Malignant pleural mesothelioma (MPM) is the most common primary malignancy of the pleura and is associated with asbestos exposure in approximately 80% of patients. The patient prognosis is poor, with a median survival of 9-17 months after diagnosis. However, improved survival and decreased morbidity and mortality have been demonstrated when the diagnosis is made in the early stages of disease and specific treatment strategies are implemented. A staging system that focuses on the extent of primary tumor (T), lymph node involvement (N), and metastatic disease (M) has been devised by the International Mesothelioma Interest Group and emphasizes factors related to overall survival. Radiologists should recognize the manifestations of MPM across multiple imaging modalities, translate these findings into the updated staging system, and understand the effects of appropriate staging on treatment and survival. Computed tomography (CT) remains the primary imaging modality used to evaluate MPM and efficiently demonstrates the extent of primary tumor, intrathoracic lymphadenopathy, and extrathoracic spread. However, additional imaging modalities, such as magnetic resonance (MR) imaging of the thorax and positron emission tomography (PET)/CT with fluorodeoxyglucose, have emerged in recent years and are complementary to CT for disease staging and evaluation of patients with MPM. Thoracic MR imaging is particularly useful for identifying invasion of the chest wall, mediastinum, and diaphragm, and PET/CT can accurately demonstrate intrathoracic and extrathoracic lymphadenopathy and metastatic disease.

Kummell disease, or avascular necrosis of a vertebral body, presents as vertebral osteonecrosis typically affecting a thoracic vertebra with compression deformity, intravertebral vacuum cleft, and exaggerated kyphosis weeks to months after a minor traumatic injury. This rare disease is increasing in prevalence secondary to an aging population and the associated rise in osteoporosis. Treatment with vertebroplasty or surgical decompression and fusion is often required. We present a classic case of Kummell disease to illustrate the salient features of the condition, with associated imaging findings on computed tomography and magnetic resonance imaging.

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Ependymomas represent 4% of all primary central nervous system neoplasms in adults, with 30% occurring in the spinal cord. We describe a young man with neurological deficits following a motor vehicle accident who was found to have an intramedullary cervicothoracic ependymoma. CASE REPORTA previously healthy 18-year-old man presented to the emergency department following a motor vehicle accident. All four extremities were weak immediately following the accident, with right-sided weakness noted on initial physical examination. Head and cervical spine computed tomography (CT) revealed no abnormalities. Cervical spine magnetic resonance imaging (MRI) revealed an expansile intramedullary mass at the cervicothoracic junction (Figures 1a, 1b) and mild interspinous ligament sprain. Th e patient's neurologic defi cit resolved within 24 hours. Th e patient underwent laminectomy and laminoplasty with complete resection of the mass ( Figure 1c) and had an uncomplicated postoperative course. Neurological examination immediately following surgery revealed decreased right lower extremity proprioception, 2+/5 strength at the right L2 to L3 levels, and 4/5 strength at the right L4 to S1 levels. DISCUSSIONEpendymomas are the most common intramedullary neoplasm in adults and represent 60% of all intramedullary tumors. Th ey arise from ependymal cells lining the central canal of the spinal cord. Th ese tumors have a mean age of presentation of 38.8 years and a slight male predominance (57.4%) (1, 2). Th e clinical presentation of ependymoma is similar to that of other intramedullary lesions, with a prolonged history of slowly worsening myelopathic symptoms prior to diagnosis.MRI evaluation is the imaging modality of choice in the patient with suspected cord neoplasm. Ependymomas are typically iso-to hypointense relative to the spinal cord on unenhanced T1-weighted images, with the vast majority exhibiting at least some degree of enhancement following intravenous gadolinium administration (1, 3, 4). T2-weighted images usually reveal a hyperintense intramedullary lesion. Ependymomas may cause hematomyelia as well as subarachnoid hemorrhage, with 20% to 33% of lesions displaying a "cap sign" of signal hypointensity at the lesion margins secondary to hemosiderin deposition from intralesional chronic microhemorrhages. Cysts are often associated with ependymomas, with the majority representing nontumoral (polar) cysts at the margins of the lesion. True tumoral cysts (surrounded by enhancement) arise less frequently (1, 3, 4).The preferred treatment for spinal cord ependymomas is complete surgical resection. Current advances in microsurgical technique and intraoperative monitoring enable frequent complete resection without worsening postoperative neurologic function (5). In a series of 31 cases described by Chang et al (5), only 10% of cases were associated with worsening neurological function, while 26% showed improvement and the rest remained stable. The preoperative neurologic status of the patient is the greatest predictor of postoper...