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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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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The purpose of this retrospective review is to determine the MR imaging features of pilocytic astrocytoma (PA) in the spinal cord to help neuroradiologists preoperatively differentiate PA from other intramedullary tumors. Neuro-oncology database review revealed 13 consecutive patients with a pathological spinal PA diagnosis and availability of preoperative MR imaging. Three patients had preoperative diffusion-weighted MR imaging. Demographics and conventional and diffusion MR imaging records were retrospectively evaluated. Among 13 cases of spinal PA, six PAs were located in the cervical region, 4 in the cervical-thoracic region, and 3 in the thoracic region. The average length of vertebral segments involved for the tumors were 4.7 ± 4.6 segments. Six tumors had associated syringomyelia. Eight PAs were located eccentrically in the spinal cord, and eleven had well-defined margins. Eight tumors (61.5%) were intermixed cystic and solid. All were contrast-enhanced, and 53.8% of all PAs showed focal nodule enhancement of the solid components. Two PAs showed intratumoral hemorrhages, and only one demonstrated cap sign. The ADC values (n = 3) of the tumors were 1.40 ± 0.28 × 10− 3 mm2/s (min–max: 1.17–1.71 × 10− 3 mm2/s). PA should be considered in the differential diagnosis of intramedullary tumors that occur in the cervical and thoracic regions. Eccentric growth pattern, well-defined margin, intermixed cystic and solid appearance, focal nodular enhancement of solid components and syringomyelia are relatively frequent features. Relatively high ADC values compared with normal-appearing spinal cord parenchyma are common in spinal PA.
Pilocytic astrocytoma
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Objective To analyze the MRI appearance of intramedullary spinal cord metastasis (ISCM) and the difference between ISCM and other common tumors of inner spinal cord for improving the knowledge of the disease. Methods Eleven cases of ISCM were analyzed retrospectively. MR examinations including pre-contrast and Gd-DTPA enhancement were performed in all the cases. Results MRI appearance of 4 cases clinically and 7 cases pathologically proved were analyzed (average age of onset was 46.4±2.8 years). Multiple lesions occurred in 6 cases distributing in cervical cord, thoracic cord, conus or cauda equina. Mono-lesion occurred in 5 cases: 3 occurred in conus, 1 occurred in cervical cord, 1 occurred in the boundary of cervical cord and bulbus medullae. ISCM mainly displayed hypointensity or isointensity on T1WI and heterogeneousc hyperintensity on T2WI. On contrast study, all tumors showed marked enhancement, appearing patching, ring-shaped, mottling and nodosity enhancement. Affiliated signs included spinal cord thickening, peripheral edema, spinal cord cavity et al. Conclusion MRI can well demonstrate the inner structure and signal character of ISCM, identify the extension and development of lesion, thus can contribute the diagnosis and differential diagnosis; however ISCM have no characteristic manifestations on MRI, clinical data should be analyzed comprehensively to draw the final diagnosis.
Spinal Cord Diseases
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Spinal Cord Neoplasm
Intensity
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We studied 17 cases of spinal cord tumors using magnetic resonance imaging. According to the intensity of image and histological feature of spinal cord tumors, we identified two groups in T2 weighted imaging. One was a hypointensity group showing cystic or vascular tumors, and the other was hyperintensity group of solid tumors. Preoperative images of swelling, narrowing, deviation of the spinal cord were remained after the operations. Grafted free fatty tissue for the prevention of adhesion was recognized well also after the operation. Postoperative imagings sometime showed pseudo-deviation of the spinal cord which was easy to be mistaken as the remains of tumors and narrowing of the spinal cord. In conclusions, The magnetic resonance imaging makes very early detection of spinal cord tumors possible, and it is valuable for a diagnosis of the spinal cord tumor associated with brain tumor.
