Feasibility of a novel diagnostic chart of intramedullary spinal cord tumors in magnetic resonance imaging

Objective: The purpose of this study was to determine characteristic imaging findings of intramedullary spinal cord tumor in magnetic resonance imaging (MRI). Material and Methods: We retrospectively analyzed MRI in 15 patients with histologicaly proven intramedullary spinal cord tumors. The demographic data, MRI findings with histological findings were recorded in terms of age, location, length, morphology, signal intensity, the presence or absence of cyst and hemorrhage, enhancement pattern, other associated findings, necrosis, vascular proliferation and WHO grading. Results: Among the 15 patients, spinal cord ependymomas were eccentric 75%, well-define border 62.5% and cervicothoracic spine located 37.5%. Spinal cord astrocytomas were eccentrically located and ill-define border 85.7%, cervicothoracic and thoracic spine located 28.5%. A cystic component was seen in 87.5% of spinal cord ependymoma and 71.5% of astrocytomas. Intratumoral hemorrhage occurred in 75% of spinal cord ependymomas, and 57.1% of astrocytomas. In 12.5% of spinal cord ependymomas, a curvilinear low T2 signal, suggesting marginal hemorrhage, was seen at the upper and/or lower margins of the tumors. Twenty-five percent of spinal cord ependymoma and 57.2% of astrocytomas showed heterogeneous enhancement, while in 12.5% of spinal cord ependymomas, enhancement was homogeneous. Conclusion: Although no statistically significant characteristic MRI feature to distinguish between ependymoma and astrocytoma is detected. By percentage we found that border, length and signal intensity of tumors may help diagnosis. With pathological correlation, all of spinal cord ependymomas are mark hypervascular tumor, but astrocytomas never showed.

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Multisession CyberKnife Radiosurgery for Intramedullary Spinal Cord Arteriovenous Malformations

Neurosurgery ◽

10.1227/01.neu.0000215891.25153.ba ◽

2006 ◽

Vol 58 (6) ◽

pp. 1081-1089 ◽

Cited By ~ 89

Author(s):

John Sinclair ◽

Steven D. Chang ◽

Iris C. Gibbs ◽

John R. Adler

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Arteriovenous Malformations ◽

Conus Medullaris ◽

Spinal Angiography ◽

Resonance Imaging ◽

Intramedullary Spinal Cord ◽

Cyberknife Radiosurgery

Abstract OBJECTIVE: Intramedullary spinal cord arteriovenous malformations (AVMs) have an unfavorable natural history that characteristically involves myelopathy secondary to progressive ischemia and/or recurrent hemorrhage. Although some lesions can be managed successfully with embolization and surgery, AVM size, location, and angioarchitecture precludes treatment in many circumstances. Given the poor outlook for such patients, and building on the successful experience with radiosurgical ablation of cerebral AVMs, our group at Stanford University has used CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) to treat selected spinal cord AVMs since 1997. In this article, we retrospectively analyze our preliminary experience with this technique. METHODS: Fifteen patients with intramedullary spinal cord AVMs (nine cervical, three thoracic, and three conus medullaris) were treated by image-guided SRS between 1997 and 2005. SRS was delivered in two to five sessions with an average marginal dose of 20.5 Gy. The biologically effective dose used in individual patients was escalated gradually over the course of this study. Clinical and magnetic resonance imaging follow-up were carried out annually, and spinal angiography was repeated at 3 years. RESULTS: After a mean follow-up period of 27.9 months (range, 3–59 mo), six of the seven patients who were more than 3 years from SRS had significant reductions in AVM volumes on interim magnetic resonance imaging examinations. In four of the five patients who underwent postoperative spinal angiography, persistent AVM was confirmed, albeit reduced in size. One patient demonstrated complete angiographic obliteration of a conus medullaris AVM 26 months after radiosurgery. There was no evidence of further hemorrhage after CyberKnife treatment or neurological deterioration attributable to SRS. CONCLUSION: This description of CyberKnife radiosurgical ablation demonstrates its feasibility and apparent safety for selected intramedullary spinal cord AVMs. Additional experience is necessary to ascertain the optimal radiosurgical dose and ultimate efficacy of this technique.

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A Survey of 65 Tumors within the Spinal Cord: Surgical Results and the Importance of Preoperative Magnetic Resonance Imaging

Neurosurgery ◽

10.1227/00006123-199111000-00002 ◽

1991 ◽

Vol 29 (5) ◽

pp. 651-657 ◽

Cited By ~ 82

Author(s):

Jacques Brotchi ◽

Olivier Dewitte ◽

Danielle Balériaux ◽

Arlette Vandesteene ◽

Christian Raftopoulos ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Surgical Results ◽

