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Published on: July 16, 2018
MRI characteristics and resectability in spinal cord glioma
Scott C Seaman1, Girish Bathla2, Brian J Park1
1Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA USA.
Objective:
The histopathology of intramedullary spinal cord tumors (IMSCT) can be suspected from the MRI features and characteristics. Ultimately, the confirmation of diagnosis requires surgery. This retrospective study addresses MRI features including homogeneity of enhancement, margination, and associated syrinx in intramedullary astrocytomas (IMA) and ependymomas (IME) that assist in diagnosis and predict resectability of these tumors.
Methods:
Single-center retrospective analysis of IMA and IME cases since 2005 extracted from the departmental registry/electronic medical records post IRB approval (IRB 201,710,760). We compared imaging findings (enhancement, margination, homogeneity, and associated syrinxes) between tumor types and examined patient outcomes.
Results:
There were 18 IME and 21 IMA. On preoperative MRI, IME was favored to have homogenous enhancement (OR 1.8, p = 0.0001), well-marginated (p < 0.0001, OR 0.019 [95 % CI 0.002-0.184]), and associated syrinx (p = 0.015, OR 0.192 [95 % CI 0.049-0.760]). Total excision, subtotal excision, and biopsy were performed in 12, 5, and 1 patients in the IME cohort, respectively. In the IMA group, tumors were heterogeneous and poorly marginated in 20 of the 21 patients. Total excision, subtotal excision, and biopsy were undertaken in 2, 13, and 6 patients, respectively. The success of excision was predicted by MRI, with a significant difference in the extent of resection between IME and IMA (X2 = 14.123, p = 0.001). In terms of outcome, ordinal regression analysis showed that well-margined tumors and those with homogeneous enhancement were associated with a better postoperative McCormick score. Extent of resection had statistically significant survival (p = 0.026) and recurrence-free survival (p = 0.008) benefits.
Conclusion:
The imaging characteristics of IME and IMA have meaningful clinical significance. Homogeneity, margination, and associated syrinxes in IME can predict resectability and complexity of surgery.
Insights
MRI features like enhancement and margination help differentiate spinal cord tumors. Ependymomas (IME) often show homogenous enhancement and clear margins, predicting better surgical outcomes compared to astrocytomas (IMA).
Area of Science:
- Neurosurgery
- Radiology
- Oncology
Background:
- Intramedullary spinal cord tumors (IMSCT) diagnosis relies on MRI features, but surgical confirmation is definitive.
- Differentiating between intramedullary astrocytomas (IMA) and ependymomas (IME) preoperatively is crucial for surgical planning and predicting outcomes.
Purpose of the Study:
- To analyze MRI characteristics such as enhancement homogeneity, margination, and associated syrinx formation in IMA and IME.
- To determine if these MRI features can predict tumor resectability and influence surgical outcomes.
Main Methods:
- Retrospective analysis of 39 patients (18 IME, 21 IMA) diagnosed since 2005.
- Comparison of preoperative MRI findings (enhancement, margination, syrinx) between IMA and IME.
- Correlation of imaging features with surgical extent and patient outcomes (McCormick score, survival, recurrence-free survival).
Main Results:
- Ependymomas (IME) were significantly associated with homogenous enhancement (OR 1.8, p=0.0001), well-defined margins (p<0.0001), and associated syrinx (p=0.015) compared to astrocytomas (IMA).
- IMA typically presented as heterogeneous and poorly marginated tumors.
- MRI findings predicted the extent of resection, with a significant difference between IME and IMA (X²=14.123, p=0.001).
- Well-marginated tumors with homogenous enhancement correlated with better postoperative McCormick scores.
- Extent of resection significantly impacted survival (p=0.026) and recurrence-free survival (p=0.008).
Conclusions:
- Specific MRI characteristics of IME (homogeneity, clear margins, syrinx) are clinically significant for predicting resectability and surgical complexity.
- Preoperative MRI assessment aids in differentiating IMA from IME and guides surgical strategy for improved patient outcomes.
