Radiographic Features of Spinal Meningioma and Schwannoma: A Novel Specific Feature-Ginkgo Leaf Sign

Meningiomas and schwannomas are common intradural-extramedullary spinal tumors. Because of their different origins, they necessitate different surgical procedures, which makes preoperative diagnosis important.

In this study, clinical and imaging data for 62 patients diagnosed with either meningioma or schwannoma across multiple institutions were analyzed.

The average age of patients was older (67.6 vs. 58.9 years), and the frequency of females was higher (72% vs. 46%) for meningioma than for schwannoma. Meningiomas were mostly found in the thoracic region (84%), whereas schwannomas were commonly located in the lumbar region (54%). For each tumor type, specific radiological findings were identified. For meningiomas, findings included the ginkgo leaf sign (GLS) (sensitivity 58%, specificity 100%), oval shape (sensitivity 84%, specificity 63%), dural tail sign (DTS) (sensitivity 75%, specificity 100%), and intertumoral calcification (sensitivity 39%, specificity 100%). Combining GLS and DTS greatly improved sensitivity to 89% (specificity 100%). For schwannomas, specific findings included a lobule shape (sensitivity 25%, specificity 95%), dumbbell shape (sensitivity 54%, specificity 100%), and cystic changes (sensitivity 54%, specificity 97%).

GLS may be a specific radiological feature for meningiomas and can aid in diagnosis when combined with DTS. Understanding these distinct radiological characteristics is valuable for preoperative differential diagnosis of intradural-extramedullary spinal tumors.