was arising from the spinous process,

1:33

as we were concerned about with the CT scan,

1:36

it would lead to narrowing of the CSF

1:40

space at the level of the lesion.

1:42

So this is indeed a calcified intradural

1:45

extramedullary lesion. And with that,

1:48

we would say this is most likely a meningioma.

1:51

We'd want to look at the post gadolinium-enhanced scans

1:55

because meningiomas do show typically

1:57

uniform enhancement. Now, this is a little bit tricky because

2:01

this lesion was calcified,

2:03

and calcification generally does not show enhancement.

2:07

But let's let's look at it nonetheless.

2:08

So let's pull down the post gadolinium-enhanced scans,

2:12

and I will then magnify this for you and

2:16

bring it up a little bit into our area.

2:19

So there we go. So, on this pair of scans,

2:23

we have the non-contrast scan on the right and the

2:26

post-contrast T1-weighted scan on the left.

2:29

And what you see is indeed an enhancing lesion that is

2:33

in the intradural extramedullary compartment in the thoracic

2:36

spine, which showed calcification. This is a meningioma.

2:40

Absolutely.

2:41

Move on to the next case.