MRI characteristics and resectability in spinal cord glioma

• Published in: Clinical neurology and neurosurgery Vol. 200; p. 106321
• Main Authors: Seaman, Scott C., Bathla, Girish, Park, Brian J., Woodroffe, Royce W., Smith, Mark, Menezes, Arnold H., Noeller, Jennifer, Yamaguchi, Satoshi, Hitchon, Patrick W.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2021; Elsevier Limited
• Subjects: Adolescent; Adult; Astrocytoma; Biopsy; Brain tumors; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - surgery; Clinical significance; Cohort Studies; Diagnosis; Electrodes; Electronic medical records; Female; Glioma; Glioma - diagnostic imaging; Glioma - surgery; Histopathology; Humans; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Middle Aged; MRI; Neurology; Neurosurgical Procedures - methods; Paralysis; Patients; Preoperative Care - methods; Regression analysis; Retrospective Studies; Spinal cord; Spinal cord astrocytoma; Spinal cord ependymoma; Spinal Cord Neoplasms - diagnostic imaging; Spinal Cord Neoplasms - surgery; Statistical analysis; Surgeons; Surgery; Survival; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - surgery; Tumors; Young Adult; MRI; Spinal cord astrocytoma; Spinal cord ependymoma
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2020.106321

•Unlike astrocytomas, ependymomas have homogenous enhancement, and margination.•MRI features of ependymoma predict a favorable surgical cleavage plane at surgery.•Irrespective of pathology, extent of resection correlates with outcome.•Intramedullary ependymomas have a more favorable survival than astrocytomas. The histopathology of intramedullary spinal cord tumors (IMSCT) can be suspected from the MRI features and characteristics. Ultimately, the confirmation of diagnosis requires surgery. This retrospective study addresses MRI features including homogeneity of enhancement, margination, and associated syrinx in intramedullary astrocytomas (IMA) and ependymomas (IME) that assist in diagnosis and predict resectability of these tumors. Single-center retrospective analysis of IMA and IME cases since 2005 extracted from the departmental registry/electronic medical records post IRB approval (IRB 201,710,760). We compared imaging findings (enhancement, margination, homogeneity, and associated syrinxes) between tumor types and examined patient outcomes. There were 18 IME and 21 IMA. On preoperative MRI, IME was favored to have homogenous enhancement (OR 1.8, p = 0.0001), well-marginated (p < 0.0001, OR 0.019 [95 % CI 0.002−0.184]), and associated syrinx (p = 0.015, OR 0.192 [95 % CI 0.049−0.760]). Total excision, subtotal excision, and biopsy were performed in 12, 5, and 1 patients in the IME cohort, respectively. In the IMA group, tumors were heterogeneous and poorly marginated in 20 of the 21 patients. Total excision, subtotal excision, and biopsy were undertaken in 2, 13, and 6 patients, respectively. The success of excision was predicted by MRI, with a significant difference in the extent of resection between IME and IMA (X2 = 14.123, p = 0.001). In terms of outcome, ordinal regression analysis showed that well-margined tumors and those with homogeneous enhancement were associated with a better postoperative McCormick score. Extent of resection had statistically significant survival (p = 0.026) and recurrence-free survival (p = 0.008) benefits. The imaging characteristics of IME and IMA have meaningful clinical significance. Homogeneity, margination, and associated syrinxes in IME can predict resectability and complexity of surgery.