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Ependymoma Radiology in the Spine

Ependymoma Radiology in the Spine Through various imaging techniques such as MRI and CT scans, ependymoma tumors in the spine can be detected, assessed, and monitored, providing valuable insights for accurate diagnosis and treatment planning.

Ependymoma, primarily occurring in the spinal cord, requires early detection for effective management. Radiology imaging techniques play a pivotal role in identifying ependymoma tumors and guiding subsequent treatment decisions. Throughout this article, we will explore how MRI, CT scans, and other imaging modalities contribute to the comprehensive assessment of ependymoma in the spine.

Accurate diagnosis is crucial for developing effective treatment plans. Our expert contributors will discuss the radiologic assessment of ependymoma, examining the advantages and limitations of different imaging techniques. Furthermore, we will delve into the characteristics and classification of ependymoma spine tumors, facilitating precise treatment strategies.

Early detection and accurate diagnosis are cornerstones to improved patient outcomes. That’s why we will explore the collaborative approach in ependymoma management, with a focus on the leading expertise of Acibadem Healthcare Group. Their multidisciplinary team utilizes cutting-edge radiology techniques to ensure comprehensive care for patients with ependymoma in the spine.

Stay tuned as we discuss the latest advancements in ependymoma radiology research, including emerging imaging techniques and technologies. These innovations hold promise for enhancing the diagnosis, treatment, and surveillance of ependymoma tumors in the spine.

Throughout this article, we will provide valuable insights into the field of ependymoma radiology in the spine. Our aim is to equip healthcare professionals and patients alike with the knowledge they need to make informed decisions and promote better outcomes for individuals affected by this rare spinal tumor.

Understanding Ependymoma: A Rare Spinal Tumor

Ependymoma is a rare type of spinal tumor that primarily affects the central nervous system. It arises from ependymal cells, which line the ventricles and the spinal cord. While ependymoma can occur in various parts of the central nervous system, it particularly manifests in the spine.

Early detection of ependymoma is crucial for optimizing treatment outcomes, and radiology imaging techniques play a vital role in its diagnosis. By utilizing advanced imaging modalities, healthcare professionals can identify ependymoma tumors in the spine and assess their characteristics and potential impact on surrounding tissues.

Diagnosing ependymoma in the spine often involves the use of magnetic resonance imaging (MRI) and computed tomography (CT) scans. These imaging techniques provide detailed images that help healthcare providers evaluate the location, size, and extent of the tumor. Through careful analysis of the radiology findings, clinicians can determine the most appropriate treatment approach.

Ependymoma in the spine presents various challenges due to its rarity and the intricate anatomy of the spinal cord. Accurate diagnosis relies heavily on the expertise of radiologists and their ability to identify subtle imaging features that set ependymoma apart from other spinal tumors. Furthermore, interdisciplinary collaboration between radiologists, neurosurgeons, and oncologists ensures comprehensive patient care.

Hence, understanding the characteristics of ependymoma and the significance of early diagnosis through radiology imaging techniques is crucial in providing effective care for individuals affected by this rare spinal tumor.

Ependymoma Characteristics in the Spine:

Let’s take a closer look at some key characteristics of ependymoma in the spine:

  • Location: Ependymoma tumors in the spine can occur in various regions, including the cervical, thoracic, and lumbar spine.
  • Growth Pattern: Ependymoma tumors in the spine typically exhibit an intramedullary growth pattern, meaning they grow within the spinal cord itself.
  • Appearance: On imaging studies, ependymoma tumors often present as well-defined masses with variable contrast enhancement.
  • Surrounding Structures: Ependymoma in the spine can exert mass effect on nearby structures, such as the spinal cord, nerve roots, and blood vessels.

Understanding these characteristics and being able to identify them on radiological images are essential for accurate diagnosis, treatment planning, and monitoring of ependymoma in the spine.

Ependymoma Subtypes and Grades:

Ependymoma tumors in the spine can be further classified into different subtypes and grades based on their histological features and molecular characteristics. This classification system helps healthcare providers understand the tumor’s behavior and select the most appropriate treatment approach.

Ependymoma Subtypes Ependymoma Grades
Spinal myxopapillary ependymoma Grade I
Spinal ependymoma Grade II
Spinal anaplastic ependymoma Grade III

The classification of ependymoma into subtypes and grades helps guide treatment decisions and prognosis, where lower-grade tumors often have a more favorable outcome compared to higher-grade tumors.

