A comparative study of pathology with the manifestation of MRI in spinal cord ependymal neoplasms
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Objective To explore the correlation between the manifestation of MRI and pathology, and to improve the knowledge in spinal cord ependymal neoplasms. Methods The MRI manifestation, pathology, operational records and follow-up data were analyzed retrospectively in 44 cases with spinal cord ependymal neoplasms. Results Among 44 cases of spinal cord ependymal neoplasms, 24 were ependymoma (WHO gradeⅡ); 10 anaplastic ependymomas (WHO grade Ⅲ) and 8 mucinous papillary ependymomas (WHO gradeⅠ); 2 mixed type glioma with ependymas (WHO grade Ⅱ). There were 19 lesions in the cervical, 6 in the thoracic, and 19 in the lumbar and sacral segments in MRI. Clear tumor margins were seen in 84.1% (37/44) of all patients; on T1-weighted MRI, most were isointensive or hypointensive signals. Most tumors were hyperintense or confounding on T2-weighted MRI. 86.4% (38/44) enchanced markedly; 77.3% (34/44) were heterogeneous enchancement. Rostral and caudal cysts were seen in 43.2% (19/44) of all patients. Well-defined margins, though 90.9% (40/44) of all patients lacking true tumor envelopes, were seen in 72.7% (32/44) of the operational findings. Statistical analysis indicated that pathology types and grades in spinal cord ependymal neoplasms were correlated with lesion positions (P0.05), operational residua with tumor margins in operation or MRI, without correlation with pathologial types and grades (P0.05). No significant statistical difference was found in tumor margins between operation and MRI. Conclusion The spinal cord ependymal neoplasms show characteristic manifestations on MRI. MRI can show the intra-tumor structures and the extent of the tumor very well, which is helpful in differential diagnosis, respectability prediction metastases detection and eveluation of the response to treatment.Keywords:
Ependymoma
Spinal Cord Neoplasm
Ependymal Cell
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Objective:To study the MR imaging features of spinal cord ependymomas. Methods: 16 cases of ependymomas with histologically confirmed were retrospectively reviewed in terms of location, size, pattern of growth,signal intensity, enhancement pattern as well as the presence or absence of cystic degeneration,hemorrhage and cap sign on MRI imaging. Results; All spinal cord ependymomas showed epicenteral growth and 3 cases of filar ependymomas were complicated with inter-vertebral foramina dilatation. The tumors were involved in 2.7 numbers of vertebral highness along congifudinal direction. Majority of tumors were iso- or hypointense on T1W1 and all were hyperintense on T2W1. 10 cases of spinal ependymomas were associated with cranial and/or caudal reactive cystic degerantion of spinal cord. Three spinal ependymomas showed cystic area within the tumor and two with intratumoral hemorrhage. Cap sign was observed in 5 cases of tumors on T2WI imaging. 15 cases of tumors showed obviously enhancement and 14 cases had well-defined margins on the contrast-enhanced images. Conclusion: Spinal cord ependymomas have charicteristic MR features, which is helpful to improve the diagnosis.
Ependymoma
Contrast Enhancement
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Objective To evalute the magnetic resonance(MR)imaging features of intramedullary ependymomas.Methods The clinical and MR imaging materials of 15patients with spinal cord ependymomas confirmed by operation and pathology were reviewed.Results Among 15cases of ependymomas,12were cervical and 1thoracic,and 2lumbar.All tumors were located centrically in the spinal cord,with a mean length of 2.1along the neuraxis.Clear tumor margins were seen in 13ependymomas.Most of tumors were isointensity or mixed intensity on T1WI and hyperintensity or mixed intensity on T2WI.Rostral and/or caudal cysts were seen in 10ependymomas,intratumoral cysts were found in 4tumors.Intratumoral hemorrhage was shown in 2tumors.Cap signwas seen in 2tumors.7of 15ependymomas had uniform contrast enhancement.Conclusion Central locations,clear tumor margins,and more uniform enhancement can help differentiate ependymomas from other intramedullary spinal cord tumors.
