Spinal perimedullary vein enlargement sign: an added value for the differentiation between intradural-extramedullary and intramedullary tumors on magnetic resonance imaging.
BACKGROUND
The purpose of this study was to determine the added value of the perimedullary spinal vein enlargement sign on magnetic resonance imaging (MRI) in distinguishing intradural-extramedullary tumors (IDEMTs) from intramedullary spinal tumors (IMTs).


METHODS
Two hundred and eight consecutive spinal intradural tumors with histopathologic confirmation (21 IMTs, 187 IDEMTs) were enrolled. Two readers blinded to the final pathological diagnosis and clinical data independently assessed the venous enlargement sign to determine the agreement between them and jointly distinguished IDEMTs from IMTs according to the common MRI findings. Sensitivity, specificity, and accuracy for the diagnosis of IDEMTs were calculated for the common MRI findings, vein enlargement sign, and a combination of both.


RESULTS
Intraobserver agreement and interobserver agreement for both readers was excellent. The sensitivity, specificity, and accuracy of common MRI findings for differentiating IDEMTs from IMTs were 83.4, 95.2, and 89.3 %, respectively. Thirty-one IDEMTs were mistakenly diagnosed as IMTs, in which seven were cases with vein enlargement signs. By applying the vein enlargement sign to the common MRI findings, the specificity remained at 95.2 %, while the sensitivity improved to 89.3 % and the accuracy increased to 92.3 %.


CONCLUSIONS
The spinal perimedullary vein enlargement sign is useful in assessing intradural tumors and to differentiate IDEMTs from IMTs.
Department of Shandong Medical Imaging Research Institute, Shandong University, Jinan, 250000, People's Republic of China.
Tao
T
Gong
Department of Radiology, Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China.
Yubo
Y
Liu
Department of Shandong Medical Imaging Research Institute, Shandong University, Jinan, 250000, People's Republic of China. wgb7932596@hotmail.com.
Guangbin
G
Wang
Department of Radiology, Zhongshan Hospital, Shanghai, People's Republic of China.
Li
L
Yang
Philips Healthcare, Shanghai, People's Republic of China.
Weibo
W
Chen
Department of Shandong Medical Imaging Research Institute, Shandong University, Jinan, 250000, People's Republic of China.
Fei
F
Gao
Department of Shandong Medical Imaging Research Institute, Shandong University, Jinan, 250000, People's Republic of China.
Xin
X
Chen
D003937:Diagnosis, Differential; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013116:Spinal Cord / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology*; D013120:Spinal Cord Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D014680:Veins / Q000000981:diagnostic imaging / Q000473:pathology*
Intradural-extramedullar; Intramedullary; MR imaging; Spinal cord tumors; Vein enlargement