Spinal Cord Ependymomas: MR Imaging Features and Differential Diagnosis
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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.Keywords:
Ependymoma
Contrast Enhancement
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Spinal hemangioblastoma is a rare tumor. Its incidence varies from 1.6 to 2.1% of primary spinal cord tumors. In this report, the authors described MRI (magnetic resonance imaging) of spinal hemangioblastoma and its surgical results. [MATERIALS AND METHODS] This series included 10 spinal hemangioblastomas studied with CT or MRI. There were 8 men and 2 women. The age ranged from 21 to 68 years, with a mean age of 45 years. 6 patients were preoperatively and postoperatively studied with a resistive 0.15 T system (Toshiba MRT 15A) or a superconductive 1.5 T system (GE Signa or Siemens Magnetom). The lesions were single in 8 out of 10 patients and multiple in 2. 10 spinal hemangioblastomas were located in intramedullary space and 2 in both intramedullary and extramedullary space. 8 out of 10 patients (80%) were associated with cyst. [RESULTS] (1) MRI In T1-weighted MR images after administration of Gd-DTPA, the solid component of the tumor enhanced brilliantly. The enhanced lesions contained serpiginous areas of signal void, reflecting vascular structures in 5 out of 6 cases. The intrinsic spinal cord signal was heterogenous with low intensity areas representing the associated cyst. The cyst appeared either isointensive to cerebrospinal fluid (CSF) or hyperintense relative to CSF and slightly hypointense relative to the spinal cord. The precise delineation of the tumor was impossible without enhancement. Noncontrast T1-weighted MR images displayed diffuse widening of the spinal cord. On T2-weighted MR images, all regions of the spinal cord enlargement increased in signal. (2) Postoperative results All 10 cases of spinal hemangioblastomas were totally removed with good postoperative results and the associated cysts were drained. The postoperative MRI showed the disappearance of the tumor and significant reduction in the size of the cyst. [CONCLUSION] (1) Gd-DTPA enhanced MRI was useful in defining and outlining the solid component of spinal hemangioblastoma. (2) The complete removal of the tumor with only drainage of the cyst was possible with good postoperative results.
Hemangioblastoma
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Objective: To study the MR imaging features of lateral ventricular ependymomas.Materials and Methods: 38 cases of lateral ventricular 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 cyst on MR imaging.Results: Almost of tumors were iso-or hypointense on T1WI and all of tumors were hyperintense on T2WI.A cystic component was seen in 73.7% of lateral ventricular ependymomas and intratumoral hemorrhage was rare.Almost of tumors were irregular margins.22(57.9%)cases of tumors infiltrated vicinity of brain tissue and 30(78.9%) cases extended to opposite side ventricle or third ventricle.Almost of tumors(89.5%)showed obviously non-uniform enhancement and 4 cases showed slight non-uniform enhancement.Conclusion: Lateral ventricular ependymomas have certain MR features,which are very help to make correct preoperative diagnosis and different diagnosis.
Ventricular system
Ependymoma
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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.
Ependymoma
Spinal Cord Neoplasm
Ependymal Cell
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Summary. To assess the utility of gadolinium-DTPA (Gd) and of MR imaging in the evaluation of spinal cord tumors, ten consecutive patients were prospectively evaluated. T1proton density-, and T2-weighted images were obtained in sagittal or axial planes. Tl-weighted images were obtained before and after intravenous administration. Five tumors were within the cervical spinal cord; 3 neoplasms were within the thoracic cord; i neoplasm extended from the cervical to the thoracic cord and 1 neoplasm extended from the cervical cord to the conus medullaris. Four tumors were ependymomas; 3 were astrocytomas; 1 was an hemangioblastoma, and 1 was a metastatic malignant peripheral nerve sheath tumor. The remaining patient died prior to spinal surgerY andno autopsy was obtained. Oftheprecontrast sequences, tumors were best evaluated using T1weighted images. Abnormal findings included cord widening, presence of a tumor mass, intratumoral or other associated cyst(s), and hemorrhage. Nevertheless, T1weighted images obtained following the administration of GD were superior relative to all other pre- and post-contrast sequences for defining tumor margins, characterizing cyst(s) and delineating tumor masses. Based primarily on their appearance on post-contrast Tl-weighted images, tumor-associated cysts could be subcategorized into 3 types: intratumoral cysts (found within the contrast-enhancing soft tissue mass); nonenhancing extratumoral cysts (found either rostral or caudal to the enhancing tumor mass); and enhancing extratumoral cysts (having an enhancing wall or containing an enhancing nodule). Our results indicate that Tl-weighted MR images obtained both before and after administration of Gd are sufficient for characterizing the varying components of intramedullary spinal cord tumors. This information assists in treatment planning and follow-up of patients with these tumors.
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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 explore the MRI characteristics of hemangioblastoma of the spinal cord.Methods:MRI appearance of 12 spinal cord hemangioblastoma patients with surgically and pathologically proved were analyzed restrospectively.Results:In the 12 cases of spinal cord hemangioblastomas,3 case had multiple lesions,one patient also had intracranial hemangioblastoma.The lesions were located in cervical spinal cord in 7 cases,thoracic spinal cord 3 cases,cervical thoracic segement in 1 case,thoracic lumbar segement in 1 case.MRI appearance:the signal on T1WI of the tumors showed iso-hypointense in contrast to the normal spinal cord,higher intensity(n=1)than blood;and mixed hyper-hypointense signal on T2WI.After enhancement,nodular tumors showed marked enhancement with distinct border on T1WI.The blood flow-void-sign(n=11)within and around the masses was seen on T2WI or on contrast scans.There were secondary syringomyelia or cystic changes,above or below the tumor in 10 cases.Conclusion:MRI is an efficient method in the diagnosis of spinal cord hemangioblastoma.It plays an important role in the diagnosis and differential diagnosis of hemangioblastoma.
Hemangioblastoma
Spinal Cord Neoplasm
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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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To improve the accuracy of qualitative diagnosis of intracranial ependymomas by analyzing their magnetic resonance (MR) images.The MR images of 13 cases of intracranial ependymomas confirmed by pathological examinations were investigated retrospectively.In the 10 cases of ventricle ependymomas, the tumors were identified in the fourth ventricle in 3 cases and in the lateral ventricle in 7 cases. The T(1)-weighted MR images presented isointense or hypointense signals and T(2)-weighted images showed inhomogeneous hyperintense ones. No edema occurred around these tumors, and the contrast-enhanced scans presented inhomogeneous enhancement. In the other 3 cases of ependymomas in the brain parenchyma, including 2 cases of supratentorial and 1 subtentorial ependymomas. The tumor parenchyma presented hypointense signals in T(1)-weighted MR images as compared to the signals of the brain parenchyma, and in T(2)-weighted images, the signals intensities were similar to or higher than those of the gray matter. Mild edema could be seen around the tumors. Enhanced scans of the tumor parenchyma showed mild to moderate enhancement.MR examination may help in the preoperative detection of intracranial ependymomas.
Parenchyma
Ependymoma
Fourth ventricle
Brain 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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