Weekly Image Challenge – April 16, 2023

An interesting case of a 74 years old male patient, with no co-morbid, who had presented with paraparesis. What is the most likely diagnosis?

  1. Schwannoma
  2. Ependymoma
  3. Meningioma
  4. Metastasis
  5. Dermoid cyst


Congratulations to those who selected meningioma. It is an intradural extramedullary, homogenously enhancing lesion. There is no extension towards the nerve root or foramen, which differentiates it from schwannoma. The spinal cord is pushed to the right.

Metastasis can be intradural extramedullary, but there is often a history of primary tumor elsewhere, and it usually has surrounding edema.

Ependymoma is intramedullary spinal cord lesion.

Dermoid cyst is often hyperintense on T1, shows heterogenous contrast enhancement, and usually presents at young age.