Volume 41, Pages (January 2017)

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Volume 41, Pages 48-52 (January 2017) Differentiation of recurrent spinal ependymoma from postradiation treatment necrosis through multiparametric PET-MR and perfusion MRI Mojgan Hojjati, Vasant Garg, Chaitra A. Badve, Salim E. Abboud, Andrew E. Sloan, Leo J. Wolansky Clinical Imaging Volume 41, Pages 48-52 (January 2017) DOI: 10.1016/j.clinimag.2016.09.002 Copyright © 2016 Elsevier Inc. Terms and Conditions

Fig. 1 (a) Sagittal T1 post-Gadolinium-enhanced image from 2012 demonstrates a heterogeneously enhancing expansile intramedullary lesion at the T10/T11 level and prior ependymal resection site; (b) subsequent sagittal T1 post-Gadolinium-enhanced image of 2014 with interval increase in size of this heterogeneously enhancing expansile mass; (c) sagittal T2-weighted image demonstrates inhomogeneous hyperintensity and possible cystic components within the intramedullary lesion. The rim of hypointensity along the caudal tumor margin is representative of a hemosiderin cap. Note the mild peritumoral edema, which is frequently seen with intramedullary tumors. Clinical Imaging 2017 41, 48-52DOI: (10.1016/j.clinimag.2016.09.002) Copyright © 2016 Elsevier Inc. Terms and Conditions

Fig. 2 (a) sagittal T1 post-Gadolinium-enhanced image from 2014 demonstrates a heterogeneously enhancing expansile intramedullary lesion at the T10/T11 level and prior ependymal resection site; sagittal (b) and axial (c) MR-PET fused images (with MR attenuation correction) demonstrates increased 18F-fluodeoxyglucose (18F-FDG) radiotracer activity within this lesion. Clinical Imaging 2017 41, 48-52DOI: (10.1016/j.clinimag.2016.09.002) Copyright © 2016 Elsevier Inc. Terms and Conditions

Fig. 3 (a) Sagittal T1 post-Gadolinium-enhanced image from 2014 demonstrates a heterogeneously enhancing expansile intramedullary lesion at the T10/T11 level and prior ependymal resection site; (b) sagittal T2-weighted DSC rCBV map is with associated increased perfusion; (c) sagittal T1-weighted DCE K-trans map demonstrates increased permeability. Increased perfusion and permeability are typical characteristics of viable neoplasm. Clinical Imaging 2017 41, 48-52DOI: (10.1016/j.clinimag.2016.09.002) Copyright © 2016 Elsevier Inc. Terms and Conditions

Fig. 4 T1-weighted DCE time–concentration permeability curve demonstrates a steep upslope in the vascular phase followed by slowly ascending enhancing plateau, which is characteristic of neovascularity and viable neoplasm. Clinical Imaging 2017 41, 48-52DOI: (10.1016/j.clinimag.2016.09.002) Copyright © 2016 Elsevier Inc. Terms and Conditions

Fig. 5 (a) Sagittal T1 post-Gadolinium-enhanced image from 2014 demonstrates a heterogeneously enhancing expansile intramedullary lesion at the T10/T11 level and prior ependymal resection site; MRAC PET image without MR fusion (b) and MRAC PET image with MR fusion (c) images demonstrate 18F-FDG hypermetabolism within lesion and concerning for recurrent tumor. Clinical Imaging 2017 41, 48-52DOI: (10.1016/j.clinimag.2016.09.002) Copyright © 2016 Elsevier Inc. Terms and Conditions