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Intracranial and spinal ependymomas: review of MR images in 61 patients.

Choi JY, Chang KH, Yu IK, Kim KH, Kwon BJ, Han MH, Kim IO - Korean J Radiol (2002 Oct-Dec)

Bottom Line: Forty- nine percent (17/35) of those in the spinal cord were associated with rostral and/or caudal reactive cysts.Intratumoral hemorrhage occurred in 57% (4/7) of supratentorial, 32% (6/19) of infratentorial, and 9% (3/35) of spinal cord tumors.Peritumoral edema occurred in 57% (4/7) of supratentorial, 6% (3/19) of infratentorial and 23% (8/35) of spinal cord tumors.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Korea.

ABSTRACT

Objective: To compare the age distribution and characteristic MR imaging findings of ependymoma for each typical location within the neuraxis.

Materials and methods: During a recent eleven-year period, MR images of 61 patients with histologically proven ependymomas were obtained and retrospectively reviewed in terms of incidence, peak age, location, size, signal intensity, the presence or absence of cyst and hemorrhage, enhancement pattern, and other associated findings.

Results: Among the 61 patients, tumor location was spinal in 35 (57%), infrartentorial in 19 (31%), and supratentorial in seven (12%). In four of these seven, the tumor was located in brain parenchyma, and in most cases developed between the third and fifth decade. Approximately half of the infratentorial tumors occurred during the first decade. The signal intensity of ependymomas was nonspecific, regardless of their location. A cystic component was seen in 71% (5/7) of supratentorial, 74% (14/19) of infratentorial, and 14% (5/35) of spinal cord tumors. Forty- nine percent (17/35) of those in the spinal cord were associated with rostral and/or caudal reactive cysts. Intratumoral hemorrhage occurred in 57% (4/7) of supratentorial, 32% (6/19) of infratentorial, and 9% (3/35) of spinal cord tumors. In 17% (6/35) of spinal ependymomas, a curvilinear low T2 signal, suggesting marginal hemorrhage, was seen at the upper and/or lower margins of the tumors. Peritumoral edema occurred in 57% (4/7) of supratentorial, 6% (3/19) of infratentorial and 23% (8/35) of spinal cord tumors. Seventy-two percent (5/7) of supratentorial and 95% (18/19) of infratentorial tumors showed heterogeneous enhancement, while in 50% (17/34) of spinal cord tumors, enhancement was homogeneous.

Conclusion: Even though the MR imaging findings of ependymomas vary and are nonspecific, awareness of these findings, and of tumor distribution according to age, is helpful and increases the likelihood of correct preoperative clinical diagnosis.

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A 27-year-old man with ependymoma of the cervical cord.A. Sagittal T2-weighted SE image (3500/120) shows that in the upper cervical cord, a heterogeneously intense mass with a low signal intensity rim (arrows) at its upper and lower margins is present. Associated peritumoral edema (arrowheads) is also apparent.B. Sagittal contrast-enhanced T1-weighted SE image (500/15) of the tumor depicts heterogeneous mild enhancement.
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Figure 7: A 27-year-old man with ependymoma of the cervical cord.A. Sagittal T2-weighted SE image (3500/120) shows that in the upper cervical cord, a heterogeneously intense mass with a low signal intensity rim (arrows) at its upper and lower margins is present. Associated peritumoral edema (arrowheads) is also apparent.B. Sagittal contrast-enhanced T1-weighted SE image (500/15) of the tumor depicts heterogeneous mild enhancement.

Mentions: Intratumoral hemorrhage occurred in 13 (21%) of the 61 ependymomas [in four (57%) of seven supratentorial, six (32%) of 19 infratentorial, and three (9%) of 35 spinal cord tumors] (Figs. 1 and 4). At T2-weighted imaging, rim(s) of low signal intensity, suggesting marginal hemorrhage between normal and tumor tissue, were seen at the upper or lower margins of six (17%) of 35 spinal cord ependymomas; four of the six were cervical (Fig. 7), one was thoracic (Fig. 6), and one was filar.


