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Variety of preoperative MRI changes in spinal cord ependymoma of WHO grade II: a case series

  • Kazuyoshi Kobayashi
  • Kei Ando
  • Fumihiko Kato
  • Koji Sato
  • Mitsuhiro Kamiya
  • Mikito Tsushima
  • Masaaki Machino
  • Kyotaro Ota
  • Masayoshi Morozumi
  • Satoshi Tanaka
  • Shunsuke Kanbara
  • Sadayuki Ito
  • Naoki Ishiguro
  • Shiro Imagama
Original Article

Abstract

Purpose

To report a case series of surgically proven spinal ependymomas of WHO grade II in which there were changes in the preoperative MRI characteristics over time.

Methods

A total of 71 patients with spinal cord ependymoma of WHO grade II underwent surgery. There were ten cases in which surgery was performed at an average of 2.2 years after the tumor was found. Cystic components, syringomyelia, hemorrhage “cap sign,” Gd enhancement pattern, characteristic changes in MRI, MIB-1 index, and neurological assessment during the preoperative period were examined.

Results

Cases with a huge cyst showed further enlargement of the cyst on the caudal and rostral sides with hemosiderin formation over time and changes in the pattern of Gd enhancement. In contrast, cases without initial cyst did not show cyst formation, and nodular homogeneous lesion remained without changes in Gd enhancement. Regarding neurological status, two cases with cyst enlargement and hemosiderin formation had worsened non-independent gait preoperatively.

Conclusions

MRI in cases of spinal ependymomas of WHO grade II showed characteristics such as hemorrhage and cyst formation that varied over time. In particular, cases with cyst and hemosiderin showed tumor enlargement, including enlargement of lesions on the caudal and rostral sides and enlargement of Gd-enhanced lesions. These characteristics might influence gait ability during preoperative period. We emphasize that early surgery is still the standard of care for cervical intramedullary ependymoma, and our findings in this study should not be interpreted to indicate that such early surgery is not necessary in symptomatic cases.

Graphical abstract

These slides can be retrieved under electronic supplementary material.

Keywords

Ependymoma MRI WHO classification Cyst formation Gd enhancement 

Notes

Funding

Funding was from institutional sources only

Compliance with ethical standards

Conflict of interest

None of the authors have a conflict of interest.

Supplementary material

586_2018_5760_MOESM1_ESM.pptx (7.1 mb)
Supplementary material 1 (PPTX 7320 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Kazuyoshi Kobayashi
    • 1
  • Kei Ando
    • 1
  • Fumihiko Kato
    • 2
  • Koji Sato
    • 3
  • Mitsuhiro Kamiya
    • 4
  • Mikito Tsushima
    • 1
  • Masaaki Machino
    • 1
  • Kyotaro Ota
    • 1
  • Masayoshi Morozumi
    • 1
  • Satoshi Tanaka
    • 1
  • Shunsuke Kanbara
    • 1
  • Sadayuki Ito
    • 1
  • Naoki Ishiguro
    • 1
  • Shiro Imagama
    • 1
  1. 1.Department of Orthopaedic SurgeryNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of Orthopaedic SurgeryChubu Rosai HospitalNagoyaJapan
  3. 3.Department of Orthopaedic SurgeryJapanese Red Cross Nagoya Daini HospitalNagoyaJapan
  4. 4.Department of Orthopaedic SurgeryAichi Medical UniversityNagakuteJapan

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