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{{Ependymoma}}
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==Overview==
==Overview==
 
Brain MRI may be diagnostic of ependymoma. Finding on brain MRI suggestive of ependymoma include large mixed cystic/solid lesion with [[haemorrhage]] and [[fluid]] which may indicate areas of [[necrosis]].  
Imaging plays a central role in the diagnosis of ependymoma. On MRI brain, ependymoma is characterized by isointense to hypointense on T1-weighted scans, or hyperintense to white matter on T2-weighted MRI.


==MRI==
==MRI==
===Brain===
*T1
*T1
**Solid portions of ependymoma typically are isointense to hypointense relative to white matter
:*Solid portions of ependymoma typically are isointense to hypointense relative to white matter
 
*T2
*T2
**Hyper intense to white matter
:*Hyperintense to white matter
**More reliable in differentiating tumor margins than non-contrast T1-weighted images (but less reliable than contrast enhanced T1)
:*More reliable in differentiating tumor margins than non-contrast T1-weighted images (but less reliable than contrast enhanced T1)


*T2* (e.g. SWI)
:*Foci of blooming from [[haemorrhage]] or [[calcification]]


{| align="left"
*T1 C+ (Gd)
|-valign="top"
:*Enhancement present but [[heterogeneous]]
| [[Image:Ependymoma of 4th ventricle in MRI.jpg|thumb|350px|MRI showing ependymoma in 4th ventricle]]
:*Enhancement with [[gadolinium]] is useful in differentiating tumor from adjacent [[vasogenic edema]] and normal brain parenchyma.
| [[Image:459px-Ependymom sag FLAIR.jpg|thumb|350px|MRI Ependymoma of 4th ventricle in MRI]]
*DWI (diffusion weighted MRI)
|}
:*Restricted [[diffusion]] may be seen in solid components especially in [[anaplastic|anaplastic tumour]]
<br clear="left"/>
:*Diffusion should be interpreted with caution in masses with significant haemorrhage or calcification
*MR Spectroscopy
:*[[Choline]] peak elevation according to the cellularity of tumor
:*[[N-Acetylaspartate]] peak reduction
:*Elevated [[choline]]/[[creatinine]] ratio
:*[[Lipid]] and [[lactate]] rise when degeneration occurs
<gallery>
Image:
A91344c612b07b087964a93ee047df big gallery.jpg|T1<ref name=radio> Image courtesy of  Dr Frank Gaillard. [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/ependymoma-lateral-ventricle ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
Image:
73c54460c3e8d80f3d18cd522ed152 big gallery.jpg|T2<ref name=radio> Image courtesy of  Dr Frank Gaillard. [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/ependymoma-lateral-ventricle ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
Image:
Ependymoma-lateral-ventricle(5).jpg|FLAIR<ref name=radio> Image courtesy of  Dr Frank Gaillard. [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/ependymoma-lateral-ventricle ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
Image:
Ependymoma-lateral-ventricle(7).jpg|T1<ref name=radio> Image courtesy of  Dr Frank Gaillard. [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/ependymoma-lateral-ventricle ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
Image:
Ependymoma-lateral-ventricle(97777).jpg|T1 C+<ref name=radio> Image courtesy of  Dr Frank Gaillard. [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/ependymoma-lateral-ventricle ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
Image:
Ependymoma-lateral-ventricle(9).jpg|DWI<ref name=radio> Image courtesy of Dr Frank Gaillard. [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/ependymoma-lateral-ventricle ‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
</gallery>
<sup>''Note'':There is a large left frontal mixed cystic/solid lesion, measuring approximately 4x4x5cm in perpendicular dimensions, with intralesional haemorrhage and fluid level which may indicate areas of necrosis. Large surrounding vasogenic edema involving the contralateral hemisphere, and significant mass effect causing almost 2cm midline shift, obstructing the monro foramina resulting moderate non-communicating hydrocephalus.</sup>


==References==
==References==
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{{reflist|2}}
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Latest revision as of 22:18, 26 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]

Overview

Brain MRI may be diagnostic of ependymoma. Finding on brain MRI suggestive of ependymoma include large mixed cystic/solid lesion with haemorrhage and fluid which may indicate areas of necrosis.

MRI

  • T1
  • Solid portions of ependymoma typically are isointense to hypointense relative to white matter
  • T2
  • Hyperintense to white matter
  • More reliable in differentiating tumor margins than non-contrast T1-weighted images (but less reliable than contrast enhanced T1)
  • T2* (e.g. SWI)
  • T1 C+ (Gd)
  • DWI (diffusion weighted MRI)
  • Restricted diffusion may be seen in solid components especially in anaplastic tumour
  • Diffusion should be interpreted with caution in masses with significant haemorrhage or calcification
  • MR Spectroscopy

Note:There is a large left frontal mixed cystic/solid lesion, measuring approximately 4x4x5cm in perpendicular dimensions, with intralesional haemorrhage and fluid level which may indicate areas of necrosis. Large surrounding vasogenic edema involving the contralateral hemisphere, and significant mass effect causing almost 2cm midline shift, obstructing the monro foramina resulting moderate non-communicating hydrocephalus.

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Image courtesy of Dr Frank Gaillard. Radiopaedia(original file ‘’here’’).Creative Commons BY-SA-NC

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