title: A Nonenhancing World Health Organization Grade II Intramedullary Spinal Ependymoma in the Conus: Case Illustration and Review of Imaging Characteristics.
abstract: Spinal ependymomas comprise ~60% of all intramedullary tumors in adults. Ependymomas demonstrate distinct imaging features, such as central location within the spinal cord, symmetrical expansion, intra- and extratumoral cysts, hemosiderin caps, and strong enhancement on contrast-injected, T1-weighted magnetic resonance (MR) imaging. In adults, most ependymomas are myxopapillary, and in children, most are nonmyxopapillary. In general, nonmyxopapillary or classic ependymomas are hyperintense on T2- and hypointense on T1-weighted MR imaging, but whereas the signal intensity on T1 and T2 is variable, homogeneous contrast enhancement is usually a characteristic finding. Here, the authors provide an overview on spinal ependymomas with an emphasis on imaging characteristics and morphological background and present the case of a World Health Organization grade II ependymoma in the conus that did not enhance. Interestingly, the tumor contained a large hemorrhagic cyst. Just as hemorrhagic metastatic tumors may not enhance, a hemorrhagic ependymoma may likewise not enhance after administration of contrast agent. Thus, the differential diagnosis of a nonenhancing intramedullary lesion in the conus should include ependymoma, particularly if there is concomitant hemorrhage.
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Science, University at Buffalo, State University of New York, Buffalo, New York.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Fanous
authors.affiliation: Department of Neurosurgery, University of Utah, Salt Lake City, Utah.
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Jost
authors.affiliation: Department of Neurosurgery, University of Utah, Salt Lake City, Utah.
authors.forename: Meic H
authors.initials: MH
authors.lastname: Schmidt
keywords: MR imaging; ependymoma; intramedullary; spinal cord; tumor