[Intraspinal extradural tumors].

clinical issueIntraspinal extradural lesions represent the most frequent group of spinal tumors and comprise a broad spectrum of primary and secondary neoplasms as well as intradural extramedullary tumors with secondary extradural extension. Because even small epidural lesions can cause significant neurological deficits through compression of the spinal cord or cauda equina, a prompt and accurate diagnosis is essential. RADIOLOGICAL STANDARD PROCEDURES: Contrast-enhanced magnetic resonance imaging (MRI) is the imaging modality of first choice as it enables a reliable assessment of the tumor extent, the relationship to the spinal cord, dural sac and nerve roots as well as possible bone marrow infiltration. Characteristic imaging features, such as the origin of the mass, dorsal cortical destruction, neural foraminal widening or a dumbbell-shaped growth pattern, often enable a targeted narrowing down of the underlying tumor entity. PRACTICAL RECOMMENDATIONS: In adults secondary epidural tumors should be primarily considered in the differential diagnosis as they account for the majority of intraspinal extradural masses. In particular, metastases, plasma cell neoplasms and lymphomas are of high clinical relevance. A systematic assessment of the anatomical location, growth pattern and possible osseous alterations are essential to narrow down the differential diagnosis and to guide appropriate further diagnostic evaluation and treatment planning.