Ependymoma MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

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

Brain

• T1

• Solid portions of ependymoma typically are isointense to hypointense relative to white matter 7

• T2

• Hyperintense to white matter
• More reliable in differentiating tumour 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

• T1 C+ (Gd)

• Enhancement present but heterogeneous
• Enhancement with gadolinium is useful in differentiating tumour from adjacent vasogenic oedema and normal brain parenchyma

• DWI/ADC

• 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

• MRS

• Choline peak elevation according to the cellularity of tumor
• N-Acetylaspartate peak reduction
• Elevated choline/creatinine ratio
• Lipid and lactate rise when degeneration occurs

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