Ependymoma Imaging Techniques: MRI Spine

In the diagnosis and treatment of ependymoma in the spine, Magnetic Resonance Imaging (MRI) plays a crucial role. MRI offers several benefits in imaging ependymoma tumors, enabling accurate detection and evaluation.

One of the key advantages of MRI is its ability to provide detailed images of the spine and surrounding structures. This non-invasive imaging technique uses a powerful magnetic field and radio waves to create high-resolution pictures that offer valuable insights into the location, size, and characteristics of ependymoma tumors.

With MRI, healthcare professionals can assess the extent of tumor involvement in the spinal cord and surrounding tissues, facilitating treatment planning. By precisely visualizing the tumor’s location, MRI aids in determining the optimal surgical approach and helps guide radiation therapy targeting.

MRI is particularly effective in distinguishing ependymoma from other spinal tumors. By examining the tumor’s appearance, MRI can provide valuable information regarding tumor grade and characteristics, contributing to accurate diagnosis and prognosis.

In addition, MRI offers the advantage of being radiation-free. This makes it a safe imaging option, especially for pediatric patients or individuals who require multiple imaging sessions for monitoring purposes.

Overall, MRI is an invaluable tool in the diagnosis and management of ependymoma in the spine. Its ability to provide detailed images, assess tumor involvement, and aid in treatment planning makes it an essential component of the multidisciplinary approach to ependymoma care.

Ependymoma Imaging Techniques: CT Scan Spine

In the diagnosis and evaluation of ependymoma in the spine, Computed Tomography (CT) scans play a crucial role. With their ability to produce detailed cross-sectional images, CT scans provide valuable information for identifying and monitoring ependymoma tumors.

CT scans use X-ray technology and advanced computer algorithms to create precise images of the spine. The high-resolution images generated by CT scans allow radiologists to visualize the size, location, and characteristics of ependymoma tumors in the spine, aiding in accurate diagnosis and treatment planning.

The CT scan procedure involves the patient lying on a table that slides into a doughnut-shaped machine. X-ray beams pass through the body, capturing multiple images from different angles. These images are then reconstructed by the computer, creating a clear and detailed representation of the spine.

Advantages of CT Scans for Ependymoma Imaging

CT scans offer several advantages when it comes to imaging ependymoma in the spine:

  • Excellent visualization of bone structures: CT scans provide exceptional clarity when it comes to examining bony structures and detecting any abnormalities related to ependymoma tumors.
  • Rapid imaging: CT scans are quick and can be completed in a relatively short time. This makes them particularly useful in emergency cases or when patients require immediate evaluation.
  • Contrast-enhanced imaging: By using contrast agents, CT scans can enhance the visualization of blood vessels and soft tissues, allowing for better assessment of ependymoma tumors and their surrounding structures.
  • Availability: CT scanners are widely available in hospitals and imaging centers, making them easily accessible for patients requiring ependymoma imaging.

The combination of speed, accuracy, and availability makes CT scans an indispensable tool for radiologists and healthcare professionals in the diagnosis, staging, and monitoring of ependymoma tumors in the spine.

Advantages of CT Scans for Ependymoma Imaging
Excellent visualization of bone structures
Rapid imaging
Contrast-enhanced imaging
Availability

Radiologic Assessment of Ependymoma in the Spine

When it comes to diagnosing and evaluating ependymoma in the spine, radiology plays a crucial role. Various imaging modalities are used to assess the extent and characteristics of ependymoma tumors, providing valuable information for treatment planning and patient management.

Ependymoma radiology spine involves the use of advanced imaging techniques to visualize and analyze the spinal cord and surrounding structures. These techniques enable radiologists to accurately detect and characterize ependymoma tumors, aiding in diagnosis and treatment decision-making.

Magnetic Resonance Imaging (MRI) for Ependymoma Spine Imaging

MRI is widely utilized in ependymoma spine imaging due to its superior soft tissue resolution and ability to assess the spinal cord and its surrounding structures in detail. It provides multiplanar imaging capabilities, enabling the visualization of ependymoma tumors from different angles.

In ependymoma cases, MRI scans can reveal important information about the tumor’s location, size, and involvement with adjacent tissues. They can also help differentiate ependymomas from other spinal cord tumors, enabling accurate diagnosis and appropriate treatment planning.

