title: The Clinical Significance of Ependymal Enhancement at Presentation in Patients with Malignant Glioma.
abstract: BACKGROUND
  The current study evaluated the rate of ependymal enhancement and whether its presence influences survival of patients with malignant glioma (GBM).
  
  
  METHODS
  A retrospective review of all patients who were treated in our institution from 2005 to 2011 was conducted. Data extracted from the medical records included age, date of diagnosis, co-morbidities, treatment regimen, and time of death. Magnetic resonance images (MRI) were evaluated for the presence of ependymal enhancement and its extent, and the correlation to survival was investigated.
  
  
  RESULTS
  Between 2005 and 2011, 230 patients were treated for GBM. Eighty-nine patients were excluded from the study due to insufficient data, leaving 141 patients for analysis. Median age at diagnosis was 60 years. Sixty-seven (40.6%) patients had evidence of ependymal enhancement on MRI (group A), and 70 (42.4%) patients did not have evidence of enhancement. The assessment of ependymal enhancement was inconclusive due to mass effect and ventricular compression that precluded accurate assessment for 28 (17%) patients (group C). Median survival was 14 months for group A (range, 12-16 months), 15.9 months for group B (range, 14.28-17.65 months), and 11.7 months for group C (range, 6.47-16.92 months) (P>0.05). A multivariate analysis to predict survival indicated that male gender (P=0.039), hypertension (P=0.012), and biopsy only compared to complete gross tumor resection (P=0.001) were significant for poor survival.
  
  
  CONCLUSIONS
  Pretreatment ependymal enhancement on MRI was not found to be associated with poorer survival. These results might be due to better treatments options compared to prior reports.
authors.affiliation: Division of Oncology & Neuro-Oncology Unit, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Orit
authors.initials: O
authors.lastname: Kaidar-Person
authors.affiliation: Division of Oncology & Neuro-Oncology Unit, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Firas
authors.initials: F
authors.lastname: Darawshe
authors.affiliation: Division of Oncology & Neuro-Oncology Unit, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Tzahala
authors.initials: T
authors.lastname: Tzuk-Shina
authors.affiliation: Department of Radiology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Ayelet
authors.initials: A
authors.lastname: Eran