PMC7385376_01
A 21-year-old woman with supratentorial intraparenchymal anaplastic ependymoma in the left parietal lobe on (A) T1-weighted image, (B) diffusion-weighted images, (C) apparent diffusion coefficient, and (D) contrast T1-weighted image. The tumor appears as heterogeneous signal intensity, large cysts, reduced diffusion within the soft tissue component, and mild peritumoral edema.
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F1
Most SAEs (91.7%) are extraventricular in origin (Figure 1), but most IAEs (91.7%) are intraventricular (Figure 2). On DWI, almost all solid tissues of SAEs appeared hyperintense (Figures 1, 5), whereas IAEs exhibited iso-hypointense signals. Cysts and necrosis were associated with 56 anaplastic ependymomas; however, large cysts more likely occurred in SAEs (Figure 1).
A 33-year-old man with infratentorial anaplastic ependymoma in the fourth ventricle on (A) T1-weighted image, (B) diffusion-weighted images, (C) apparent diffusion coefficient, and (D) contrast T1-weighted image. The tumor appears as heterogeneous signal intensity, small cysts, non-reduced diffusion within the soft tissue component, and absent peritumoral edema.
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F2
Most SAEs (91.7%) are extraventricular in origin (Figure 1), but most IAEs (91.7%) are intraventricular (Figure 2).
A 70-year-old man with supratentorial intraparenchymal anaplastic ependymoma in the right frontal lobe on (A) T1-weighted image and (B) contrast T1-weighted image. The tumor appears as heterogeneous signal intensity and marked peritumoral edema.
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F3
Of 60 intracranial anaplastic ependymomas, most lesions were well-defined (n = 45) and round-like (n = 36) (Figure 3).
A 76-year-old man with supratentorial intraparenchymal anaplastic ependymoma in the left temporal lobe on (A) T1-weighted image and (B) T2-weighted image. The tumor appears as heterogeneous signal intensity and moderate peritumoral edema.
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F4
T1-weighted imaging, compared with the gray matter, the SAEs exhibited heterogeneous signal intensity (Figures 4, 5), whereas IAEs were iso-hypointense. T2 signals were predominantly hyperintense in IAEs.
A 20-year-old man with supratentorial intraparenchymal anaplastic ependymoma in the left frontal lobe on (A) T1-weighted image, (B) diffusion-weighted images, (C) fluid-attenuated inversion recovery (FLAIR), and (D) contrast T1-weighted image. The tumor appears as heterogeneous signal intensity, big cysts, reduced diffusion within the soft tissue component, and mild peritumoral edema. There is an area of focal hyperintensity within the tumor, representing hemorrhage.
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F5
T1-weighted imaging, compared with the gray matter, the SAEs exhibited heterogeneous signal intensity (Figures 4, 5), whereas IAEs were iso-hypointense. T2 signals were predominantly hyperintense in IAEs. On DWI, almost all solid tissues of SAEs appeared hyperintense (Figures 1, 5), whereas IAEs exhibited iso-hypointense signals.
A 12-year-old man with supratentorial intraparenchymal anaplastic ependymoma in the right frontal lobe on magnetic resonance spectroscopy (MRS). (A) The tumor shows increased choline (Cho)/creatine (Cr) and marked decreased N-acetyl-aspartate (NAA), (B) peritumoral area regions of interest (ROIs) display increased Cho/Cr and moderate decreased NAA, and (C) compared to the normal-appearing white matter.
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F6
On MRS, both tumor and peritumoral area regions of interest (ROIs) displayed abnormal metabolic signals compared to the normal-appearing white matter (Figure 6).
The distribution of Cho/Cr and Cho/NAA ratio.
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F7
The mean +- SD choline/creatine (Cho/Cr) and choline/N-acetyl-aspartate (Cho/NAA) ratio of anaplastic ependymomas were 6.58 +- 4.26 (range, 2.2-18.6 cm) and 8.84 +- 6.34 (range, 2.13-28.7 cm), respectively, representing typical high-grade tumors (Figure 7).
A 27-year-old woman with infratentorial anaplastic ependymoma in the fourth ventricle on (A) T1-weighted image, (B) T2-weighted image, (C) contrast T1-weighted image, and (D) magnetic resonance spectroscopy (MRS). The tumor appears as heterogeneous signal intensity with increased Cho/Cr and marked decreased NAA.
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F8
MRS was performed only in one patient with IAE, which also showed increase in Cho/Cr and Cho/NAA ratio (Figure 8).