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[Intramedullary glioma. Postoperative MRI aspects]
1Service de Neuroradiologie, CIERM - CHU Bicêtre, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre.
Abstract:
MRI is the standard exploration of intramedullary tumours. Following up the patients is of prime importance to detect and treat possible recurrences at an early stage. The purpose of this paper is to specify the postoperative MRI semiology of intraspinal gliomas. During the 1986-1992 period, 47 patients operated upon in the Bicêtre hospital for primary intraspinal tumours were followed up with high-field MR (1.5 Tesla, Signa, G.E.). The retrospective visual study was carried out by two neuro-radiologists. The patients' group consisted of 24 women and 23 men aged from 15 to 67 years (mean 38 years). The tumours treated were 29 ependymomas and 18 astrocytomas. Eighty-five MRI examinations were analysed. Most of them comprised at least two planes in T1 and T2-weighted spin echo sequences with gadolinium injection, then only T1-weighted spin echo sequences after gadolinium injection (0.1 mmol/kg). The mean postoperative follow up period in the 47 patients was 32 months (range 7 to 84 months). Contrast enhancement of the spinal cord was observed in 20 cases. In the 6 patients with recurrence (5 astrocytomas, 1 malignant ependymoma) there was a segmental increase of spinal cord volume with contrast enhancement after gadolinium injection. In 3 out of these 6 patients clinical deterioration appeared later than MRI semiology. In clinically stable patients neither enhancement nor increase in spinal cord size was found in 27 cases, and enhancement alone was noted in 12 cases. There was no reliable criterion in the analysis of post gadolinium signal enhancement that could be used to differentiate recurrence from cicatricial contrast enhancement.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Postoperative MRI is crucial for detecting intraspinal glioma recurrence. Spinal cord volume increase with contrast enhancement on MRI can indicate recurrence, often appearing before clinical symptoms.
Area of Science:
- Neurosurgery
- Radiology
- Oncology
Context:
- Magnetic Resonance Imaging (MRI) is the standard diagnostic tool for intramedullary tumors.
- Early detection and treatment of postoperative recurrences are critical for patient outcomes.
- Intraspinal gliomas, including ependymomas and astrocytomas, require vigilant follow-up.
Purpose:
- To define the postoperative Magnetic Resonance Imaging (MRI) characteristics of intraspinal gliomas.
- To correlate MRI findings with tumor recurrence and patient follow-up.
- To evaluate the utility of contrast enhancement in identifying recurrent disease.
Summary:
- This study analyzed 85 MRI examinations from 47 patients with intraspinal gliomas (ependymomas and astrocytomas) followed for an average of 32 months postoperatively.
- Recurrence, observed in 6 patients, was associated with segmental spinal cord volume increase and contrast enhancement, often preceding clinical deterioration.
- While contrast enhancement was noted in stable patients, a combination of volume increase and enhancement was specific to recurrence, though differentiating from cicatricial enhancement remained challenging.
Impact:
- MRI findings, particularly spinal cord volume changes and contrast enhancement, can aid in the early detection of intraspinal glioma recurrence.
- Understanding postoperative MRI semiology is essential for timely intervention and improved patient management.
- Further research may be needed to refine criteria for differentiating recurrent tumors from post-surgical changes.