Central neurocytoma: Radiological and clinico-pathological findings in 18 patients and one additional MRS case

Abstract

To evaluate clinical findings and radiological characteristics of central neurocytoma (CN) in 18 patients and magnetic resonance spectroscopy (MRS) features in one additional case. Clinical and imaging findings of 18 patients (nine female and nine male; age range, 18-37 years old (27.8±5.7)) with histopathological diagnosis of CN were evaluated retrospectively. Eight patients underwent CT and eight had MR imaging. Both MR and CT images were acquired for other two patients. We also assessed the tumour NADC values. Clinical data, such as presenting symptoms and medical histories were collected. MRS was also obtained for one additional case. Clinical symptoms at the time of presentation were headaches (n=11), dizziness (n=6), visual disturbances (n=2), etc. Eight lesions were unilateral ventricle (44%) and ten were located in both lateral ventricles. Three tumours continued towards the foramen of Monro and one to the third ventricle. The maximum diameter of the CNs varied from 3.4 to 9.2 cm (5.2±1.5 cm). On CT, diffuse and diverse calcifications were observed in nine cases and cysts varying in sizes were revealed in all. On MRI, the solid parts of the tumours were mainly hypo- to isointense on all T1WI and isointense to grey matter on T2WI. Clusters of cysts gave the tumours a "swiss cheese/soap bubble" inhomogeneous hyperintense appearance on T2WI and FLAIR images. Heterogeneous moderate enhancement (5/8) was present on T1 postcontrast images. On DWI, the tumours had heterogeneous hyperintense appearances and the tumour NADC values were 0.93±0.21.On MRS, elevated Cho and Gly peaks and reduced Cr and NAA peaks were obtained. CN is almost exclusively located in the body of lateral ventricle in young adults. It is discovered due to symptoms of raised intracranial pressure. The distinct radiological features such as: (1) diffuse and diverse calcifications on CT images; (2) clusters of cysts of varying sizes resulting in the "swiss cheese/soap bubble" appearance on T2WI and heterogeneous moderate enhancement on MR images; (3) the incorporation of the septum pellucidum in bilateral tumours and abutting of the septum pellucidum in unilateral tumours together with the attachment of the wall of the ventricles can help in the diagnosis of preoperative central neurocytoma.