Spinal Cord Neoplasm
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Objective To study the MR characteristics of intracerebral ependymomas. Methods Twenty cases with pathologically proved intracerebral ependymomas were analyzed with emphasis on tumor size,location,relationship to ventricles,edema,signal characteristics and contrast enhancement. Results In these 20 cases,intracerebral ependymomas were typically large,cystic or solid cystic,without evident edema around the tumors. Most lesions were found in children and young adults. The tumors showed ring enhancement or mural nodual enhancement or in hetetogeneous manner. All tumors had strong relationship to the lateral ventricle. Conclusion Intracerebral ependymomas have specific MRI features, which can be helpful in the differentiation of brain neoplasms.
Ependymoma
Contrast Enhancement
Lateral ventricles
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Clonus
Tetraparesis
Neck pain
Cervical spondylosis
Hyperreflexia
Fasciculation
Foramen magnum
Neurological examination
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Objective To evaluate the MR features of spinal hemangioblastomas. Methods Sixteen patients (6 male, 10 female, age ranged from 15 to 57, mean age 30.7) with histologically proven spinal hemangioblastomas were included in this study. Results Total 23 spinal hemangioblastomas were displayed by MR studies. The tumor frequently occurred in cervical cord (14/23), usually above C3 level (9/14). The tumor commonly involved the posterior aspect of the cord (16/23). The spinal hemangioblastoma usually showed iso hypointensity on T 1WI and hyperintensity on T 2WI. The extensive cord enlargement with cyst formation or syrinx was common. On unenhanced study, the tumor may be indistinguishable from cyst or syrinx. Flow void was shown in 9 patients, and in 8 tumors on the dorsal surface of the cord or tumor. On contrast study, all tumors showed marked homogeneous enhancement with clear borders. Conclusions The spinal hemangionblastomas usually present as multiple lesions with marked contrast enhancement. The extensive cord enlargement and flow void in the dosal part of the tumors are common in these patients. MR study, especially the contrast enhancement T 1WI, can clearly demonstrate the tumor.
Hemangioblastoma
Spinal Cord Neoplasm
Syrinx (medicine)
Ependymoma
Contrast Enhancement
Spinal cord tumor
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Objective To study the MR imaging features of spinal cord ependymomas.Materials and 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 cyst, hemorrhage and “cap sign” on MR imaging.Results All spinal cord ependymomas were showed as epicenteral growth and 3 cases of filar ependymomas combined with intervertebral foramina dilatation. The average number of vertebral segments involved with tumors was 2.7. Most of tumors were iso or hypointense on T_1WI and all of tumors were hyperintense on T_2WI. 10 cases of spinal ependymomas were associated with rostral and/or caudal reactive cysts. A cystic component was seen in 3 spinal ependymomas. Intratumoral hemorrhage occurred in 2 cases of spinal ependymomas. “Cap sign” was seen in 5 cases of tumors on T_2WI imaging. 15 cases of tumors were obviously enhanced and 14 cases had well-defined margins.Conclusion Spinal cord ependymomas have certain MR features, which are very helpful to make correct preoperative diagnosis and differential diagnosis.
Ependymoma
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Objective To study the MR imaging features of intramedullary spinal cord ependymomas.Methods 13 cases of ependymomas histologically confirmed were retrospectively reviewed in terms of location,signal intensity,enhancement pattern as well as the presence or absence of cyst,hemorrhage andcap sign,intervertebral foramina dilatation on MR imaging.Results Six tumors were cervical,3 were thoracic,and 4 were conus medullaris and filum ferminale.Tumors were iso-or hypointense on T1WI and were hyperintense or heterogeneously hyperintense on T2WI.Nine cases of ependymomas were associated with cysts.Intratumoral hemorrhage occurred in 3 cases of spinal ependymomas.Cap sign was seen in 2 cases of tumors on T2WI.Two cases of ependymomas were seen with intervertebral foramina dilatation.All patients received contrast material and tumors were enhanced by contrast material(mild enhancement in 1 case,moderate enhancement in 3,obvious enhancement in 9) and 11 lesions had well-defined margins.Conclusion Spinal cord ependymomas have certain MR features,which are very helpful to make correct preoperative diagnosis.
Conus medullaris
Ependymoma
Contrast Enhancement
Spinal Cord Neoplasm
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