Imaging predictors of intracranial ependymomas

OBJECTIVE: To identify significant imaging prognostic factors for intracranial ependymomas. METHODS: This series includes 32 patients (18 male and 14 female), with an age at surgery ranging from 1 to 69 years (median, 20.5 years). The preoperative images and medical records were reviewed. The following imaging predictors, including tumor size, consistency, signal character, enhanced pattern, calcification, hemorrhage, perifocal edema, and tumor spread, were analyzed by 2 radiologists independently. Overall survival and progression-free survival were calculated by the Kaplan and Meier method. The difference in these imaging predictors in terms of overall survival and progression-free survival was tested for statistical significance by the log-rank test. Multivariate analysis was also performed using the Cox proportional hazard model. RESULTS: The results revealed that the presence of tumor spread on preoperative images was the only significant imaging predictor in overall and progression-free survivals (P < 0.0001). The hazard ratio of progression-free survival in the presence of tumor spread on preoperative images was 18.59 (95% confidence interval: 1.57-220.13; P = 0.020). CONCLUSION: The presence of tumor spread on preoperative images is the only significant imaging predictor for patients with intracranial ependymomas.     

颅内生殖细胞瘤的放射治疗

放射治疗在颅内生殖细胞瘤的治疗中起重要作用,但传统放疗并发症较多。随着放疗技术的进步,降低颅内生殖细胞瘤并发症的发生率提高治愈率已成为可能,近年也不乏大宗、长时间观察病例报道,澄清了一些该病在放疗方面有争议的和处理不规范的问题。     

脊髓室管膜瘤的MR影像诊断

目的 研究脊髓室管膜瘤的MR影像特征.方法 回顾性分析经手术病理证实的15例脊髓室管膜瘤的临床及磁共振表现.结果 15例脊髓室管膜瘤中,12例位于颈髓,1例位于胸髓,2例位于腰髓.全部肿瘤呈中心性生长,平均累及2.1个椎体单位.13例肿瘤边界清.平扫T1 WI大部分肿瘤呈等信号或混杂信号,在T2 WI大部分呈高信号或混杂信号.10例肿瘤实质头端或尾端反应性囊变,4例瘤内囊变,2例肿瘤内出血,2例肿瘤可见”帽征”.7例肿瘤明显均匀强化.结论 肿瘤中心性生长,边界清、明显均匀强化是室管膜瘤与其它脊髓肿瘤的主要鉴别依据.     

31例颅内室管膜瘤术后放射治疗的预后分析

目的 讨论颅内室管膜瘤的临床特点、治疗转归和预后因素。方法 回顾性分析2009年1月-2012年6月收治的31例颅内室管膜瘤术后放射治疗患者的临床资料,男22例,女9例,平均年龄18岁(3~60岁);17例患者行手术全切,14例患者行次全切除;平均放疗剂量53.9 Gy(48.6~60 Gy);观察疗效,分析患者3和5年的疾病无进展时间,总生存时间。对年龄、性别、肿瘤部位、手术切除情况、病理分级、放疗方式、放疗剂量、辅助治疗8个因素进行单因素分析,Cox比例风险模型分析影响预后的因素。结果 中位随访51个月。7例患者术后放疗后复发,5例为原位复发,2例发生全中枢播散。死亡患者6例,其中4例为儿童第Ⅳ脑室间变性室管膜瘤患者。3和5年的无进展生存率(PFS) 分别为80.6% 和75.9%,3和5年的总生存率(OS)分别为 83.9%和76.2%。手术全切组(17/31)和次全切除组(14/31)的3年和5年PFS分别为94.1%和64.3%,90.9%和57.1%,差异均有统计学意义(χ²=4.685、6.311, P<0.05);手术全切组和次全切除组的5年OS分别为83.3%和64.3%,差异有统计学意义(χ²=4.238, P<0.05)。放疗剂量≤55 Gy和>55 Gy两组患者的5年PFS分别为64.2%和100.0%,差异有统计学意义(χ²=4.210, P<0.05)。未观察到严重的不良反应。结论 手术是室管膜瘤的首选治疗方法,部分切除和间变性室管膜瘤患者,术后放疗是最重要的辅助手段。手术切除程度和放疗剂量影响室管膜瘤患者预后。     

