Ecchordis physaliphoris (EP) and chordoma arise from notochord remnants along the neuraxis from the clivus to the sacrum. Lagman et al reported a classification for these tumors. The authors are from Cooper University Hospital, Cedars-Sinai Medical Center and Vanderbilt University.
Parameters:
(1) clinical (asymptomatic vs symptomatic)
(2) imaging features
(3) size in mL
(4) gadolinium enhancement
Clinical
Imaging
Size in mL
Gadolinium
Grade
asymptomatic
classic for EP, no stalk
NA
not enhanced
I
asymptomatic
classic for EP, with stalk
NA
not enhanced
II
symptomatic
classic for EP, with stalk
< 6 mL
not enhanced
III
symptomatic
bone erosion
> 6 cm
NA
IV
symptomatic
NA
> 6 cm
gadolinium enhanced
IV
CN palsy
bone destruction; T1 hyperintense
NA
gadolinium enhanced
V
where:
• Gadolinium enhancement indicates higher grade.
• Classic findings for EP: T1-hypointense, T2 hyperinense, lack of gadolinium enhancement.
Grade
Behavior
I
benign (EP)
II
benign (EP)
III
indeterminate
IV
malignant (chordoma)
V
malignant (chordoma)
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