From the Guidelines
MRI findings in chordoma typically show a destructive midline bone lesion with characteristic signal intensities, including hypointensity to isointensity on T1-weighted images and high signal intensity on T2-weighted images, with heterogeneous enhancement after gadolinium contrast administration, as described in the most recent guidelines 1.
Key MRI Features
- Hypointense to isointense masses on T1-weighted images
- High signal intensity on T2-weighted images due to high water content and gelatinous nature
- Heterogeneous enhancement after gadolinium contrast administration
- Internal septations and areas of hemorrhage or calcification
- Lobulated contours and extension into adjacent soft tissues
Common Locations
- Sacrococcygeal region (50-60%)
- Skull base/clivus (25-35%)
- Mobile spine (less common)
Diagnostic Considerations
- Chordomas can be differentiated from chondrosarcomas based on high signal on diffusion-weighted imaging (DWI) with corresponding low apparent diffusion coefficient (ADC) values 1
- Benign notochordal cell tumors can be distinguished from chordomas based on radiological features, and biopsy is not recommended unless the lesion changes over time 1
From the Research
MRI Findings in Chordoma
- Chordomas demonstrate intermediate to low signal intensity on T1-weighted MR images 2
- They characteristically demonstrate very high signal intensity on T2-weighted MR images, likely reflecting the high fluid content of vacuolated cellular components 2
- MR imaging of chordoma reveals multilobulated areas of marrow replacement on T1-weighting and high signal intensity on T2-weighting, reflecting the myxoid component within the lesion and areas of hemorrhage seen histologically 3
- Moderate to marked enhancement is common and often heterogeneous on contrast material-enhanced images 2
Dynamic Contrast-Enhanced MR Perfusion Imaging
- Plasma volume mean, plasma volume maximum, and vascular permeability mean in the ROIs significantly decreased after radiation therapy 4
- Area under the curve values also demonstrated significant differences after radiation therapy 4
- Dynamic contrast-enhanced MR perfusion parameters may be useful for monitoring chordoma growth and response to radiation therapy 4
Characteristics of Chordoma on MRI
- Chordomas often appear as a centrally located, well-circumscribed, expansile soft-tissue mass that arises from the clivus with associated extensive lytic bone destruction on CT, but MRI is the single best imaging modality for evaluation 2
- The characteristic dynamic MR signal intensity-time curve of chordoma may provide a radiographic means of distinguishing chordoma from other spinal lesions 4