Resonance Imaging ◽

Intramedullary Spinal Cord ◽

Cavitron Ultrasonic Surgical Aspirator ◽

Highly Sensitive ◽

Previously Treated ◽

Ultrasonic Surgical Aspirator

Abstract Between January 1984 and December 1990. 65 intramedullary spinal cord tumors were diagnosed and operated on. In this series, all patients underwent magnetic resonance imaging investigations and were operated on with the Cavitron ultrasonic surgical aspirator whenever necessary. Major surgical difficulties have been found in patients previously treated by radiotherapy with or without biopsy. We found magnetic resonance imaging to be a highly sensitive imaging procedure and the method of choice for visualizing tumors within the spinal cord. Nevertheless, accurate diagnosis may only be suggested by magnetic resonance imaging, rather than made definitively. Surgery is necessary in every case in order to obtain a definite diagnosis. Radical surgery can be performed when a plane exists between the tumor and the normal spinal cord: biopsy or debulking with the Cavitron ultrasonic surgical aspirator should be performed when the tumor is infiltrative. We have performed 33 so-called total resections, 22 partial resections, and 10 biopsies, among which 5 were performed on lipomas. Surgical results were assessed at 3 months after surgery, showing 35 improvements (53%), 24 stabilizations (37%), and 6 deteriorations (10%).

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Sequential Magnetic Resonance Imaging Finding of Intramedullary Spinal Cord Abscess including Diffusion Weighted Image: a Case Report

Korean Journal of Radiology ◽

10.3348/kjr.2011.12.2.241 ◽

2011 ◽

Vol 12 (2) ◽

pp. 241 ◽

Cited By ~ 5

Author(s):

Jae Eun Roh ◽

Seung Young Lee ◽

Sang-Hoon Cha ◽

Bum Sang Cho ◽

Min Hee Jeon ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Case Report ◽

Magnetic Resonance ◽

Imaging Finding ◽

Magnetic Resonance Imaging Finding ◽

Diffusion Weighted Image ◽

Resonance Imaging ◽

Intramedullary Spinal Cord ◽

Intramedullary Spinal Cord Abscess

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Reassesement of T1-weighted Images in Magnetic Resonance Imaging. Differencial Diagnosis of Intramedullary Spinal Cord Diseases.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.49.703 ◽

2000 ◽

Vol 49 (3) ◽

pp. 703-707

Author(s):

Kenzo Fujii ◽

Toshihiko Taguchi ◽

Tsukasa Kanchiku ◽

Shinya Kawai

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Resonance Imaging ◽

Intramedullary Spinal Cord ◽

Spinal Cord Diseases

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Magnetic resonance imaging of intramedullary spinal cord metastases

Clinical Imaging ◽

10.1016/0899-7071(95)00033-x ◽

1996 ◽

Vol 20 (4) ◽

pp. 238-242 ◽

Cited By ~ 3

Author(s):

Joel B. Markus

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Resonance Imaging ◽

Intramedullary Spinal Cord

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Intramedullary spinal cord sarcoidosis mimicking glioma by magnetic resonance imaging: case report

Spinal Cord ◽

10.1038/sc.1991.29 ◽

1991 ◽

Vol 29 (3) ◽

pp. 203-206

Author(s):

R A Hauser ◽

S L Alden ◽

D N Coar ◽

M R Cundiff ◽

C C Bundshuh

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Case Report ◽

Magnetic Resonance ◽

Resonance Imaging ◽

Intramedullary Spinal Cord ◽

Spinal Cord Sarcoidosis

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Subependymomas: An analysis of Clinical and Imaging Features

Neurosurgery ◽

10.1227/01.neu.0000209928.04532.09 ◽

2006 ◽

Vol 58 (5) ◽

pp. 881-890 ◽

Cited By ~ 65

Author(s):

Brian T. Ragel ◽

Anne G. Osborn ◽

Kum Whang ◽

Jeannette J. Townsend ◽

Randy L. Jensen ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Spinal Cord Tumor ◽

Benign Tumors ◽

Resonance Spectroscopy ◽

Imaging Features ◽

Resonance Imaging ◽

Radiographic Appearance ◽

Intramedullary Spinal Cord

Abstract OBJECTIVE: Subependymomas are slow-growing, benign tumors usually found incidentally in the fourth ventricle at autopsy. They are typically associated with the ventricular system and become apparent clinically only when symptoms of hydrocephalus or mass effect develop. We review clinical, histological, and contemporary radiographic presentations of 16 subependymomas, including 2 intraparenchymal tumors. METHODS: We retrospectively evaluated eight patients with pathologically proven subependymomas. Initial magnetic resonance imaging and magnetic resonance spectroscopy were reviewed when available. Imaging was also available on eight outside subependymoma cases reviewed by our radiology department. RESULTS: Twelve of these subependymomas were intraventricular, one was in the posterior fossa, two were intraparenchymal, and one was an intramedullary spinal cord tumor. These lesions were hypo- to hyperintense on T1- and T2-weighted magnetic resonance imaging, with minimal to moderate enhancement. Initial complaints included headache, seizures, tingling sensations, and weakness. Among our eight patients who underwent gross total resection with no adjuvant therapy, no recurrences have been noted on follow-up magnetic resonance imaging. CONCLUSION: Subependymomas are rare, representing only 0.51% of all central nervous system tumors operated on during an 8-year period at the University of Utah. Clinical symptoms were associated with tumor location: intracranial masses caused headaches, seizures, and neurological complaints, and spinal cord locations resulted in neurological deficit. The authors review the clinical presentation, management, and contemporary radiographic appearance of this rare tumor.

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