Intracranial and spinal ependymomas: review of MR images in 61 patients.

Choi JY, Chang KH, Yu IK, Kim KH, Kwon BJ, Han MH, Kim IO - Korean J Radiol (2002 Oct-Dec)

A 27-year-old man with ependymoma of the cervical cord.A. Sagittal T2-weighted SE image (3500/120) shows that in the upper cervical cord, a heterogeneously intense mass with a low signal intensity rim (arrows) at its upper and lower margins is present. Associated peritumoral edema (arrowheads) is also apparent.B. Sagittal contrast-enhanced T1-weighted SE image (500/15) of the tumor depicts heterogeneous mild enhancement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2713843&req=5

Figure 7: A 27-year-old man with ependymoma of the cervical cord.A. Sagittal T2-weighted SE image (3500/120) shows that in the upper cervical cord, a heterogeneously intense mass with a low signal intensity rim (arrows) at its upper and lower margins is present. Associated peritumoral edema (arrowheads) is also apparent.B. Sagittal contrast-enhanced T1-weighted SE image (500/15) of the tumor depicts heterogeneous mild enhancement.
Mentions: Intratumoral hemorrhage occurred in 13 (21%) of the 61 ependymomas [in four (57%) of seven supratentorial, six (32%) of 19 infratentorial, and three (9%) of 35 spinal cord tumors] (Figs. 1 and 4). At T2-weighted imaging, rim(s) of low signal intensity, suggesting marginal hemorrhage between normal and tumor tissue, were seen at the upper or lower margins of six (17%) of 35 spinal cord ependymomas; four of the six were cervical (Fig. 7), one was thoracic (Fig. 6), and one was filar.

Bottom Line: Forty- nine percent (17/35) of those in the spinal cord were associated with rostral and/or caudal reactive cysts.Intratumoral hemorrhage occurred in 57% (4/7) of supratentorial, 32% (6/19) of infratentorial, and 9% (3/35) of spinal cord tumors.Peritumoral edema occurred in 57% (4/7) of supratentorial, 6% (3/19) of infratentorial and 23% (8/35) of spinal cord tumors.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Korea.

ABSTRACT

Objective: To compare the age distribution and characteristic MR imaging findings of ependymoma for each typical location within the neuraxis.

Materials and methods: During a recent eleven-year period, MR images of 61 patients with histologically proven ependymomas were obtained and retrospectively reviewed in terms of incidence, peak age, location, size, signal intensity, the presence or absence of cyst and hemorrhage, enhancement pattern, and other associated findings.

Results: Among the 61 patients, tumor location was spinal in 35 (57%), infrartentorial in 19 (31%), and supratentorial in seven (12%). In four of these seven, the tumor was located in brain parenchyma, and in most cases developed between the third and fifth decade. Approximately half of the infratentorial tumors occurred during the first decade. The signal intensity of ependymomas was nonspecific, regardless of their location. A cystic component was seen in 71% (5/7) of supratentorial, 74% (14/19) of infratentorial, and 14% (5/35) of spinal cord tumors. Forty- nine percent (17/35) of those in the spinal cord were associated with rostral and/or caudal reactive cysts. Intratumoral hemorrhage occurred in 57% (4/7) of supratentorial, 32% (6/19) of infratentorial, and 9% (3/35) of spinal cord tumors. In 17% (6/35) of spinal ependymomas, a curvilinear low T2 signal, suggesting marginal hemorrhage, was seen at the upper and/or lower margins of the tumors. Peritumoral edema occurred in 57% (4/7) of supratentorial, 6% (3/19) of infratentorial and 23% (8/35) of spinal cord tumors. Seventy-two percent (5/7) of supratentorial and 95% (18/19) of infratentorial tumors showed heterogeneous enhancement, while in 50% (17/34) of spinal cord tumors, enhancement was homogeneous.

Conclusion: Even though the MR imaging findings of ependymomas vary and are nonspecific, awareness of these findings, and of tumor distribution according to age, is helpful and increases the likelihood of correct preoperative clinical diagnosis.

Show MeSH
Related in: MedlinePlus