Dengbin Sun, Fei Chen, Zhaoping Wang

Department of Neurosurgery, Jining First People’s Hospital, Jining, Shandong, 272508, People’s Republic of China

Correspondence: Zhaoping Wang, Department of Neurosurgery, Jining First People’s Hospital, No. 269, Mengzi Avenue, High-tech Zone, Jining, Shandong, 272508, People’s Republic of China, Tel +86 13685475152, Email wang_zhaoping25@163.com

Objective: To summarise and analyse the imaging manifestations and pathological features of patients with ependymoma, and to explore the potential correlation between them.
Methods: The study included 32 patients with ependymoma diagnosed between January 2020 and December 2024, all of whom underwent computed tomography and magnetic resonance imaging examinations. Imaging analysis included lesion diameter, location, morphology, surrounding oedema and enhancement manifestations; pathological analysis included histopathological examination and immunohistochemical detection, with detection indicators including glial fibrillary acidic protein (GFAP), S-100 protein, EMA, Ki-67 and other markers. Statistical analysis was performed using the chi-square test, with p < 0.05 considered statistically significant.
Results: Among the 32 patients, the average age was 40.7 ± 18.4 years, with adults accounting for 90.6% and children 9.4%. Tumours were distributed in multiple locations, most commonly in the spinal canal (31.3%) and the fourth ventricle (18.8%). Imaging features showed that tumours mostly presented low signal on T1WI (87.5%), with high and low signals each accounting for about 45% on T2WI, and all cases showed heterogeneous enhancement on enhanced T1WI. Nineteen cases (59.4%) had restricted diffusion, 19 cases (59.4%) had cystic components and 25 cases (78.1%) had necrosis. Pathological results showed that most tumours were World Health Organization grade II (46.9%), with 12 cases (80.0%) having ZFTA fusion (L1CAM overexpression). Immunohistochemical detection showed a positivity rate of 75.0% for GFAP and 62.5% for Ki-67. Statistical analysis showed that ZFTA fusion tumours were more likely to be located in the fourth ventricle (p = 0.02) and were significantly associated with cystic components, stellate signs and necrosis (p < 0.05). In cases with a Ki-67 index > 10%, 89.5% showed significant enhancement (p < 0.05).
Conclusion: This study confirmed a significant correlation between imaging and pathological features of ependymoma. Imaging examinations can provide important clues for diagnosis but pathological examinations are needed to improve accuracy.

Keywords: ependymoma, correlation, magnetic resonance imaging, MRI, computed tomography, CT, pathology