Diagnosis: Intramedullary enhancing lesion with cord expansion : ependymoma
LEARNING POINTS
Intramedullary ependymomas become enhanced after administration of gadopentetate dimeglumine; the enhanced borders are usually sharply marginated.
characteristically located centrally in an expanded spinal cord
The WHO histologic subtypes of ependymoma are classified into three grades based on degree of malignancy seen on microscopy:
grade I lesions: Myxopapillary ependymoma and subependymoma
Grade II lesions include classic, cellular, papillary, clear cell, and tanycytic subtypes -55-75%
IMAGING FINDINGS
MRI is modality of choice: Cord expansion is a key finding to identify intramedullary tumors, ependymomas are typically hypointense on T1, hyperintense on T2, and enhance with contrast
Perfusion MRI and MR spectroscopy are not typically useful due to the small diameter of the spinal canal and the movement of the spinal cord with arterial blood flow, CT also of little value.
On PET, ependymomas typically appear hypometabolic due to their low cellular density and slow growth
Complete surgical resection has been established as first-line treatment and can be curative. However, SCEs tend to recur when complete tumor resection is not possible
