OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.

中文翻译：

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脊髓胶质瘤的MRI特征和可切除性


目的从MRI表现和特点可怀疑脊髓髓内肿瘤（IMSCT）的组织病理学变化。最终，确诊需要手术。这项回顾性研究探讨了 MRI 特征，包括髓内星形细胞瘤 (IMA) 和室管膜瘤 (IME) 的增强均匀性、边缘化和相关空洞，有助于诊断和预测这些肿瘤的可切除性。方法 对 2005 年以来的 IMA 和 IME 病例进行单中心回顾性分析，这些病例是从 IRB 批准后的部门登记/电子病历中提取的（IRB 201,710,760）。我们比较了肿瘤类型之间的影像学表现（增强、边缘化、同质性和相关的空洞）并检查了患者的治疗结果。结果 IME 18 例，IMA 21 例。在术前 MRI 上，IME 倾向于具有均匀增强（OR 1.8，p = 0.0001）、边缘良好（p < 0.0001，OR 0.019 [95 % CI 0.002-0.184]）和相关的空洞（p = 0.015，OR 0.192） [95% CI 0.049-0.760]）。 IME 队列中分别有 12 名、5 名和 1 名患者进行了全切除、次全切除和活检。在 IMA 组中，21 名患者中有 20 名患者的肿瘤呈异质性且边缘较差。分别对 2 名、13 名和 6 名患者进行了全切除、次全切除和活检。 MRI 预测切除的成功，IME 和 IMA 之间的切除范围存在显着差异（X2 = 14.123，p = 0.001）。就结果而言，序数回归分析显示，边缘良好的肿瘤和均匀强化的肿瘤与更好的术后 McCormick 评分相关。切除范围对生存率（p = 0.026）和无复发生存率（p = 0.008）具有统计学意义的益处。 结论 IME和IMA的影像学特征具有有意义的临床意义。 IME 中的均匀性、边缘化和相关注射管可以预测手术的可切除性和复杂性。