MRI symptomatology of primary intraspinal cord gliomas

MRI has now been recognized as the best technique for exploration of spinal tumours and, in particular, tumours within the spinal cord. Based on a retrospective study of 74 operated glial tumours, we are trying to define a specific semiology for intramedullary astrocytomas and ependymomas. Thirty-four cases were selected including 17 astrocytomas (7 low-grade, 10 high-grade) and 17 ependymomas (1 of which was grade III) for whom the pre-operative MRI examination was complete, with T1-weighted sequences without, then with gadolinium, and T2-weighted sequences. The examination was performed using a high-field and in most cases 1.5 Tesla machine. Analysis, correlated with operative data and pathology results, comprised on the one hand patients' distribution by age, sex and location of the tumour on the spinal cord, and on the other hand the MRI semiology concerning the sagittal and axial localization of the fleshy portion after gadolinium injection, the limits of the tumour, the homo- or heterogeneous character of its enhancement, the possible existence of stigmas of intra- or peritumoral chronic bleeding, and finally the presence or absence of associated cysts in the 34 exploitable cases. Some semiological differences were elicited between astrocytomas and ependymomas: the patient's age at the time of diagnosis was predominantly 0 to 20 for astrocytomas (astrocytomas 39%, ependymomas 4%), and the well-limited character of the fleshy portion of the tumour after gadolinium injection was found in 70% of ependymomas, 40% of high-grade astrocytomas and 14% of low-grade astrocytomas. The homogeneity of contrast enhancement in ependymomas has been classically defined, but it did not show in our series. Finally, it seems that high-grade astrocytomas are characterized by the rare presence of hemosiderin deposits (high-grade 20%, low-grade 57%, ependymomas 58%) and by the absence or reduced extension of overlying and underlying cysts.