PMC5421221_01
Spinal cord MRI of a young patient affected by an extensive cervicothoracic spinal ependymoma. (a) Consecutive sagittal T2-weighted images show a cervicothoracic spinal ependymoma with a solid part (arrows), some cystic parts (arrowheads) and a small amount of late sub-acute bleeding inside the neoplasm (methemoglobin) (empty arrow). Note the syringomyelia at T6-T9 level (a' - empty arrowhead). Note also caliber change of the spinal cord at C2-C3 level and moderate widening of spinal canal. (b) Sagittal noncontrast T1-weighted shows a cervicothoracic spinal ependymoma with a solid part (arrow), some cystic parts (arrowhead), and a small amount of late sub-acute bleeding inside the neoplasm (methemoglobin) (empty arrow). (c) Sagittal post-contrast T1-weighted image shows the cervicothoracic extension of ependymoma's solid part. (d) Sagittal DWIBS-MIP reconstruction, (e) sagittal ADC map and (f) fused T1-weighted/DWIBS images show a high restriction of diffusion a the level of ependymoma's solid part, respectively high, low and high (red) signal intensity. (g) Sagittal T2-weighted images show, at C6-C7 and (g') C5 level, white matter peripheral displacement surrounding ependymoma (empty arrows) and a small intralesional cyst (arrowhead), respectively
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The mass extended from C2 to T3 and was characterized by a solid part slightly hyperintense on T2-weighted images and hypointense on T1-weighted images; some cystic components and a small amount of late subacute bleeding inside the neoplasm were also detected (methemoglobin) [Figure 1]. Contrast-enhanced T1-weighted images showed a significant degree of lesion enhancement [Figure 1c].
Spinal cord MRI tractography of a young patient affected by spinal ependymoma. The panel shows no infiltration of the spinal cord but rather cord fibers peripherally displacement. (a and b) Sagittal post-contrast T1-weighted images, without (a) and with (b) spinal cord tractography overlayed, show the extension of ependymoma's compact part. Note the change in caliber of spinal cord at C2-C3 level. (c-e) Sagittal color-coded fractional anisotropy (FA) map (c), FA map, (d), and ADC map (e), show low intensity values (arrows) corresponding to the ependymoma, centrally placed. (f-i) Sagittal color-coded FA map with spinal cord tractography overlaid shows different point of fiber displacement (arrows), rather than infiltration, by ependymoma. Images h, i, and l were obtained by using a "virtual cut" of part of the spinal cord fibers obtained respectively at C3-C4 (h) and C2-C3. (i,j) levels. (l) Axial color-coded FA map with spinal cord tractography overlaid and (k) T2-weighted images at C2-C3 level shows white matter peripheral displacement surrounding ependymoma. Arrow indicates fibers lack in the central part of spinal cord, caused by a central position of the neoplasm
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Moreover, DTI FT showed the sparing of white matter fiber tracts by the neoplasm and the peripheral displacement of fiber bundles [Figure 2]. Sagittal color-coded FA map, FA map, and ADC map, showed low intensity values corresponding to an high cellularity lesion, centrally placed [Figure 2]. By using a manipulation of the 3D FT output data, we performed a "virtual cut" of part of the spinal cord fibers, obtained at C2-C3 and C3-C4 levels respectively [Figure 2f-i], showing properly that white matter fiber tracts were peripheral displaced, surrounding the lesion, without any apparent sign fibers interruption.
Histological appearance of spinal ependymoma. Histological examination reveals a tumor composed of glial cells with oval nuclei and fibrillary processes arranged in perivascular pseudorossettes (Hematoxylin and eosin stain; original magnification, x100)
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