Magnetic resonance imaging diagnosis of chordoma and differential diagnostic tests

Summary

Chordoma arises from residual embryonic chord or ectopic chord and occurs only in the median bones, preferably at the ends of the spine. Pathologically, there are two basic types: one is benign, slow-growing, and often detected incidentally; the other is malignant, with destructive growth of the tumor. With the continuous improvement of medical imaging technology, especially the popularization of CT and magnetic resonance imaging (MRI), the diagnosis of chordoma has become more accurate, which has laid a good foundation for clinical treatment.

Operation method

Magnetic Resonance Imaging (MRI) method

Principle

The nucleus of an atom has a certain mass and a certain volume, and can be thought of as a nearly spherical solid. Experiments have shown that most of the atomic nucleus as a gyroscope, are around a certain axis for spin motion. For example, the common H11 and C136 (6 is the number of protons that is the atomic number, but also the number of charges; 13 is the number of mass = number of protons + number of neutrons) nucleus, etc. have this movement. The rotational motion of the nucleus itself is called the spin motion of the nucleus. This spin motion is generally described by the terms "spin moment", "spin momentum moment" or "spin angular momentum".

Materials and Instruments

Chordoma
Gadopentetate Glucosamine
High Field Magnetic Resonance Imaging System

Move

I. General information
Fifteen cases of surgically and pathologically confirmed chordoma in Shanxi Provincial People's Hospital from 2005 to 2010 were collected, all of which had complete clinical data and MRI images. There were 9 males and 6 females, aged 30-59 years old, with an average of 44.5 years old.
II. Clinical manifestations
Clinical manifestations of cervical chordoma are neck swelling and pain, numbness of limbs, weakness of movement, sensory and motor deficits, and difficulty in swallowing. Slope area chordoma manifested as headache, neck pain, difficulty in opening the mouth as well as headache, nasal congestion, vision loss, and unsteady gait, respectively. Clinical manifestations of sacrococcygeal chordoma are swelling and pain in the buttocks and difficulty in bowel movement.
III. Methodology
A Siemens Avanto 1.5T high-field magnetic resonance imaging system was used with head and neck spine coils. MRI plain scanning was performed first, including sagittal T1WI and T2WI scans. t1WI, transverse, and coronal; layer thickness was 4 mm. enhancement scanning was performed in some cases, and the contrast agent was gadopentetate dextran (Gd- DTPA), 15 mL, intravenously.

Results

In this group of 15 patients, 7 cases occurred around the slope area, 7 cases in the sacrococcygeal spine, and 1 case in the cervical region.MRI manifestations: the chordoma in the saddle area, slope area, and the base of the middle cranial recess was an irregularly shaped solid mass, and the edges of the lesion were foliated or blurred. The high signal of the medulla of the slope disappeared and was replaced by an abnormal tumor body. The slope was bulging and invaded the surrounding tissues obviously, and there was no obvious peripheral edema around the tumor. Low signal on T1-weighted images and heterogeneous high signal on T2-weighted images. There was obvious destruction of the adjacent bone. The tumor border is clear and the adjacent subarachnoid space is widened. After enhancement scanning, the tumor often shows moderate abnormal contrast enhancement, more uniform enhancement, and less regular morphology. Sacrococcygeal chordoma shows bone destruction of the sacrococcygeal bone, localized irregular mass, low signal on T1-weighted scans, and inhomogeneous high signal on T2-weighted images. The cervical chordoma lesion can be seen as low or equal signal on T1WI and high signal on T2WI. It is irregular in shape, with infiltrative growth, pressing forward on the pharynx and backward on the cervical cord (see Figures 1-8).

Common Problems

I. Experimental discussion

Most intracranial chordomas are seen on the slopes and often involve the infrasaddle and paraspinal regions. The tumor may extend forward to the nasopharynx and backward to affect the pontine and medulla oblongata, causing significant compression and displacement. The texture of the tumor varies in softness and hardness, depending on the major structures within the tumor. Tumors can be soft and jelly-like or hard and cartilaginous. Some tumors may contain many small foci of hemorrhage, and larger calcifications are not uncommon. A distinguishing feature of chordoma is its infiltrative growth into bone tissue, with marked destruction of bone at the site of growth.

Chordoma is more common in males, preferably in the age of 20-40 years. The main clinical symptoms of chordoma in the slope region include headache, progressive cranial nerve palsy, long fasciculus sign, and may have increased intracranial pressure. It is common for chordoma to occur in the sacrococcygeal spine, followed by the slope area, and very rare in the neck. Cervical chordoma is most common in patients aged 50-70 years old, with atypical early symptoms, often dominated by cervico-occipital discomfort, neck pain, and numbness of upper limbs. In this case, intermittent pain in the right side of the neck and pharyngeal pain were the main symptoms, and the MRI showed low or equal signal on T1-weighted scan and high signal on T2-weighted scan. Enhanced scans showed abnormal enhancement of the lesion. The vertebral body is destroyed and the intervertebral foramen is enlarged, and the signal of spinal cord compression is changed. MRI of ptero-occipital chordoma showed a large irregularly shaped substantial mass in the saddle region, the base of the middle cranial recess and the slope, without obvious peripheral edema. It showed low signal or equal signal on T1WI image and uneven high signal on T2WI. There is significant destruction of adjacent bone, which is quite evident in slope chordoma. The tumor is well demarcated with widening of the adjacent subarachnoid space. The tumor often displaces the brainstem posteriorly and involves the anterior part of the brainstem. The basilar and vertebral arteries are often encircled by the tumor without loss of "flow-through effect". The tumor often shows moderately abnormal contrast enhancement, and the enhancement is homogeneous but morphologically irregular.

Differential diagnosis: Chordoma should be differentiated from nasopharyngeal carcinoma, meningioma, craniopharyngioma and chondroma. Nasopharyngeal carcinoma originates from the pharyngeal fossa, with more uniform signal intensity, little calcification, and significant abnormal contrast enhancement. Meningiomas of the base of the cranial fossa seldom cause extensive destruction of the adjacent bone, and the T2WI image shows isosignal or even low signal, with very obvious abnormal contrast enhancement.

Craniopharyngiomas show large variations in signal intensity between T1WI and T2WI images, and enhancement is less common, usually without causing bone changes. Chondromas are difficult to distinguish from chordomas, and the only thing that helps is a GD-DTPA-enhanced MRI scan, which shows moderate enhancement in chordomas and generally no enhancement in chondromas. MRI of chordoma occurring in the sacrococcygeal spine may replace the normal sacral signal with a long T1 low-signal, long T2 high-signal shadow. Tumor growth toward the pelvis may compress the rectum and bladder and infiltrate backward toward the sacral canal. Most of them strengthen uniformly after contrast injection. Since MRI can not only scan in cross section, but also scan in sagittal and coronal planes, it can clarify the scope of the tumor, the relationship between the growth direction and the adjacent tissues, which is obviously superior to other examination methods.

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