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Ecchordosis physaliphora: typical and atypical radiologic features

 Hun Ho Park  ;  Kyu-Sung Lee  ;  Sung Jun Ahn  ;  Sang Hyun Suh  ;  Chang-Ki Hong 
 NEUROSURGICAL REVIEW, Vol.40(1) : 87-94, 2017 
Journal Title
Issue Date
Adult ; Aged ; Brain Neoplasms/diagnosis ; Brain Neoplasms/pathology ; Brain Neoplasms/surgery ; Chordoma/diagnosis ; Chordoma/pathology ; Chordoma/surgery ; Cranial Fossa, Posterior/pathology ; Cranial Fossa, Posterior/surgery ; Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Retrospective Studies ; Skull Base Neoplasms/diagnosis ; Skull Base Neoplasms/pathology ; Skull Base Neoplasms/surgery
Clival chordoma ; Computed tomography ; Ecchordosis physaliphora ; High-resolution imaging ; T2-weighted magnetic resonance imaging
Ecchordosis physaliphora (EP) is a distinct clinical entity defined as a notochordal remnant found on the dorsal surface of the clivus, occurring in about 2 % of autopsies. The aim of this study is to introduce typical and atypical imaging features of EP, which can be confused with those of clival chordoma. Forty-one patients with clinical suspicion for clival chordoma visited the outpatient clinic from June 2007 to August 2015. A retrospective review was performed with magnetic resonance imaging (MRI) and computed tomography (CT) studies to revise the diagnosis to EP. Eight of 41 patients (19.5 %) manifested lesions on the dorsal surface of the clivus that were well circumscribed and homogenous, with no septations or osteolysis. The lesions were all hypointense on T1, hyperintense on T2-weighted MRI, and had no enhancement with gadolinium. A distinct T2-hypointense pedicle, which is the hallmark of EP, was seen in five patients (62.5 %) and defined as typical EP. A characteristic T2-hypointense rim was observed in three patients and defined as atypical EP (37.5 %). The mean largest diameter of the lesions was 1.1 cm (0.6-1.8 cm). Lesion size did not change in all the patients who were followed for a mean of 3.6 years (1.4-8.2 years) by separate MRI scans performed every 6 months to 1 year. EP and clival chordoma represent different spectra of the same pathology. As the two lesions have completely different prognoses, precise knowledge of the imaging features of EP is very important. Accurate diagnosis is essential for proper treatment planning.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Park, Hun Ho(박현호) ORCID logo https://orcid.org/0000-0002-2526-9693
Suh, Sang Hyun(서상현) ORCID logo https://orcid.org/0000-0002-7098-4901
Ahn, Sung Jun(안성준) ORCID logo https://orcid.org/0000-0003-0075-2432
Lee, Kyu Sung(이규성)
Hong, Chang Ki(홍창기) ORCID logo https://orcid.org/0000-0002-2761-0373
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