Korean J Radiol.  2002 Dec;3(4):219-228. 10.3348/kjr.2002.3.4.219.

Intracranial and Spinal Ependymomas: Review of MR Images in 61 Patients

• Choi JY
• Chang KH
• Yu IK
• Kim KH
• Kwon BJ
• Han MH
• Kim IO

• KMID: 1118788
• DOI: http://doi.org/10.3348/kjr.2002.3.4.219

Abstract

OBJECTIVE
To compare the age distribution and characteristic MR imaging findings of ependymoma for each typical location within the neuraxis. MATERIALS AND METHODS: During a recent eleven-year period, MR images of 61 patients with histologically proven ependymomas were obtained and retrospectively reviewed in terms of incidence, peak age, location, size, signal intensity, the presence or absence of cyst and hemorrhage, enhancement pattern, and other associated findings. RESULTS: Among the 61 patients, tumor location was spinal in 35 (57%), infrartentorial in 19 (31%), and supratentorial in seven (12%). In four of these seven, the tumor was located in brain parenchyma, and in most cases developed between the third and fifth decade. Approximately half of the infratentorial tumors occurred during the first decade. The signal intensity of ependymomas was nonspecific, regardless of their location. A cystic component was seen in 71% (5/7) of supratentorial, 74% (14/19) of infratentorial, and 14% (5/35) of spinal cord tumors. Forty- nine percent (17/35) of those in the spinal cord were associated with rostral and/or caudal reactive cysts. Intratumoral hemorrhage occurred in 57% (4/7) of supratentorial, 32% (6/19) of infratentorial, and 9% (3/35) of spinal cord tumors. In 17% (6/35) of spinal ependymomas, a curvilinear low T2 signal, suggesting marginal hemorrhage, was seen at the upper and/or lower margins of the tumors. Peritumoral edema occurred in 57% (4/7) of supratentorial, 16% (3/19) of infratentorial and 23% (8/35) of spinal cord tumors. Seventy-two percent (5/7) of supratentorial and 95% (18/19) of infratentorial tumors showed heterogeneous enhancement, while in 50% (17/34) of spinal cord tumors, enhancement was homogeneous. CONCLUSION: Even though the MR imaging findings of ependymomas vary and are nonspecific, awareness of these findings, and of tumor distribution according to age, is helpful and increases the likelihood of correct preoperative clinical diagnosis.

Keyword

Brain, ependymoma; Brain, MR; Spinal cord, ependymoma; Spinal cord, MR

MeSH Terms

Adult
Age Distribution
Brain Neoplasms/*diagnosis/epidemiology
Ependymoma/*diagnosis/epidemiology
Female
Human
*Magnetic Resonance Imaging
Male
Retrospective Studies
Spinal Cord Neoplasms/*diagnosis/epidemiology
Support, Non-U.S. Gov't

Figure

• 

  Fig. 1 A 21-year-old man with supratentorial intraparenchymal ependymoma. A. Axial T2-weighted spin-echo (SE) image (4500/96) depicts a large tumor with an extensive cystic component (asterisk) in the left frontal lobe. The lesion focally abuts the adjacent frontal horn of the lateral ventricle (open arrow), and there is mild peritumoral edema (arrowheads). B. Axial T1-weighted SE image (500/12) demonstrates an area of focal hyperintensity within the tumor (arrow),respresenting intratumoral hemorrhage. Due, presumably, to its high protein content, the cystic component appears isointense to gray matter. C, D. Axial (C) and sagittal (D) contrast-enhanced T1-weighted SE images (500/12) show heterogeneous enhancement and a well-defined tumor margin. The cystic portion is multi-septated and enhanced (arrowheads).

• 

  Fig. 2 A 34-year-old man with supratentorial transependymal ependymoma. A. Axial T2-weighted SE image (5000/99) depicts a slightly hyperintense, large tumor located within the frontal horns of both lateral ventricles (open arrow), which are dilated. B. Axial T1-weighted SE image (600/12) shows that the tumor is slightly hypointense and has a lobulated margin. C, D. Axial (C) and coronal (D) contrast-enhanced T1-weighted SE images (500/12) depict parenchymal invasion adjacent to the left frontal horn (arrowheads), with heterogeneous enhancement.

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  Fig. 3 A 7-year-old boy with infratentorial ependymoma. A, B. Axial T2-weighted SE image (A) (3000/100) and axial T1-weighted SE image (B) (650/25) demonstrate, respectively, hyper- and isointensity of the large tumor (arrows) seen at the midline of the posterior fossa. Associated mild peritumoral edema (arrowheads) is present. C. Axial contrast-enhanced T1-weighted SE image (650/25) reveals heterogeneous enhancement and a cystic component. D. Sagittal contrast-enhanced T1-weighted SE image (450/25) shows that the tumor extends caudally through the foramen of Magendie. Its intraventricular portion (asterisk) is not enhanced, whereas the caudally extended portion (in the cisterna magna) shows relatively intense enhancement (arrows).

• 

  Fig. 4 A 3-year-old boy with infratentorial ependymoma. A. Axial T2-weighted SE image (4500/96) depicts a large slightly hyperintense mass in the fourth ventricle. The mass extends to the right cerebellopontine angle and prepontine cistern through both lateral recesses and the foramen of Luschka (arrowheads), encasing a linear signal void (arrow) thought to be a vascular structure. B. T1-weighted SE image (500/12) reveals the presence of a small area of focal high signal intensity (open arrow) within the mass, suggesting intratumoral hemorrhage. C, D. Axial (C) and sagittal (D) contrast-enhanced T1-weighted SE images (500/12) show heterogeneous enhancement, with multiple cystic components and associated peripheral rim enhancement. The mass extends to the cerebellopontine angle bilaterally, and to the level of the upper cervical cord caudally (arrows).

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  Fig. 5 A 30-year-old woman with spinal ependymoma of the cervical cord. A, B. Sagittal T2-weighted SE image (A) (4000/120) shows that the mass at the level of C-5 to C-6 (arrows) is heterogeneously hyperintense, while T1-weighted image (B) (671/12) shows hypointensity. Associated rostral and caudal cysts are also visible. C. Sagittal contrast-enhanced T1-weighted SE image (671/12) shows homogeneous enhancement and a well-defined, enhanced border (arrows). Extensive associated rostral and caudal cysts (asterisks) extend from the level of the foramen magnum to T-3.

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  Fig. 6 A 50-year-old woman with spinal ependymoma at the thoracic level. A. Sagittal T2-weighted SE image (3500/108) depicts an extensive heterogeneous lesion of mixed signal intensity in almost the entire spinal cord. Rostral and caudal cysts with inner multifocal fluid fluid levels (arrowheads) are extensive, and after previous hemorrhage, hemosiderin has been deposited. In addition, a dark line suggesting hemosiderin deposition (open arrow) is noted along the cord and the bottom of the caudal cyst. Asterisk indicates the T-5 level of the small enhancing tumor seen in B. B. Sagittal contrast-enhanced T1-weighted SE image (500/14) depicts a small area of slightly heterogeneous enhancement at the T-5 level of the spinal cord (asterisk).

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  Fig. 7 A 27-year-old man with ependymoma of the cervical cord. A. Sagittal T2-weighted SE image (3500/120) shows that in the upper cervical cord, a heterogeneously intense mass with a low signal intensity rim (arrows) at its upper and lower margins is present. Associated peritumoral edema (arrowheads) is also apparent. B. Sagittal contrast-enhanced T1-weighted SE image (500/15) of the tumor depicts heterogeneous mild enhancement.

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