Intraneural perineurioma is typically diagnosed by targeted fascicular biopsy and histopathologic analysis. Through review of clinical history and magnetic resonance imaging of consecutive patients undergoing fascicular biopsy, we define the classical features of intraneural perineurioma as no cancer history, unifocal disease, moderate-severe T2 hyperintensity, moderate-severe contrast enhancement, homogeneous contrast enhancement, fusiform shape, and enlargement of involved nerves. This combination of features has a high specificity and moderate sensitivity for the diagnosis of perineurioma. When the classical features of perineurioma defined in this study are present, the high specificity of this combination of features may obviate the need for fascicular biopsy.
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