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Research ArticleHead & Neck

Diffusion-Weighted MRI: Distinction of Skull Base Chordoma from Chondrosarcoma

K.W. Yeom, R.M. Lober, B.C. Mobley, G. Harsh, H. Vogel, R. Allagio, M. Pearson, M.S.B. Edwards and N.J. Fischbein
American Journal of Neuroradiology May 2013, 34 (5) 1056-1061; DOI: https://doi.org/10.3174/ajnr.A3333
K.W. Yeom
aFrom the Departments of Radiology (K.W.Y., N.J.F.)
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R.M. Lober
bNeurosurgery (R.M.L., G.H., M.S.B.E.)
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B.C. Mobley
dDepartments of Pathology (B.C.M.)
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G. Harsh
bNeurosurgery (R.M.L., G.H., M.S.B.E.)
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H. Vogel
cPathology (H.V.), Stanford University, Palo Alto, California
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R. Allagio
fDepartment of Pathology (R.A.), University of Padova, Padova, Italy.
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M. Pearson
eNeurosurgery (M.P.), Vanderbilt University Medical Center, Nashville, Tennessee
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M.S.B. Edwards
bNeurosurgery (R.M.L., G.H., M.S.B.E.)
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N.J. Fischbein
aFrom the Departments of Radiology (K.W.Y., N.J.F.)
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    Fig 1.

    ADC measurement. In this 22-month-old girl, poorly differentiated chordoma is seen arising from the clivus (A), which shows minimal or no enhancement (B) and relatively low T2 intensity (C). Regions of interest were drawn at all available axial planes of the tumor on the ADC map (D) and along the entire boundary of the tumor soft tissue, avoiding areas of hemorrhage, necrosis, cyst, or calcification.

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    Fig 2.

    Sample ADC measurements in various tumors. Chondrosarcoma (A and D), classic chordoma (B), and poorly differentiated chordoma (C).

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    Fig 3.

    Enhancement patterns. Examples of enhancement patterns, mild to none (top), heterogeneous (middle), and solid (bottom) are shown in poorly differentiated chordomas (A and D), classic chordoma (B), and chondrosarcoma (C, E, and F).

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    Fig 4.

    Examples of T2 intensity features of the clival tumors. High T2 intensity of chondrosarcoma (A) and classic chordoma (B) are easily recognized. Contrast this with the low T2 intensity of poorly differentiated chordoma (C and D).

Tables

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    Table 1:

    Patient characteristics and clinical data (n = 19)

    Entire Cohort (n = 19)Chondrosarcoma (n = 9)Classic Chordoma (n = 7)Poorly Differentiated Chordoma (n = 3)
    Age at diagnosis (yr)
        Median3637367
        Range2–8428–842–642–8
    Sex
        Male8 (42%)3 (33%)3 (43%)2 (67%)
        Female11 (58%)6 (67%)4 (57%)1 (33%)
    Tumor location
        Clival11 (58%)4 (44%)5 (71%)3 (100%)
        Petroclival7 (37%)4 (44%)2 (29%)0 (0%)
        Pterygoid1 (5%)1 (11%)0 (0%)0 (0%)
    New or recurrent/residual
        New16 (84%)8 (89%)5 (71%)3 (100%)
        Recurrent/residual3 (16%)1 (11%)2 (29%)0 (0%)
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    Table 2:

    ADC values for each tumor type (10−6 mm2/s)

    TumorMean ADC (Median)Minimum ADC (Median)Maximum ADC (Median)
    Chondrosarcoma (n = 9)2051 ± 262 (1977)1488 ± 360 (1352)2503 ± 512 (2392)
    Classic Chordoma (n = 7)1474 ± 117 (1460)905 ± 118 (860)2199 ± 255 (2217)
    Poorly Differentiated Chordoma (n = 3)875 ± 100 (871)491 ± 210 (469)1503 ± 127 (1557)
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    Table 3:

    MRI features for each tumor type

    TumorT2 Hypointensity>90% EnhancementClival Location
    Chondrosarcoma (n = 9)0 (0%)5 (56%)4 (44%)
    Classic chordoma (n = 7)0 (0%)1 (14%)4 (57%)
    Poorly differentiated chordoma (n = 3)3 (100%)0 (0%)3 (100%)
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American Journal of Neuroradiology: 34 (5)
American Journal of Neuroradiology
Vol. 34, Issue 5
1 May 2013
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Cite this article
K.W. Yeom, R.M. Lober, B.C. Mobley, G. Harsh, H. Vogel, R. Allagio, M. Pearson, M.S.B. Edwards, N.J. Fischbein
Diffusion-Weighted MRI: Distinction of Skull Base Chordoma from Chondrosarcoma
American Journal of Neuroradiology May 2013, 34 (5) 1056-1061; DOI: 10.3174/ajnr.A3333

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Diffusion-Weighted MRI: Distinction of Skull Base Chordoma from Chondrosarcoma
K.W. Yeom, R.M. Lober, B.C. Mobley, G. Harsh, H. Vogel, R. Allagio, M. Pearson, M.S.B. Edwards, N.J. Fischbein
American Journal of Neuroradiology May 2013, 34 (5) 1056-1061; DOI: 10.3174/ajnr.A3333
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