Computed Tomography (CT) Scan for Ependymoma Spinal Cord Radiology

CT scans are another valuable tool in ependymoma spinal cord radiology. CT imaging uses X-rays to produce cross-sectional images of the spine, providing detailed information about bony structures and any associated abnormalities. It can help identify ependymoma tumors, their size, and their impact on the surrounding vertebrae.

CT scans are particularly useful for assessing the bony involvement of ependymoma tumors in the spine. This information is crucial for surgical planning, as it helps determine the feasibility of complete tumor resection and the need for additional treatments like radiation therapy.

Advantages and Limitations of Radiologic Assessment

The radiologic assessment of ependymoma in the spine offers several advantages. These techniques provide non-invasive imaging, allowing for accurate tumor localization and assessment of tumor characteristics. They also play a crucial role in treatment planning, helping clinicians make informed decisions about the most appropriate management strategy for each patient.

However, it is important to note that radiologic assessment also has its limitations. While MRI and CT scans provide valuable information, they cannot provide a definitive diagnosis on their own. Histopathological analysis through a biopsy or surgical resection is typically required to confirm the presence of ependymoma.

Advantages of Radiologic Assessment in Ependymoma Spine Imaging Limitations of Radiologic Assessment in Ependymoma Spine Imaging
– Non-invasive imaging – Cannot provide definitive diagnosis
– Accurate tumor localization – Histopathological analysis necessary for confirmation
– Assessment of tumor characteristics
– Key role in treatment planning

Despite these limitations, radiologic assessment plays a crucial role in the overall management of ependymoma in the spine. It provides valuable information that guides treatment decisions and helps monitor tumor response to therapeutic interventions.

Ependymoma Spine Tumors: Characteristics and Classification

When it comes to diagnosing and treating ependymoma in the spine, understanding the characteristics and classification of these tumors is crucial. Radiology plays a pivotal role in providing valuable insights into the imaging features that help distinguish ependymoma from other spinal tumors.

Ependymoma spine tumors exhibit certain characteristic imaging findings that can aid in their identification and classification. These findings are essential for accurate treatment planning and ensuring the best possible outcomes for patients. By carefully analyzing radiological images, medical professionals can determine the location, size, and extent of the ependymoma tumor, as well as its relationship with surrounding structures.

Different imaging modalities, such as MRI and CT scans, are utilized to assess ependymoma spine tumors. MRI, in particular, provides detailed images that allow for a closer evaluation of the tumor’s morphology and enhancement patterns. It helps radiologists differentiate ependymoma from other spinal tumors by identifying specific characteristics such as the presence of cystic spaces, necrotic areas, and enhancement patterns.

Furthermore, the classification of ependymoma spine tumors is crucial for treatment planning. The World Health Organization (WHO) classifies ependymomas into several subtypes based on histological and molecular characteristics. These subtypes include classic ependymoma, myxopapillary ependymoma, and anaplastic ependymoma, among others.

Accurate radiological assessment is instrumental in determining the subtype of the ependymoma tumor. By analyzing the imaging features and characteristics, radiologists can help guide treatment decisions and provide essential information for surgical planning, radiation therapy, and targeted therapies.

It is important to note that the radiological assessment of ependymoma spine tumors requires expertise and collaboration between radiologists, neurosurgeons, and oncologists. The interdisciplinary approach ensures a comprehensive evaluation of the tumor, leading to more precise diagnoses and treatment plans.

In summary, ependymoma spine tumors have distinct characteristics that can be identified through radiological imaging. Accurate classification of these tumors is essential for effective treatment planning. By utilizing advanced imaging techniques and leveraging the expertise of multidisciplinary medical teams, healthcare professionals can provide optimal care for patients with ependymoma in the spine.

Diagnosing Ependymoma in the Spine

In the diagnostic process of ependymoma in the spine, radiology plays a crucial role in detecting and confirming the presence of ependymoma tumors. Through advanced imaging techniques, radiologists can provide valuable insights that aid in the accurate diagnosis of this rare spinal tumor.

When a patient presents with symptoms that may indicate the presence of an ependymoma, such as back pain, weakness, or changes in bowel or bladder habits, imaging studies are necessary to assess the spinal region thoroughly. These studies allow radiologists to visualize the spinal cord and surrounding structures to determine if a tumor is present.

