Cervical chordomas are rare tumors. Complications can arise at the time of initial resection due to the locally aggressive spread, in the setting of multifocal recurrence after surgery and radiation, as well as metastatic spread. This exhibit reviews imaging findings of cervical chordoma and the treatment implications.
Educational Goals / Teaching Points
This exhibit teaches radiologists and trainees to: 1) define margins of cervical chordoma on CT and MR imaging, 2) recognize complications due to neural and vascular injury with resection, 3) recognize chordoma recurrence, 4) identify metastatic chordoma within the neck.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This case-based exhibit uses CT, MR and PET imaging findings in patients with cervical chordoma at presentation and during surveillance to show:
1. Bone destruction by chordoma and necessity for corpectomy
2. Epidural extension of tumor with resultant spinal cord compression
3. Post-operative recurrence
4. Vascular involvement including carotid artery encasement and vertebral artery injury with associated cerebellar infarct
5. Metastatic disease
6. Involvement of the craniocervical junction
7. Nerve root compression/encasement, including the cranial nerves.
8. Laryngeal/vocal fold involvement
Radiologists need to recognize and report chordoma extension which places the patient at risk for operative complications.
Surveillance imaging of cervical chordoma requires full coverage of the neck and cervical spine. Multimodality imaging may be required, with CT providing a superior evaluation of the extent of bony involvement, and MRI providing a detailed evaluation of potentially more subtle complications of neurovascular compression.