MR-IMAGING OF MYXOPAPILLARY EPENDYMOMA - FINDINGS AND VALUE TO DETERMINE EXTENT OF TUMOR AND ITS RELATION TO INTRASPINAL STRUCTURES
MR-IMAGING OF MYXOPAPILLARY EPENDYMOMA - FINDINGS AND VALUE TO DETERMINE EXTENT OF TUMOR AND ITS RELATION TO INTRASPINAL STRUCTURES
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DOI：
10.2214/ajr.165.5.7572515
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发表时间：
1995-11-01
影响因子：
5
通讯作者：
VOLLMER, DG
中科院分区：
文献类型：
--
作者：
WIPPOLD, FJ;SMIRNIOTOPOULOS, JG;VOLLMER, DG
目标。粘液乳头状室管膜瘤是一种高度血管性的肿瘤，几乎完全发生在胸腰椎区域，其症状可能类似于椎间盘源性病理。本研究的目的是明确黏液乳头状室管膜瘤的典型MR表现，并确定MR成像在鉴别肿瘤、确定其范围以及确定其与椎管内结构的关系方面的价值。对20例(男13例，女7例；平均年龄35岁)24例经病理证实的粘液性乳头状室管膜瘤患者进行了MR检查，研究对象包括病变的大小和位置、中央椎管和神经孔的扩张情况、MR信号特征和增强方式。结果：所有患者均在MRI上发现肿块，其中17例为单发肿块，3例为多发病变。24例肿瘤中，21例为髓外硬膜内肿瘤，2例为髓内硬膜外肿瘤，1例为硬膜外后硬膜外肿瘤。两个病变有相关的脊髓空洞。病变多发生在L2椎体水平，没有肿瘤延伸至T9以上。肿瘤平均横跨四个椎节。磁共振成像显示，8个肿瘤中有5个椎管扩张，超过5个或更多个椎节段。两个肿瘤延伸到神经孔。肿瘤的T1加权信号为等信号12例，低信号3例，高信号1例。T2加权信号总是高信号。所有肿瘤在静脉注射对比剂后均有增强。结论MR成像对确定肿瘤的范围和确定肿瘤与椎管内结构的关系具有重要价值。虽然粘液乳头状室管膜瘤的MR表现是非特异性的，但可以通过延伸到多个椎体的大的、强烈强化的硬膜外胸腰段肿块来提示诊断。成像方案应检查整个胸腰椎区域，并包括IV对比度。
OBJECTIVE. Myxopapillary ependymomas are highly vascular tumors that arise almost exclusively in the thoracolumbar region and produce symptoms that may mimic discogenic pathology. The purpose of our study was to define the typical MR features of myxopapillary ependymoma and to determine the value of MR imaging in identifying the tumor, establishing its extent, and defining its relationship to intraspinal structures.MATERIALS AND METHODS. MR studies performed on 20 patients (13 men and seven women; mean age, 35 years) with 24 pathologically proven myxopapillary ependymomas were evaluated retrospectively for size and location of lesions, expansion of the central spinal canal and neural foramina, and MR signal characteristics and enhancement patterns. T1-weighted (16 patients), proton density-weighted (15 patients), T2-weighted (14 patients), and enhanced T1-weighted (nine patients) sequences were examined.RESULTS. In all patients, masses were detected on MR images, MR imaging defined solitary masses in 17 patients and multiple lesions in three. Of the 24 tumors, MR imaging characterized 21 as predominately intradural extramedullary, two as intramedullary and intradural extramedullary, and one as extradural postsacral. Two lesions had associated syrinxes. Lesions occurred most often at the level of the L2 vertebral body, and no tumor extended above T9. Tumors spanned an average of four vertebral segments. MR imaging showed expansion of the spinal canal in five of eight tumors that extended over five or more vertebral segments. Two tumors extended into the neural foramina. The T1-weighted signal of the tumor was isointense in 12 patients, hypointense in three patients, and hyperintense in one patient. The T2-weighted signal was always hyperintense. All tumors imaged after administration of IV contrast material showed enhancement.CONCLUSION, MR imaging was valuable in identifying the extent of tumors and in defining their relationship to the intraspinal structures. Although the MR findings in myxopapillary ependymoma are nonspecific, the diagnosis can be suggested by a large, intensely enhancing, intradural extramedullary thoracolumbar mass that extends for several vertebral levels. Imaging protocols should examine the entire thoracolumbar region and include IV contrast.