The primary imaging modality used in diagnosing ependymoma in the spine is magnetic resonance imaging (MRI). MRI provides detailed images of the spinal cord and surrounding tissues, helping radiologists identify the location, size, and extent of the tumor. It allows for the evaluation of tumor characteristics, including its appearance, vascularity, and possible invasion into neighboring structures.

In some cases, a computed tomography (CT) scan may also be performed to provide additional information or to complement the findings from the MRI. CT scans offer cross-sectional images of the spine, aiding in the detection and assessment of ependymoma tumors.

Role of Multidisciplinary Approaches

Accurate diagnosis of ependymoma in the spine often requires a multidisciplinary approach. Radiologists collaborate closely with other healthcare professionals, such as neurosurgeons and oncologists, to enhance the diagnostic process.

After the radiological evaluation, the imaging findings are discussed in a multidisciplinary tumor board meeting, where experts from different specialties share their expertise and collectively determine the most appropriate course of action. This collaborative approach ensures that patients receive accurate diagnoses and personalized treatment plans tailored to their specific condition.

Advantages of Radiology in Ependymoma Diagnosis Limitations of Radiology in Ependymoma Diagnosis
  • Allows non-invasive evaluation of the spinal cord and surrounding structures
  • Provides detailed information about tumor location, size, and extent
  • Assists in determining the appropriate treatment approach
  • Enables monitoring of tumor response to treatment
  • Imaging findings may overlap with other spinal tumors, requiring histopathological confirmation
  • Cannot provide information about the malignancy or grade of the tumor
  • May not detect small or early-stage ependymoma tumors
  • Potential for false-negative or false-positive results

It is important for patients and healthcare providers to recognize the strengths and limitations of radiology in diagnosing ependymoma in the spine. While imaging studies provide valuable information, histopathological analysis of a tissue sample obtained through biopsy or surgical resection remains the definitive method for confirming the diagnosis.

By combining the expertise of radiologists, neurosurgeons, and oncologists, accurate diagnosis can be achieved, leading to timely and appropriate treatment strategies for patients with ependymoma in the spine.

Treatment Planning for Ependymoma Spine Cancer

Effective treatment planning lays the foundation for successful management of ependymoma spine cancer. Radiology plays a crucial role in this process, providing valuable insights through advanced imaging techniques. By utilizing ependymoma spine cancer imaging, healthcare professionals can accurately assess the extent of the tumor and determine the most appropriate treatment approach.

Imaging techniques such as MRI and CT scans offer detailed visualization of the ependymoma tumor, allowing healthcare providers to evaluate its size, location, and proximity to vital structures. This information is vital for surgical planning, as it helps surgeons determine the feasibility of complete tumor resection while minimizing the risk of complications.

Radiology also aids in treatment selection beyond surgery. Through ependymoma spine cancer imaging, healthcare professionals can assess the tumor’s response to radiation therapy and chemotherapy. This enables them to make informed decisions regarding the intensity and duration of treatment, optimizing efficacy while minimizing side effects.

Furthermore, follow-up imaging post-treatment plays a crucial role in monitoring the tumor’s response and detecting any signs of recurrence. Regular imaging scans allow healthcare professionals to evaluate the effectiveness of the chosen treatment approach and make necessary adjustments as needed. This ongoing assessment helps ensure timely intervention and optimal patient outcomes.

Imaging Techniques for Ependymoma Spine Cancer

Imaging Technique Advantages Limitations
MRI Provides detailed soft tissue visualization May have limitations in assessing bony structures
CT Scan Offers excellent visualization of bony structures Provides limited soft tissue contrast

As shown in the table above, both MRI and CT scans have distinct advantages and limitations in imaging ependymoma spine cancer. The choice of imaging modality depends on the specific requirements of each case and the information needed for treatment planning.

In conclusion, treatment planning for ependymoma spine cancer relies heavily on radiology and advanced imaging techniques. By accurately assessing the tumor and monitoring treatment response, healthcare professionals can tailor treatment approaches to each patient’s unique needs, maximizing the chances of successful outcomes.

Monitoring Ependymoma Spine Tumors with Radiology

Regular imaging follow-up plays a crucial role in monitoring ependymoma spine tumors and assessing treatment response. Radiology techniques, such as MRI and CT scans, provide valuable insights into the tumor’s progression and help guide further management decisions.

