Intracranial ependymoma diagnosis [Neurosurgery Wiki]

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====== Intracranial ependymoma diagnosis ======

===== Radiographic features =====

The majority of [[intracranial ependymoma]]s (60%) are located in the [[posterior fossa]] ([[infratentorial]]), usually arising from the [[lateral recess]] of the [[fourth ventricle]] (molecular subgroup: [[Posterior fossa type A Ependymoma]]) and midline inferior floor of the [[fourth ventricle]] near the [[obex]] (molecular subgroup: Posterior Fossa B)
((Koeller KK, Sandberg GD. From the archives of the AFIP. Cerebral intraventricular neoplasms: radiologic-pathologic correlation. Radiographics. 22 (6): 1473-505. doi:10.1148/rg.226025118))
((Yuh EL, Barkovich AJ, Gupta N. Imaging of ependymomas: MRI and CT. Childs Nerv Syst. 2009;25 (10): 1203-13. doi:10.1007/s00381-009-0878-7))
((Smith A, Smirniotopoulos J, Horkanyne-Szakaly I. From the Radiologic Pathology Archives: Intraventricular Neoplasms: Radiologic-Pathologic Correlation. Radiographics. 2013;33 (1): 21-43. Radiographics (full text) - doi:10.1148/rg.331125192))
((AlRayahi J, Zapotocky M, Ramaswamy V, Hanagandi P, Branson H, Mubarak W, Raybaud C, Laughlin S. Pediatric Brain Tumor Genetics: What Radiologists Need to Know. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (7): 2102-2122. doi:10.1148/rg.2018180109 - ))

The remainder (40%) are located supratentorially and up to half of these are intraparenchymal.

see [[Supratentorial ependymoma]].

In contrast to [[spinal cord ependymoma]]s, [[calcification]] is common.

Posterior fossa ependymomas are apt to extend through the [[foramen of Luschka]] and [[foramen of Magendie]], hence the term plastic ependymoma. This is a characteristic feature and can be seen on both CT and MRI. 

Ependymomas are typically heterogeneous masses with areas of [[necrosis]], [[calcification]], [[cyst]]ic change and [[hemorrhage]] frequently seen. This results in a heterogeneous appearance on all modalities. 

Intraparenchymal lesions (usually supratentorial) are generally large and variable in appearance, ranging from completely solid, enhancing masses to cysts with a mural nodule, or more heterogeneous masses.

==== CT ====

Coarse calcification is common (50%) 

Cystic areas (50%) 

Solid component iso- to hypodense

Heterogeneous enhancement 

Variable hemorrhage

==== MRI ====

see [[Intracranial ependymoma MRI]].

===== References =====