Radiotherapy of intracranial germinomas

Between 1978 and 1988, 28 patients with intracranial germinoma, verified or presumed, were treated with radiation. The diagnosis was made based on histology in 6 cases, on cerebrospinal fluid (CSF) cytology in 2 cases and on clinical (response to radiation) and radiological findings in the remaining 20 cases. The target volume was the primary site plus whole brain in 23 cases, whole brain in 4 cases and the primary site only in 1 case. Whole spinal irradiation was undertaken for 14 patients, including 9 patients of high risk group, i.e., with positive findings in CSF cytology, suspected subarachnoid space seeding, multifocal tumors, infiltration to the ventricular wall or previous surgery for the tumor. The average dose was 52.8 Gy to the tumor, 28.7 Gy to the whole brain and 21 Gy to the spinal axis. Five and ten-years survival rate were 100% and 96%, respectively. No intracranial recurrence or spinal metastasis has been found so far. Therefore no spinal irradiation seems to be unnecessary for non-high risk group of patients. Approximately 20 Gy should be sufficient, if spinal irradiation is to be indicated for high risk group. The dose for the primary tumor and whole brain could have been diminished to 40 Gy and 20 Gy, respectively.     

脊髓室管膜瘤的MRI表现

目的探讨脊髓内室管膜瘤的MRI表现,提高对本病的认识。方法收集我院经病理证实的脊髓室管膜瘤13例,分析肿瘤部位、信号特点、有无囊变、出血及帽征、椎间孔扩大及肿瘤强化方式。结果肿瘤位于颈髓6例,胸髓3例,终丝及马尾4例.在T1WI上呈等、低信号,在T2WI上呈高信号、混杂信号.9例见囊变,3例可见肿瘤内出血,2例椎间孔扩大.13例均出现不同程度强化,1例呈轻度强化,3例中度强化,9例重度强化,11例肿瘤与正常脊髓分界清楚。结论髓内室管膜瘤MRI表现具有一定特点,结合其发病部位、边界、囊变、出血、强化特征及临床资料常可作出正确诊断。     

Primary intracranial myxopapillary ependymomas: report of two cases and review of the literature

Myxopapillary ependymoma is a variant of ependymoma occurring almost exclusively in the conus medullaris or filum terminale. Myxopapillary ependymoma found primarily in the brain is extremely rare. Two such cases appearing at the 4th ventricle and cerebral falx are reported. The imaging features of such tumors are a primary cystic mass with strong enhancement at its solid part. Myxopapillary ependymoma should be a possible differential diagnosis when an intracranial cystic tumor is found.     

Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension

BACKGROUND AND PURPOSE:Comprehensive diagnostic criteria encompassing the varied clinical and radiographic manifestations of spontaneous intracranial hypotension are not available. Therefore, we propose a new set of diagnostic criteria.MATERIALS AND METHODS: The diagnostic criteria are based on results of brain and spine imaging, clinical manifestations, results of lumbar puncture, and response to epidural blood patching. The diagnostic criteria include criterion A, the demonstration of extrathecal CSF on spinal imaging. If criterion A is not met, criterion B, which is cranial MR imaging findings of spontaneous intracranial hypotension, follows, with at least one of the following: 1) low opening pressure, 2) spinal meningeal diverticulum, or 3) improvement of symptoms after epidural blood patch. If criteria A and B are not met, there is criterion C, the presence of all of the following or at least 2 of the following if typical orthostatic headaches are present: 1) low opening pressure, 2) spinal meningeal diverticulum, and 3) improvement of symptoms after epidural blood patch. These criteria were applied to a group of 107 consecutive patients evaluated for spontaneous spinal CSF leaks and intracranial hypotension.RESULTS: The diagnosis was confirmed in 94 patients, with use of criterion A in 78 patients, criterion B in 11 patients, and criterion C in 5 patients.CONCLUSIONS:A new diagnostic scheme is presented reflecting the wide spectrum of clinical and radiographic manifestations of spontaneous spinal CSF leaks and intracranial hypotension.