Ependymoma radiology spine imaging allows healthcare professionals to evaluate the tumor’s size, location, and characteristics. By closely monitoring these factors, doctors can assess the effectiveness of the chosen treatment approach and make informed decisions regarding any necessary adjustments.

Assessing Treatment Response

Imaging follow-up after initiating treatment allows healthcare providers to evaluate how well the ependymoma spine tumor is responding. An ependymoma MRI spine helps determine if the tumor has decreased in size or if there are any changes in its characteristics.

During the follow-up, radiologists analyze the imaging results to compare them with previous scans, looking for signs of tumor regression or stability. This information is vital for evaluating the effectiveness of the current treatment plan and making any necessary modifications.

Detecting Recurrence

Monitoring ependymoma spine tumors with radiology also aids in detecting any signs of recurrence. Regular imaging follow-up enables healthcare professionals to identify any new tumor growth, changes in tumor characteristics, or the development of metastases.

Ependymoma spine imaging, such as an MRI or CT scan, provides detailed images that help visualize even small changes in the tumor. By detecting recurrence early on, healthcare providers can promptly intervene and adjust the treatment plan accordingly.

Guiding Further Management Decisions

The information obtained from radiology imaging plays a vital role in guiding further management decisions for ependymoma spine tumors. The imaging results help healthcare professionals determine if additional treatments, such as radiation therapy or chemotherapy, are necessary to achieve the best possible outcome.

Furthermore, the radiology findings also help in monitoring potential treatment-related complications, such as radiation-induced changes in the surrounding tissues or post-surgical changes. This allows doctors to provide appropriate care and support to patients throughout their ependymoma treatment journey.

In summary, monitoring ependymoma spine tumors with radiology through regular imaging follow-up is essential for assessing treatment response, detecting recurrence, and guiding further management decisions. By leveraging the detailed imaging provided by techniques like MRI and CT scans, healthcare professionals can ensure optimal care for patients with ependymoma in the spine.

Advances in Ependymoma Radiology Research

As researchers continue to explore the field of ependymoma radiology, significant advancements have been made in improving the diagnosis, treatment, and surveillance of this rare spinal tumor. These breakthroughs have the potential to revolutionize patient care and outcomes for individuals affected by ependymoma in the spine.

Emerging Imaging Techniques

One area of focus in ependymoma radiology research is the development of innovative imaging techniques that provide enhanced visualization and diagnostic accuracy. For example, diffusion-weighted imaging (DWI) has shown promise in differentiating ependymomas from other spinal tumors by assessing the diffusion properties of water molecules within the tumor tissue.

Dynamic contrast-enhanced MRI is another exciting advancement, allowing for the assessment of blood flow and perfusion within ependymoma tumors. This technique provides valuable information about tumor vascularity and can aid in treatment planning and response evaluation.

Improved Detection and Characterization

Researchers are also exploring ways to improve the detection and characterization of ependymoma in the spine. Machine learning algorithms, trained on large datasets of ependymoma images, are being developed to assist radiologists in accurately identifying and categorizing these tumors.

Molecular imaging techniques, such as positron emission tomography (PET) scanning, are being investigated to target specific molecular markers associated with ependymoma. This approach may enable early detection of tumors and provide valuable information about tumor biology and aggressiveness.

Advancing Treatment Planning

The field of ependymoma radiology research is also focused on advancing treatment planning strategies through cutting-edge imaging technologies. Functional MRI (fMRI) is being utilized to map neurovascular structures and eloquent areas of the spine, enabling surgeons to plan more precise and tailored surgical interventions.

Additionally, radiomics, a multidimensional analysis of radiologic images, is being explored to extract quantitative features from ependymoma images. This data, combined with clinical and genetic information, has the potential to optimize treatment decisions and predict patient outcomes.

Promising Future Directions

Looking ahead, researchers are investigating novel imaging agents and modalities to further enhance ependymoma radiology. Techniques such as hyperspectral imaging and optical coherence tomography (OCT) hold promise in providing real-time, high-resolution imaging of ependymoma tumors during surgery, aiding in complete tumor resection and reducing the risk of recurrence.

