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MR characteristics of histopathologic subtypes of spinal ependymoma
1Department of Radiology, University of Miami (Fla), School of Medicine 33136, USA.
Purpose:
To examine MR characteristics and enhancement patterns of spinal ependymomas and compare these data with histopathologic subtypes.
Methods:
The MR images from 26 cases of pathologically proved spinal ependymomas were evaluated with respect to seven criteria: signal characteristics, enhancement pattern, length of involvement, cysts or syrinxes, hemorrhage, bony changes, and type of cord expansion. Signal characteristics were then correlated with histologic subtype.
Results:
In the category of enhancement pattern, our results differed markedly from published data, with only 38% of cases demonstrating classic homogeneous enhancement. The remainder of our cases (62%) demonstrated other enhancement patterns, including heterogeneous (31%), rim (19%), minimal (6%), and no enhancement (6%). Pathologic comparison revealed that one histologic subtype, the myxopapillary ependymoma, demonstrated unique imaging characteristics on T1-weighted images. A highly statistically significant percentage of this variant was hyperintense on T1, whereas most nonmyxopapillary ependymomas were hypointense.
Conclusion:
The radiologist should be aware of alternative patterns of enhancement of spinal ependymomas and not be dissuaded from the diagnosis in appropriate clinical settings. In addition, one histologic subtype, myxopapillary, often exhibits signal characteristics different from nonmyxopapillary types, appearing hyperintense on T1 probably because of their intracellular and perivascular accumulation of mucin.
Insights
Spinal ependymomas show varied MR enhancement patterns, differing from classic descriptions. Myxopapillary ependymomas often appear hyperintense on T1-weighted MRI scans.
Area of Science:
- Neuroradiology
- Oncology
- Pathology
Background:
- Spinal ependymomas are tumors arising from ependymal cells within the central nervous system.
- Accurate diagnosis and characterization are crucial for treatment planning and prognosis.
Purpose of the Study:
- To analyze magnetic resonance (MR) imaging features of spinal ependymomas.
- To compare MR characteristics, including enhancement patterns, with histopathologic subtypes.
Main Methods:
- Retrospective review of MR images from 26 pathologically confirmed spinal ependymomas.
- Evaluation of signal characteristics, enhancement patterns, lesion length, presence of cysts, hemorrhage, bony changes, and cord expansion.
- Correlation of signal characteristics with histologic subtypes.
Main Results:
- Only 38% of cases showed classic homogeneous enhancement; 62% exhibited heterogeneous, rim, minimal, or no enhancement.
- Myxopapillary ependymomas demonstrated unique T1-weighted imaging characteristics, being significantly hyperintense compared to hypointense non-myxopapillary ependymomas.
Conclusions:
- Radiologists should consider diverse enhancement patterns for spinal ependymomas.
- Myxopapillary ependymomas frequently display hyperintensity on T1-weighted images due to mucin accumulation, distinguishing them from other subtypes.