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Foraminal herniation of a lumbar disc mimicking neurinoma on CT and MR imaging
E Ashkenazi1, S Pomeranz, Y Floman
1Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel.
Abstract:
A case of a large L3-L4 intervertebral disc herniation causing a widening of the intervertebral foramen is reported. There was a soft-tissue mas within the spinal canal and intervertebral foramen. The soft-tissue mass within the spinal canal and intervertebral foramen showed marked enhancement on magnetic resonance scans after injection of a paramagnetic contrast agent (Gd-DTPA). The combination of lesion configuration and paramagnetic contrast enhancement mimicked a spinal neurinoma. There exists a degree of overlap between the imaging of herniated discs and spinal neurinomas. When this overlap involves several aspects, such as anatomic configuration, mass enhancement, and secondary foraminal dilatation, the differential diagnosis between a herniated disc and a neurinoma may be problematic.
Insights
A large intervertebral disc herniation can mimic spinal neurinoma on MRI scans. This case highlights the diagnostic challenge posed by overlapping imaging features, including foraminal widening and contrast enhancement.
Area of Science:
- Radiology
- Neurosurgery
- Spinal Imaging
Background:
- Intervertebral disc herniation and spinal neurinomas can present with overlapping imaging characteristics.
- Accurate differential diagnosis is crucial for appropriate patient management.
Observation:
- A case of large L3-L4 intervertebral disc herniation is presented.
- The herniation caused widening of the intervertebral foramen and a soft-tissue mass.
- Magnetic resonance imaging (MRI) revealed marked contrast enhancement of the mass.
Findings:
- The lesion's configuration and enhancement pattern mimicked a spinal neurinoma.
- Overlapping features included anatomic configuration, mass enhancement, and foraminal dilatation.
- Differential diagnosis between herniated disc and neurinoma was challenging.
Implications:
- This case underscores the importance of considering disc herniation in the differential diagnosis of spinal masses.
- Advanced imaging techniques and careful interpretation are necessary to distinguish between these conditions.
- Improved diagnostic accuracy can lead to timely and effective treatment strategies for spinal pathologies.