The integration of artificial intelligence and deep learning algorithms into routine radiologic practice is also on the horizon. These technologies have the potential to streamline interpretation, automate analysis, and improve the overall efficiency of ependymoma diagnosis and treatment.

By pushing the boundaries of ependymoma radiology research, clinicians and researchers aim to ultimately improve patient outcomes, enhance quality of life, and contribute to the global understanding of this rare spinal tumor.

Collaborative Approach: The Role of Acibadem Healthcare Group

When it comes to the management of ependymoma, a collaborative approach is crucial to ensure comprehensive care for patients. One institution that excels in this collaborative effort is the Acibadem Healthcare Group.

Acibadem Healthcare Group is a renowned healthcare organization known for its expertise in utilizing advanced radiology techniques in the diagnosis and treatment of ependymoma in the spine. With a team of highly skilled radiologists and medical professionals, Acibadem Healthcare Group provides top-notch care to patients facing this rare tumor.

At Acibadem Healthcare Group, multidisciplinary collaboration is at the core of their approach to ependymoma management. Specialists from various fields, including radiology, neurosurgery, oncology, and pathology, work together to develop personalized treatment plans tailored to each patient’s unique needs.

The role of radiology in the collaborative approach of Acibadem Healthcare Group is essential. By utilizing state-of-the-art imaging techniques such as MRI and CT scans, their team can accurately diagnose ependymoma tumors, determine their characteristics and location, and assess their response to treatment.

Through a seamless integration of radiology findings with other diagnostic tests and clinical evaluations, Acibadem Healthcare Group ensures that every aspect of a patient’s condition is thoroughly considered. This comprehensive approach enables the development of the most effective treatment strategies, including surgery, radiation therapy, and chemotherapy, to achieve the best possible outcomes.

Acibadem Healthcare Group’s commitment to collaboration extends beyond the medical professionals within their institution. They actively engage patients and their families in the decision-making process, empowering them to actively participate in their treatment journey. Patient education and support are integral parts of Acibadem Healthcare Group’s approach, ensuring that individuals are well-informed and equipped to make informed decisions about their care.

With its expertise, collaborative approach, and patient-centered focus, Acibadem Healthcare Group has established itself as a leader in ependymoma management. Through their dedication and commitment, they strive to improve the lives of patients facing this rare spinal tumor, continually pushing the boundaries of what is possible in radiology and healthcare.

Conclusion

In conclusion, ependymoma radiology plays a crucial role in the diagnosis and management of ependymoma tumors in the spine. Early detection through accurate imaging assessment, such as MRI spine and CT scan spine, is vital for timely intervention and improved patient outcomes.

With the help of advanced imaging techniques, healthcare professionals can accurately assess the extent and characteristics of ependymoma spine tumors, enabling them to develop personalized treatment plans tailored to each patient’s needs. This multidisciplinary collaboration involving radiologists, neurosurgeons, oncologists, and other specialists ensures comprehensive care for patients with ependymoma in the spine.

Continued research and advancements in ependymoma radiology offer promising possibilities for enhancing the diagnosis, treatment, and surveillance of this rare spinal tumor. By leveraging innovative imaging technologies, we can further improve our understanding of ependymoma, leading to more targeted and effective therapeutic approaches.

In conclusion, ependymoma radiology in the spine is a vital component of the comprehensive care provided to patients. Through early diagnosis, accurate imaging assessment, and multidisciplinary collaboration, we can make significant strides in the management of ependymoma tumors, ultimately leading to improved patient outcomes and quality of life.

FAQ

What role does radiology play in diagnosing ependymoma in the spine?

Radiology plays a crucial role in diagnosing ependymoma in the spine. Imaging techniques such as MRI and CT scans are used to detect ependymoma tumors and provide valuable insights for diagnosis and treatment planning.

What is ependymoma and how is it diagnosed through radiology?

Ependymoma is a rare type of spinal tumor. Radiology imaging techniques, such as MRI and CT scans, are used to detect and evaluate ependymoma tumors in the spine. Early diagnosis through these imaging modalities is crucial for timely and effective treatment.

How does MRI assist in imaging ependymoma in the spine?

MRI (Magnetic Resonance Imaging) plays a significant role in imaging ependymoma in the spine. It provides detailed images that help detect and assess ependymoma tumors. MRI also aids in treatment planning by providing information on tumor location, size, and involvement of nearby structures.

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