Ependymoma
Spinal Cord Neoplasm
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Objective To describe the MRI features in 38 cases of midbrain tumors. Methods From 1993 to 1997,MRI was performed in 38 patients with midbrain tumors. There were 27 males and 11 females. Mean age was 24.9 years. All patients underwent surgical operation. Results Of the 38 patients, 11 tumors occurred predominantly in the tectum, 20 tumors in the tegmentum and 7 with downward extension to the pons, 7 tumors were located in the cerebral aqueduct. The histological diagnosis was lowgrade astrocytoma in 16 cases, highgrade astrocytoma in 15 cases, oligoastrocytoma in 5 cases, and ependymoma in 2 cases. Conclusions There was a wide variety of MRI features related to the site and pathology of midbrain tumors. With the advent of MRI, the delineation of the lesions is more precise, and the tumor type can usually be correctly assumed.
Tectum
Tegmentum
Pons
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Objective To investigate MRI findings of myxopapillary ependymomas( MPE) in spinal canal and to compare these findings with pathologic results. Methods MR findings in 12 patients with surgically-confirmed MPE in spinal canal were retrospectively analyzed. MRI signs included tumor location,shape,size,signal intensity and internal enhancement. The results were analyzed. Results The lesion of MPE was single in all the 12 patients. The lesions were located at the conus medullaris region( n = 1) or at the filum terminale area( n = 11). 75% of lesions( 9 /12) were situated around L2 level. Plain MRI scanning demonstrated that the lesions showed iso-signal on T1WI and patch high-signal within the tumor could be seen in 9 patients,while on T2WI high-signal was seen in 11 patients and iso-signal in one patient,and heterogeneous signal intensity with flagpole-like or patch low-signal could be detected in 10 lesions. Contrast-enhanced MRI scanning revealed that all the lesions had heterogeneous enhancement,and these areas that were characterized by high-signal on T1WI or low-signal on T2WI showed no enhancement at all. Pathologically,the tumor was rich in blood supply and easily bled. The tumor cells arranged around vascular myxoid stromal cores in a papillary radial pattern,and abundant myxoid was collected in the vessels or around the vascular cells. Conclusion The characteristic MRI manifestations of myxopapillary ependymomas in spinal canal are iso-signal mixed with high-signal within the tumor on T1WI and heterogeneous enhancement on enhanced scans. These MRI manifestations are strongly consistent with the pathologic findings.
Filum terminale
Conus medullaris
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Forty-eight Gd-DTPA-enhanced MR examinations of the spine were performed in 40 patients referred for MR because of clinically suspected spinal tumor or for further evaluation of an expanded cord. The study group consisted of 32 patients with spinal tumors (seven ependymomas; seven astrocytomas; four hemangioblastomas; two arteriovenous malformations; two unidentified intramedullary neoplasms; four meningiomas; and single cases of metastatic breast carcinoma, cavernous hemangioma with associated hematomyelia, neurinoma, angiolipoma, drop metastasis from medulloblastoma, and epidermoid with diastematomyelia). In the remaining eight patients, other diagnoses were established: thoracic disk herniation (two patients), lumbosacral meningocele (one), syringomyelia secondary to arachnoiditis (four), and expanded cord secondary to gliotic tissue (one). All but two diagnoses were proved histologically by biopsy, surgery, or autopsy; in the two patients with arteriovenous malformations, the definitive diagnosis was made by spinal angiography. Contrast enhancement occurred in 30 of the 32 spinal tumors, and Gd-DTPA-enhanced T1-weighted images proved helpful in defining and outlining intra- and extramedullary spinal neoplasms. All ependymomas and astrocytomas (including low-grade astrocytomas) enhanced. In meningiomas, an immediate and uniform contrast uptake was demonstrated. Additional advantages of Gd-DTPA MR include the differentiation of solid tumor components vs syrinx or cyst or pseudotumoral areas of cord expansion, and the differentiation of residual or recurrent tumor from scar tissue in postoperative patients. Our results suggest that IV-injected Gd-DTPA improves MR sensitivity and specificity in the evaluation of spinal lesions.