Spontaneous intracranial hypotension is an increasingly recognized cause of new daily persistent headaches, particularly among young and middle-aged people, but an initial misdiagnosis remains common.¹ Mechanical factors combine with an underlying structural dural disorder to cause the primary spontaneous spinal CSF leak.^2,3 The prototypical patient with spontaneous intracranial hypotension presents with orthostatic headaches, has pachymeningeal enhancement on cranial MR imaging, and is treated with an epidural blood patch, as reflected by the revised 2004 diagnostic criteria according to the International Classification of Headache Disorders (ICHD-2).⁴ However, it has become well established that the spectrum of clinical as well as radiographic manifestations of spontaneous intracranial hypotension is unusually broad,^1,5 and this is not reflected by the ICHD-2 criteria. We report a new set of diagnostic criteria for spontaneous spinal CSF leaks and spontaneous intracranial hypotension encompassing its varied clinical and radiographic manifestations. The intent of these criteria is to present a diagnostic scheme that can be used to more reliably diagnose spontaneous spinal CSF leaks and intracranial hypotension.     

Spontaneous spinal cerebrospinal fluid leak and intracranial hypotension

A case of intracranial hypotension with spontaneous cerebrospinal fluid (CSF) leak was reported. A Tc-99m diethyltriaminepentacetic acid radionuclide cisternography (RNC) showed the accumulation of radioactivity in the area of the subarachnoid space, the poor migration of the isotope over the convexities, and the early appearance of kidney and bladder activity. To localize the site of CSF leak, RNC will be the choice, and when the time comes, RNC will work well in the location of the leak.     

Radiotherapy of bone metastases of a spinal meningeal hemangiopericytoma

Hemangiopericytoma is a rate tumor arising from pericapillary cells or pericytes of Zimmerman, and can occur anywhere capillaries are found. We describe a patient with a meningeal hemangiopericytoma who was treated with primary surgical resection and experienced multiple bone metastases 20 years after the first treatment. This patient with multiple bone metastases was treated with multiple courses of irradiation and good palliation was achieved.     

Intramedullary spinal cord and leptomeningeal metastases from intracranial low-grade oligodendroglioma

We present an unusual case of a patient with an intracranial low-grade oligodendroglioma who developed recurrence with an intramedullary spinal cord metastasis and multiple spinal leptomeningeal metastases. The intramedullary spinal cord metastasis showed mild enhancement similar to the original intracranial primary, while the multiple spinal leptomeningeal metastases revealed no enhancement. This is the seventh reported case of symptomatic intramedullary spinal cord metastasis from a low-grade oligodendroglioma.     

Ruptured spinal dermoid cyst with disseminated intracranial fat droplets

Fat droplets in the cerebrospinal fluid (CSF) is a well-known complication of ruptured intracranial dermoid tumours. We report an unusual case of a ruptured spinal dermoid tumour. MR images showed a tethered spinal cord and an intramedullary fat-containing mass. Fat droplets were revealed in the ventricles and the cisternal spaces on brain CT and brain MR. In the English literature, a ruptured spinal dermoid tumour accompanying a tethered spinal cord is extremely rare.     

Detection and treatment of spinal CSF leaks in idiopathic intracranial hypotension

Introduction

This study aimed to evaluate the diagnostic imaging findings and treatment results of patients with idiopathic intracranial hypotension (IIH) due to cerebrospinal fluid (CSF) leaks.

Methods

Between February 2009 and April 2012, 26 IIH patients (15 men, median age 49?years) presenting with orthostatic headache (n?=?20) and/or with spontaneous subdural effusions or subarachnoid hemorrhage (n?=?19) were enrolled. Twenty-three patients underwent a whole spine CT and MRI myelography, starting 45?min after the intrathecal injection of 9?cc of iomeprol (Imeron 300 M) and 1?cc of gadobutrolum (Gadovist). Three patients only underwent MR myelography after intrathecal gadobutrolum injection. Adjacent to the level(s) of the detected CSF leak(s) along the nerve roots, 20?cc of fresh venous blood with 0.5?cc Gadovist was injected epidurally (blood patch, BP). The distribution of the BP was visualized by MRI the following day. Treatment results were evaluated clinically and by myelography 2?weeks after the application of the BP. Retreatment was offered to patients with persistent symptoms and continued CSF leakage.

Results

CSF leaks were detected at the cervical (n?=?12), thoracic (n?=?25), or lumbar (n?=?21) spine. In 23 patients, more than one spinal segment was affected. One patient refused treatment. BP were applied in one (n?=?9) or several (n?=?16) levels. Clinical and/or radiological improvement was achieved after one (n?=?16), two (n?=?5), three (n?=?3), or five (n?=?1) BPs.

Conclusion

CT and MRI myelography allow the reliable detection of spinal CSF leaks. The targeted and eventually repeated epidural BP procedure is a safe and efficacious treatment.