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<meta name="DC.Title" content="MRI Signal Intensity and Electron Ultrastructure Classification Predict the Long-Term Outcome of Skull Base Chordomas" />
<meta name="DC.Identifier" content="10.3174/ajnr.A6557" />
<meta name="DC.Date" content="2020-05-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2020 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: MR imaging is a useful and widely used evaluation for chordomas. Prior studies have classified chordomas into cell-dense type and matrix-rich type according to the ultrastructural features. However, the relationship between the MR imaging signal intensity and ultrastructural classification is unknown. We hypothesized that MR imaging signal intensity may predict both tumor ultrastructural classification and prognosis.

MATERIALS AND METHODS: Seventy-nine patients with skull base chordomas who underwent 95 operations were included in this retrospective single-center series. Preoperative tumor-to-pons MR imaging signal intensity ratios were calculated and designated as ratio on T1 FLAIR sequence (RT1), ratio on T2 sequence (RT2), and ratio on enhanced T1 FLAIR sequence (REN), respectively. We assessed the relationships among signal intensity ratios, ultrastructural classification, and survival.

RESULTS: Compared with the matrix-rich type group, the cell-dense type chordomas showed lower RT2 (cell-dense type: 1.90 ± 0.38; matrix-rich type: 2.61 ± 0.60 P  &lt; .001). The model of predicting cell-dense type based on RT2 had an area under the curve of 0.83 (95% CI, 0.75–0.92). In patients without radiation therapy, both progression-free survival ( P  = .003) and overall survival ( P  = .002) were longer in the matrix-rich type group than in the cell-dense type group. REN was a risk factor for progression-free survival (hazard ratio  = 10.24; 95% CI, 1.73–60.79); RT2 was a protective factor for overall survival (hazard ratio  = 0.33; 95% CI, 0.12–0.87); and REN was a risk factor for overall survival (hazard ratio = 4.76; 95% CI, 1.51–15.01).

CONCLUSIONS: The difference in MR imaging signal intensity in chordomas can be explained by electron microscopic features. Both signal intensity ratios and electron microscopic features may be prognostic factors.

