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Astrocytoma


KEY FACTS

Terminology

  • Primary neoplasm of astrocytic origin within spinal cord

Imaging

  • Fusiform expansion of cord with enhancing component of variable morphology

    • Almost always enhances

  • Cervical > thoracic

  • Usually ≤ 4 segments

    • Occasionally multisegmental, even holocord (more common with pilocytic astrocytoma)

  • ± cyst/syrinx (fluid slightly T1 hyperintense to cerebrospinal fluid)

  • Hyperintense on proton density and T2WI MR

  • Myelopathy should be evaluated with contrast-enhanced MR

Top Differential Diagnoses

  • Ependymoma

  • Hemangioblastoma

  • Syringohydromyelia

  • Autoimmune or inflammatory myelitis

Pathology

  • 80-90% low grade

  • 10-15% high grade

Clinical Issues

  • Slow onset of myelopathy

  • May cause painful scoliosis

  • Most are slow growing

    • Malignant tumors may cause rapid neurologic deterioration

  • Most common intramedullary tumor in children and young adults

  • Overall, ependymomas > astrocytomas (2:1)

Diagnostic Checklist

  • Myelopathy should be evaluated with MR

Sagittal graphic of cervical spine astrocytoma shows a fusiform solid mass
with a rostral cystic cord component
.

Sagittal T1WI C+ MR reveals a heterogeneously enhancing cervical cord mass
. The tumor subtype and histological grade are the most important prognostic factors. Malignant transformation, although common in recurrent adult low-grade gliomas, is unusual in pediatric low-grade intramedullary spinal cord tumors.

Axial T1WI C+ MR depicts an intramedullary enhancing tumor in the cervical cord
. Astrocytomas tend to have an eccentric growth pattern and are T2 hyperintense. Up to 1/3 are reportedly nonenhancing but have mass effect and cord expansion.

Axial CECT illustrates a heterogeneously enhancing mass
within the central spinal canal in this case of cervical spinal cord astrocytoma with holocord edema (not shown).

TERMINOLOGY

Synonyms

  • Intramedullary glioma

Definitions

  • Primary neoplasm of astrocytic origin within spinal cord (SC)

IMAGING

General Features

  • Best diagnostic clue

    • Enhancing infiltrating mass expanding SC

  • Location

    • Cervical > thoracic

  • Size

    • Usually ≤ 4 segments

    • May be extensive, especially with pilocytic histology

  • Morphology

    • Fusiform spinal expansion, with enhancing component of variable morphology

    • Occasionally asymmetric, even exophytic

      • –

        Eccentric > central growth pattern

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