Hemangioblastoma
Ependymoma
Spinal Cord Neoplasm
Lumbosacral joint
Syrinx (medicine)
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Object Enhancement of pathological entities in the central nervous system is a common finding when the blood–brain barrier has been compromised. In the brain, the presence or absence of gadolinium enhancement is often an indicator of tumor invasiveness and/or grade. In the spinal cord, however, contrast enhancement has been shown in all tumor types, regardless of grade. In this study the authors explore the incidence of nonenhancing tumors of the spinal cord and the clinical course of patients with these lesions. Methods A retrospective analysis was conducted in which investigators examined the patterns of enhancement of histologically proven intramedullary spinal cord tumors that had been evaluated at the Mayo Clinic between 1998 and 2002. The tumors that did not enhance were the subject of this report. Results A total of 130 patients with intramedullary tumors were evaluated. Of those, 11 patients (9%) had tumors that did not enhance. Histologically, a majority of tumors were astrocytomas (eight low-grade and two high-grade lesions); one tumor was a subependymoma. Morphologically, most of the tumors were diffuse and none had associated cysts. Tumors spanned from two to seven levels and were located throughout the spinal cord (four cervical, three cervicothoracic, one thoracic, and three thoracolumbar). Biopsy procedures were performed in eight patients, subtotal resection was performed in two, and gross-total resection in one. After a mean follow-up period of 19 months, tumors remained stable in eight patients but progressed in three, two of whom died. Conclusions A number of intramedullary spinal cord tumors will not enhance after addition of contrast agents. The absence of enhancement does not imply the absence of tumor.
Spinal Cord Neoplasm
Spinal cord tumor
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Background: Tumors of the spinal cord or canal constitute approximately 15% to 20% of central nervous system tumors. The differential diagnosis of spinal neoplasms is primarily based on location of the lesion relative to the spinal cord and the age, sex and clinical presentation. The aim and objective of the study was to determine the sensitivity of magnetic resonance imaging (MRI) in diagnosing intra spinal tumors and to correlate findings on MRI with histopathological diagnosis.Methods: This is a retrospective study. The study group included all the patients who presented to our hospital with progressive sensory or motor deficits, para or quadriperesis with or without bladder/bowel Involvement. Only patients with Intra dural lesions such as intradural extra medullary and Intra medullary lesions were included in the study. All the extra dural lesion cases such as vertebral tumors, degenerative/osteoporotic compressions and Trauma related cord compressions were excluded from the study.Results: Of the forty intradural tumors, 28 were extramedullary and 12 were intramedullary. Most of the tumors were located in the cervical and the dorsolumbar spine accounting for more than 50%. The most common tumor encountered in our study was schwannoma (22/40), followed by ependymoma (7/40), meningioma (4/40), astrocytoma (4/40), one each of Hemangioblastoma, Neuroentericcyst and Dermoid cyst. Ependymomas, Astrocytomas and hemangioblastoma were intramedullary lesions and the remaining lesions constituted Intra Dural extra medullary lesions.Conclusions: MRI was found to be a highly sensitive imaging procedure and the method of choice for intradural tumor evaluation and to differentiate extra medullary from Intra medullary lesions. It is not sensitive enough to differentiate the Intra medullary tumors. Nevertheless, definite diagnosis could be made by histopathology only.
Hemangioblastoma
Ependymoma
Histopathology
Spinal Cord Neoplasm
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Objective To determine the MRi maging features of pri mary PNETin the spinal cord .Methods We retro-spectively reviewed MRi maging studies of 4 histologically and clinically confirmed pri mary PNETs in the spinal cord . Allfour patients underwent spinal MRstudy before and after injection of contrast agent preoperatively .Results The patients’ages ranged from13 to 46 years with a median of 26 .5 years . On MRi mage ,two tumors were located in the thoracic cordwith the other two in the conus medullaris and the cervicothoracic cord ,respectively . And focal mass effect was found inthree tumors while diffuse enlargement of the spinal cord was seen in one tumor . Among the four tumors ,cystic area waspresent and extended caudal fromthe tumor in only one case . They were all located at the center of the spinal cord with anill-defined margin and no apparent peritumoral edema . And all of them were hypo toisointense on T1-weightedi mages ,andhyperintense on T2-weighted i mages . After contrast , moderate or marked enhancement was found in three of them, whileslight enhancement in the rest one .Conclusion Pri mary PNETs of the spinal cord appear to be more commonin adults thanin children and may be intramedullary or exophytic or combinedintramedullary-extramedullary .In addition,they may be lo-cated at all levels of the spinal cord with the thoracic spinal cord and conus medullaris being the most common.But none oftheir MRi maging features was pathognomonic and the final diagnosis depends on surgical pathology .
