What is the diagnosis and management of the Gingko leaf sign?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: November 26, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Ginkgo Leaf Sign: Diagnosis and Management

Definition and Diagnostic Significance

The Ginkgo leaf sign is a highly specific imaging finding that indicates spinal meningioma when present, with 100% specificity and positive predictive value for meningiomas arising lateral or ventrolateral to the spinal cord. 1

The sign consists of two components visible on MRI:

  • A fan-shaped appearance of the spinal cord (resembling a ginkgo leaf)
  • A streak within the tumor itself 1

Diagnostic Performance

When evaluating spinal intradural extramedullary tumors, the Ginkgo leaf sign demonstrates:

  • Sensitivity: 58% (present in 7 of 12 spinal meningiomas) 1
  • Specificity: 100% (absent in all schwannomas tested) 1
  • Positive predictive value: 100% (when present, it is perfectly predictive for spinal meningioma) 1
  • Negative predictive value: 78% 1

Clinical Application

When to Look for This Sign

  • Evaluate for the Ginkgo leaf sign when imaging reveals a spinal intradural extramedullary tumor located lateral or ventrolateral to the spinal cord 1
  • This sign is particularly valuable for differentiating spinal meningioma from schwannoma, the two most common tumors in this location 1

Imaging Modality

  • MRI is the preferred imaging modality to identify the Ginkgo leaf sign 1
  • Look specifically for the characteristic fan-shaped spinal cord configuration combined with an internal tumor streak 1

Management Implications

When the Ginkgo leaf sign is present, proceed with management appropriate for spinal meningioma rather than pursuing additional diagnostic procedures, given the 100% positive predictive value. 1

Key Management Principles

  • The presence of this sign allows confident preoperative diagnosis of spinal meningioma 1
  • Surgical planning can be tailored specifically for meningioma resection rather than schwannoma 1
  • No additional biopsy or diagnostic procedures are needed when this sign is clearly present 1

Important Caveats

  • The sign has moderate sensitivity (58%), meaning its absence does not exclude spinal meningioma 1
  • This sign is only validated for tumors arising lateral or ventrolateral to the spinal cord, not for other locations 1
  • The sign was studied in a series of 30 tumors (12 meningiomas, 18 schwannomas), so while highly specific, it requires recognition of the characteristic imaging pattern 1

References

Related Questions

What is the maximum dosage of Ginkgo biloba (Ginkgo biloba extract)?
What is the treatment for eardrum vibration?
Do Long-Acting Beta Agonists (LABAs) decrease blood pressure (hypotension)?
How can a pregnant overweight female prevent developing Deep Vein Thrombosis (DVT) after delivery?
What is the daily dose in mL of amoxicillin (amoxicillin) 125mg/5mL suspension for a child with acute otitis media?
What is the recommended management for a patient with scattered atherosclerotic plaque formation without significant stenosis or occlusion?
What is the primary management approach for a patient with severe emphysema presenting with a Gingko leaf sign?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question