CDT
:   cell-dense type
MRT
:   matrix-rich type
OS
:   overall survival
PFS
:   progression-free survival
RT1, RT2, and REN
:   ratios of tumor-to-pons signal intensity in the T1 FLAIR sequence, T2 sequence, and enhanced T1 FLAIR sequence, respectively." />
<meta name="DC.Contributor" content="J. Bai" />
<meta name="DC.Contributor" content="J. Shi" />
<meta name="DC.Contributor" content="S. Zhang" />
<meta name="DC.Contributor" content="C. Zhang" />
<meta name="DC.Contributor" content="Y. Zhai" />
<meta name="DC.Contributor" content="S. Wang" />
<meta name="DC.Contributor" content="M. Li" />
<meta name="DC.Contributor" content="C. Li" />
<meta name="DC.Contributor" content="P. Zhao" />
<meta name="DC.Contributor" content="S. Geng" />
<meta name="DC.Contributor" content="S. Gui" />
<meta name="DC.Contributor" content="L. Jing" />
<meta name="DC.Contributor" content="Y. Zhang" />
<meta name="article:published_time" content="2020-05-01" />
<meta name="article:section" content="Head &amp;amp; Neck" />
<meta name="citation_title" content="MRI Signal Intensity and Electron Ultrastructure Classification Predict the Long-Term Outcome of Skull Base Chordomas" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;MR imaging is a useful and widely used evaluation for chordomas. Prior studies have classified chordomas into cell-dense type and matrix-rich type according to the ultrastructural features. However, the relationship between the MR imaging signal intensity and ultrastructural classification is unknown. We hypothesized that MR imaging signal intensity may predict both tumor ultrastructural classification and prognosis.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Seventy-nine patients with skull base chordomas who underwent 95 operations were included in this retrospective single-center series. Preoperative tumor-to-pons MR imaging signal intensity ratios were calculated and designated as ratio on T1 FLAIR sequence (R&lt;sub&gt;T1&lt;/sub&gt;), ratio on T2 sequence (R&lt;sub&gt;T2&lt;/sub&gt;), and ratio on enhanced T1 FLAIR sequence (R&lt;sub&gt;EN&lt;/sub&gt;), respectively. We assessed the relationships among signal intensity ratios, ultrastructural classification, and survival.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Compared with the matrix-rich type group, the cell-dense type chordomas showed lower R&lt;sub&gt;T2&lt;/sub&gt; (cell-dense type: 1.90 ± 0.38; matrix-rich type: 2.61 ± 0.60 &lt;i&gt;P&lt;/i&gt; &amp;lt; .001). The model of predicting cell-dense type based on R&lt;sub&gt;T2&lt;/sub&gt; had an area under the curve of 0.83 (95% CI, 0.75–0.92). In patients without radiation therapy, both progression-free survival (&lt;i&gt;P &lt;/i&gt;= .003) and overall survival (&lt;i&gt;P &lt;/i&gt;= .002) were longer in the matrix-rich type group than in the cell-dense type group. R&lt;sub&gt;EN&lt;/sub&gt; was a risk factor for progression-free survival (hazard ratio&lt;i&gt; =&lt;/i&gt; 10.24; 95% CI, 1.73–60.79); R&lt;sub&gt;T2&lt;/sub&gt; was a protective factor for overall survival (hazard ratio &lt;i&gt; =&lt;/i&gt; 0.33; 95% CI, 0.12–0.87); and R&lt;sub&gt;EN&lt;/sub&gt; was a risk factor for overall survival (hazard ratio &lt;i&gt;=&lt;/i&gt; 4.76; 95% CI, 1.51–15.01).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;The difference in MR imaging signal intensity in chordomas can be explained by electron microscopic features. Both signal intensity ratios and electron microscopic features may be prognostic factors.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2020/05/01" />
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<meta name="citation_issn" content="0195-6108" />
<meta name="citation_issn" content="1936-959X" />
<meta name="citation_doi" content="10.3174/ajnr.A6557" />
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<meta name="citation_author" content="J. Bai" />
<meta name="citation_author_institution" content="aFrom the Department of Neurosurgery (J.B., P.Z., S. Geng, S. Gui, Y. Zhang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China" />
<meta name="citation_author_institution" content="bBeijing Neurosurgical Institute (J.B., S.Z., C.Z., Y. Zhai, S.W., M.L., C.L., Y. Zhang), Capital Medical University, Beijing, China" />
<meta name="citation_author_institution" content="cChina National Clinical Research Center for Neurological Diseases (J.B., P.Z., S. Geng, S. Gui, Y. Zhang), Beijing, China" />
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<meta name="citation_author" content="J. Shi" />
<meta name="citation_author_institution" content="dDepartment of Neurosurgery (J.S.), Tsinghua University Yuquan Hospital, Beijing, China" />
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<meta name="citation_author" content="S. Zhang" />
<meta name="citation_author_institution" content="bBeijing Neurosurgical Institute (J.B., S.Z., C.Z., Y. Zhai, S.W., M.L., C.L., Y. Zhang), Capital Medical University, Beijing, China" />
<meta name="citation_author_institution" content="eDepartment of Neurosurgery (S.Z.), Anshan Central Hospital, Anshan, China" />
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<meta name="citation_author" content="C. Zhang" />
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<meta name="citation_author_institution" content="fDepartment of Neurosurgery (Y. Zhai), First Affiliated Hospital, Zhengzhou University, Zhengzhou, China" />
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<meta name="citation_author" content="S. Geng" />
<meta name="citation_author_institution" content="aFrom the Department of Neurosurgery (J.B., P.Z., S. Geng, S. Gui, Y. Zhang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China" />
<meta name="citation_author_institution" content="cChina National Clinical Research Center for Neurological Diseases (J.B., P.Z., S. Geng, S. Gui, Y. Zhang), Beijing, China" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0002-6773-8777" />
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<meta name="citation_author_institution" content="aFrom the Department of Neurosurgery (J.B., P.Z., S. Geng, S. Gui, Y. Zhang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China" />
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<meta name="twitter:title" content="MRI Signal Intensity and Electron Ultrastructure Classification Predict the Long-Term Outcome of Skull Base Chordomas" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: MR imaging is a useful and widely used evaluation for chordomas. Prior studies have classified chordomas into cell-dense type and matrix-rich type according to the ultrastructural features. However, the relationship between the MR imaging signal intensity and ultrastructural classification is unknown. We hypothesized that MR imaging signal intensity may predict both tumor ultrastructural classification and prognosis.

