Cellular Ependymoma



  • Neoplasm arising from ependyma lining spinal cord central canal


  • Circumscribed, enhancing hemorrhagic cord mass with surrounding edema

  • Associated cysts common

  • Cervical > thoracic > conus

  • T1WI: Isointense or slightly hypointense to spinal cord

  • T2WI: Hyperintense relative to spinal cord

  • Cap sign: Hemosiderin at cranial or caudal margin

  • Most tumors enhance

  • Peripheral enhancement of tumoral cysts

Top Differential Diagnoses

  • Astrocytoma

  • Hemangioblastoma

  • Demyelinating disease

  • Idiopathic transverse myelitis


  • Arises from ependymal cells of central cord canal

    • Most intramedullary

    • Rarely can be intradural extramedullary

  • Most WHO grade II

  • Rarely WHO grade III

    • Anaplastic ependymoma

  • Association with neurofibromatosis type 2

Clinical Issues

  • Most common presentation

    • Neck or back pain

  • Other presentations

    • Progressive paraparesis, paresthesias

Diagnostic Checklist

  • Spinal cord neoplasm with associated peripheral hemorrhage suggestive of cellular ependymoma

Coronal graphic depicts an intramedullary ependymoma mildly expanding the cervical cord. Cranial and rostral cysts, as well as hemorrhagic products, are associated with this mass.

Sagittal T1WI C+ MR demonstrates a cervical intramedullary mass with solid and cystic components causing fusiform cord expansion. There are 2 areas of enhancing solid components and a rostral cyst extending cephalad into the brainstem. The adjacent solid portion shows little enhancement .

Axial T1WI C+ MR reveals an expansile intramedullary ependymoma with robust enhancement pattern.

Sagittal T2WI MR illustrates the mixed cystic and solid appearance of cervical ependymomas in a patient with neurofibromatosis type 2. In addition, there is a dural-based intradural extramedullary meningioma .



  • Spinal ependymoma

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