Journal List > J Korean Soc Radiol > v.76(6) > 1087811

Shin, Lee, Lee, Kang, Hyun, Kim, Jahng, Kim, and Kang: Various MRI Findings of Spinal Ependymoma

Abstract

Purpose

To present the typical and atypical magnetic resonance image (MRI) findings of intramedullary spinal ependymomas, and compare these findings with path-ological subtypes.

Materials and Methods

Between January 2003 to November 2014, 47 patients who had spinal ependymoma with pathologic confirmation, were retrospectively reviewed with all electronic medical records and MR images. MR imaging was done in all cases, and the images of spinal ependymomas and associated enhancement patterns were correlated with pathologic findings.

Results

The enhancement patterns were categorized into four categories: homogeneous, heterogeneous, rim-enhancement, and non-enhancement. Heterogeneous enhancement was observed in 50% of the cases. Among the 47 cases, 35 cases were well-marginated, with 21 being cervically located. All lesions were centrally located in the axial axis. Most of the cases showed T1-iso signal intensity (81%) and T2-high sig-nal intensity (72%). The hemosiderin cap sign, syringomyelia, tumoral and non-tu-moral cysts were well demonstrated. The most common pathologic type was cellular ependymoma. However, due to the small sample size, we believe it inappropriate to statistically discuss the MRI findings according to the pathologic subtype.

Conclusion

Most spinal ependymoma showed T1-iso signal intensity and T2-high signal intensity, with enhancement patterns other than homogeneous enhancement.

Index terms

Ependymoma, Spinal Cord Neoplasms, Magnetic Resonance Imaging

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Fig. 1.
A 43-year-old male patient diagnosed as cellular ependymoma. A. Sagittal T2-weighted image shows heterogeneous hyperintense lesion throughout the cervical cord, with rostral non-tumoral cyst (white arrow) and spinal cord edema caudally (black arrowheads). B. Sagittal T1-weighted contrast enhancement image shows the heterogeneous enhancement of the tumor (white arrowheads).
jksr-76-411f1.tif
Fig. 2.
A 65-year-old female patient diagnosed as cellular ependymoma. A. Sagittal T2-weighted image demonstrates well-defined lesion with hemosiderin cap sign (white arrow) and cord edema (black arrowheads). B. Homogeneous enhancement (white arrowheads) of the solid lesion of the tumor is noted on sagittal T1-weighted contrast enhancement image.
jksr-76-411f2.tif
Fig. 3.
A 41-year-old male patient with cellular ependymoma. A. On the sagittal T1-weighted image, an approximately 3.5cm sized well-defined intramedullary mass in the cranio-cervical junction (white arrowheads). B. On the sagittal T2-weighted image, mass contained mainly cystic component with peripheral solid portion (white arrowheads) and rostral cord edema. C. On the sagittal contrast enhanced T1-weghted image, mass showed peripheral rim-enhancement (white arrowheads).
jksr-76-411f3.tif
Fig. 4.
A 45-year-old female patient with cellular ependymoma. A-C. Sagittal T2, T1, and T1 contrast enhancement image shows heterogeneous T2 hyperintense, T1 isointense lesion with no enhancement (white arrowheads).
jksr-76-411f4.tif
Fig. 5.
A 20-year-old female patient, who was finally diagnosed as anaplastic ependymoma. A. Initial sagittal T2-weighted and T1-weighted contrast enhancement image demonstrates heterogeneous enhancing lesion (white arrowheads) at thoracolumar spine, with caudal syrngomyelia (white arrows) and rostral tumoral cyst (black arrows). Initial diagnosis for the patient was cellular ependymoma. B. After tumor recurrence and reoperation, the patient was finally diagnosed as anaplastic ependymoma. The last MRI shows an extensive, heterogeneous enhancing lesion throughout the spine.
jksr-76-411f5.tif
Table 1.
MRI Appearance of Total 47 Ependymomas
Image Findings Cases (%)
Margin  
 Well-defined 35 (74)
 Ill-defined 12 (26)
T1 signal intensity  
 Low signal intensity 6 (13)
 Iso signal intensity 38 (81)
 High signal intensity 3 (6)
T2 signal intensity  
 Low signal intensity 0 (0)
 Iso signal intensity 13 (28)
 High signal intensity 34 (72)
Contrast-enhancement  
 Homogeneous 17 (37)
 Heterogeneous 23 (50)
 Rim 5 (11)
 None 1 (2)
Hemosiderin cap  
 Positive 20 (43)
 Negative 27 (57)
Syringomyelia  
 Positive 31 (66)
 Negative 16 (34)
Tumoral cyst  
 Positive 22 (47)
 Negative 25 (53)
Nonetumoral cyst  
 Positive 10 (21)
 Negative 37 (79)

The contrast enhancement study was performed total 46 patients.

Table 2.
Image Findings According to the Pathologic Type
  Conventional (39, 83%) Anaplastic (1, 2%) Myxopapillary (7, 15%)
Cellular (36, 77%) Papillary (1, 2%) Tanycytic (2, 4%)
Longitudinal location          
 Cervical 19 0 2 0 0
 Thoracic 11 0 0 0 1
 Lumbo-sacral 5 1 0 1 6
Axial location     All central location    
Margin          
 Well-defined 25 1 1 1 7
 Ill-defined 11 0 1 0 0
T1          
 Low signal intensity 6 0 0 0 0
 Iso signal intensity 27 1 2 1 7
 High signal intensity 3 0 0 0 0
T2          
 Low signal intensity 0 0 0 0 0
 Iso signal intensity 12 1 0 0 0
 High signal intensity 24 0 2 1 7
Contrast-enhancement          
 Homogeneous 12 0 1 0 2
 Heterogeneous 18 1 1 1 4
 Rim 5 0 0 0 0
 None 1 0 0 0 0

The contrast-enhancement study was performed total 46 patients.

One patient with cellular ependymoma showed multifocal longitudinal location.

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