STUDY DESIGN: Retrospective multicenter study. OBJECTIVE: The goal of this study is to determine the characteristic imaging features of spinal ependymoma in a review of magnetic resonance imaging (MRI) data for a large series of surgically proven cases. SUMMARY OF BACKGROUND DATA: Common spinal intramedullary neoplasms are mostly ependymomas and comprise 50% to 60% of spinal neuroepithelial tumors in adults. Preoperative prediction of the pathological diagnosis could enhance surgical planning and explanation of the procedure to patients. However, these types of tumors exhibit a variety of MRI findings. METHODS: Records were examined for 59 patients who underwent surgery for spinal cord ependymoma and had a pathological diagnosis of cellular ependymoma of World Health Organization classification grade II. RESULTS: The ependymomas included 28 in the cervical spine, 34 in the thoracic spine, and 3 conus lesions. All cases were isointense or hypointense on T1-weighted MRI, and 55 (93%) were hyperintense on T2-weighted MRI. Tumors were located centrally in all cases; 50 (85%) showed surrounding cord edema; and 52 (88%) had associated cysts, including 36 (61%) rostral or caudal cysts, 10 (17%) intratumoral cysts, and 6 (10%) with syringomyelia. Of the 59 tumors, 17 (29%) showed the "cap sign," a rim of extreme hypointensity seen around the tumor on T2-weighted images, due to hemosiderin. In gadolinium-enhanced MRI, all cases were enhanced, and 27 (46%), 16 (27%), 11 (19%), and 5 (8%) cases showed homogeneous, heterogeneous, rim, and nodular enhancement, respectively. CONCLUSION: Hypointense changes on T2-weighted MRI and hemosiderin deposition reflect easy bleeding. Tumors are associated with various types of cysts, and gadolinium-enhancement patterns reflect a variety of intratumor cellular components. In cases in which the whole tumor shows gadolinium enhancement on MRI, rostral, or caudal cyst and a cap sign with hemorrhage are characteristics of grade II classical ependymoma. LEVEL OF EVIDENCE: 3.
STUDY DESIGN: Retrospective multicenter study. OBJECTIVE: The goal of this study is to determine the characteristic imaging features of spinal ependymoma in a review of magnetic resonance imaging (MRI) data for a large series of surgically proven cases. SUMMARY OF BACKGROUND DATA: Common spinal intramedullary neoplasms are mostly ependymomas and comprise 50% to 60% of spinal neuroepithelial tumors in adults. Preoperative prediction of the pathological diagnosis could enhance surgical planning and explanation of the procedure to patients. However, these types of tumors exhibit a variety of MRI findings. METHODS: Records were examined for 59 patients who underwent surgery for spinal cord ependymoma and had a pathological diagnosis of cellular ependymoma of World Health Organization classification grade II. RESULTS: The ependymomas included 28 in the cervical spine, 34 in the thoracic spine, and 3 conus lesions. All cases were isointense or hypointense on T1-weighted MRI, and 55 (93%) were hyperintense on T2-weighted MRI. Tumors were located centrally in all cases; 50 (85%) showed surrounding cord edema; and 52 (88%) had associated cysts, including 36 (61%) rostral or caudal cysts, 10 (17%) intratumoral cysts, and 6 (10%) with syringomyelia. Of the 59 tumors, 17 (29%) showed the "cap sign," a rim of extreme hypointensity seen around the tumor on T2-weighted images, due to hemosiderin. In gadolinium-enhanced MRI, all cases were enhanced, and 27 (46%), 16 (27%), 11 (19%), and 5 (8%) cases showed homogeneous, heterogeneous, rim, and nodular enhancement, respectively. CONCLUSION: Hypointense changes on T2-weighted MRI and hemosiderin deposition reflect easy bleeding. Tumors are associated with various types of cysts, and gadolinium-enhancement patterns reflect a variety of intratumor cellular components. In cases in which the whole tumor shows gadolinium enhancement on MRI, rostral, or caudal cyst and a cap sign with hemorrhage are characteristics of grade II classical ependymoma. LEVEL OF EVIDENCE: 3.
Authors: Kevin Mckay; Mark Attiah; Tianyi Niu; Daniel Nagasawa; Kunal Patel; Bilwaj Gaonkar; Barbara Van de Wiele; Natalie Moreland; Alexander Tucker; Pedro Churchman; Ulrich Batzdorf; Luke Macyszyn Journal: Surg Neurol Int Date: 2019-11-22
Authors: David R Ghasemi; Martin Sill; Konstantin Okonechnikov; Andrey Korshunov; Stephen Yip; Peter W Schutz; David Scheie; Anders Kruse; Patrick N Harter; Marina Kastelan; Marlies Wagner; Christian Hartmann; Julia Benzel; Kendra K Maass; Mustafa Khasraw; Ronald Sträter; Christian Thomas; Werner Paulus; Christian P Kratz; Hendrik Witt; Daisuke Kawauchi; Christel Herold-Mende; Felix Sahm; Sebastian Brandner; Marcel Kool; David T W Jones; Andreas von Deimling; Stefan M Pfister; David E Reuss; Kristian W Pajtler Journal: Acta Neuropathol Date: 2019-08-14 Impact factor: 17.088