Conus medullaris
Spinal cord tumor
Pathognomonic
Spinal Cord Neoplasm
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Objective: The purpose of this study was to determine characteristic imaging findings of intramedullary
spinal cord tumor in magnetic resonance imaging (MRI).
Material and Methods: We retrospectively analyzed MRI in 15 patients with histologicaly proven intramedullary spinal cord tumors. The demographic data, MRI findings with histological findings were
recorded in terms of age, location, length, morphology, signal intensity, the presence or absence of cyst
and hemorrhage, enhancement pattern, other associated findings, necrosis, vascular proliferation and
WHO grading.
Results: Among the 15 patients, spinal cord ependymomas were eccentric 75%, well-define border 62.5% and cervicothoracic spine located 37.5%. Spinal cord astrocytomas were eccentrically located and ill-define border 85.7%, cervicothoracic and thoracic spine located 28.5%. A cystic component was seen in 87.5% of spinal cord ependymoma and 71.5% of astrocytomas. Intratumoral hemorrhage occurred in 75% of spinal cord ependymomas, and 57.1% of astrocytomas. In 12.5% of spinal cord ependymomas, a curvilinear low T2 signal, suggesting marginal hemorrhage, was seen at the upper and/or lower margins of the tumors. Twenty-five percent of spinal cord ependymoma and 57.2% of astrocytomas showed heterogeneous enhancement, while in 12.5% of spinal cord ependymomas, enhancement was homogeneous.
Conclusion: Although no statistically significant characteristic MRI feature to distinguish between ependymoma and astrocytoma is detected. By percentage we found that border, length and signal intensity of tumors may help diagnosis. With pathological correlation, all of spinal cord ependymomas are mark hypervascular tumor, but astrocytomas never showed.
Ependymoma
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Objective To investigate the relationship between MRI features and pathologic findings in adult supratentorial primitive neuroectodermal tumor( SPNET) in order to improve its diagnostic level.Methods A total of 10 patients with pathologically proved SPNET were included in this study.The clinical,pathological and MRI materials were collected.The imaging characteristics of SPNET were retrospectively analyzed.The correlation between imaging features and pathological results were evaluated.The male-to-female ratio was 7:3;and the median age was 45.0 years.Clinical manifestations included headache and vomiting episode( n = 7),headache associated with syncope( n = 2),and numbness of face and tongue( n = 1).Both plain and contrast-enhanced MRI scans with a GE 1.5T MRI scanner were performed in all patients.Results Solitary lesion was seen in all patients.The lesions were located at the frontal lobe( n = 5),temporal lobe( n =3) and parietal lobe( n = 2) with involvement of corpus callosum in one case.Before operation no metastasis was detected.The lesions were larger in size with a sharp border and obvious space-occupying effect.No edema was observed in 3 cases,mild edema was seen in 5 cases and notable edema in 2 cases;bleeding was found in 2 cases,while no calcification was seen.Cystic-solid lesion was found in 6 cases,presenting as a large cyst with small nodules;the nodules were usually located on the cerebral convexity and the cyst was very close to the midline.Solid lesion was seen in 4 cases,focal necrosis was accompanied in some cases,which was characterized by hypointensity or isointensity signals on T1 WI and slight hyperintensity or hyperintensity signals on T2 WI,and presentedsignet ringorhoneycombenhancement after contrast injection.Conclusion The MRI characteristics of adult SPNET are closely related to its pathological features.Although adult supratentorial primitive neuralectoderm tumors have certain MRI features,the confirmation of the diagnosis still depends on pathological examination.
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