MATERIALS AND METHODS: Seventy-nine patients with skull base chordomas who underwent 95 operations were included in this retrospective single-center series. Preoperative tumor-to-pons MR imaging signal intensity ratios were calculated and designated as ratio on T1 FLAIR sequence (RT1), ratio on T2 sequence (RT2), and ratio on enhanced T1 FLAIR sequence (REN), respectively. We assessed the relationships among signal intensity ratios, ultrastructural classification, and survival.

RESULTS: Compared with the matrix-rich type group, the cell-dense type chordomas showed lower RT2 (cell-dense type: 1.90 ± 0.38; matrix-rich type: 2.61 ± 0.60 P  &lt; .001). The model of predicting cell-dense type based on RT2 had an area under the curve of 0.83 (95% CI, 0.75–0.92). In patients without radiation therapy, both progression-free survival ( P  = .003) and overall survival ( P  = .002) were longer in the matrix-rich type group than in the cell-dense type group. REN was a risk factor for progression-free survival (hazard ratio  = 10.24; 95% CI, 1.73–60.79); RT2 was a protective factor for overall survival (hazard ratio  = 0.33; 95% CI, 0.12–0.87); and REN was a risk factor for overall survival (hazard ratio = 4.76; 95% CI, 1.51–15.01).

CONCLUSIONS: The difference in MR imaging signal intensity in chordomas can be explained by electron microscopic features. Both signal intensity ratios and electron microscopic features may be prognostic factors.

CDT
:   cell-dense type
MRT
:   matrix-rich type
OS
:   overall survival
PFS
:   progression-free survival
RT1, RT2, and REN
:   ratios of tumor-to-pons signal intensity in the T1 FLAIR sequence, T2 sequence, and enhanced T1 FLAIR sequence, respectively." />
<meta name="og-title" property="og:title" content="MRI Signal Intensity and Electron Ultrastructure Classification Predict the Long-Term Outcome of Skull Base Chordomas" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/41/5/852" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: MR imaging is a useful and widely used evaluation for chordomas. Prior studies have classified chordomas into cell-dense type and matrix-rich type according to the ultrastructural features. However, the relationship between the MR imaging signal intensity and ultrastructural classification is unknown. We hypothesized that MR imaging signal intensity may predict both tumor ultrastructural classification and prognosis.

MATERIALS AND METHODS: Seventy-nine patients with skull base chordomas who underwent 95 operations were included in this retrospective single-center series. Preoperative tumor-to-pons MR imaging signal intensity ratios were calculated and designated as ratio on T1 FLAIR sequence (RT1), ratio on T2 sequence (RT2), and ratio on enhanced T1 FLAIR sequence (REN), respectively. We assessed the relationships among signal intensity ratios, ultrastructural classification, and survival.

RESULTS: Compared with the matrix-rich type group, the cell-dense type chordomas showed lower RT2 (cell-dense type: 1.90 ± 0.38; matrix-rich type: 2.61 ± 0.60 P  &lt; .001). The model of predicting cell-dense type based on RT2 had an area under the curve of 0.83 (95% CI, 0.75–0.92). In patients without radiation therapy, both progression-free survival ( P  = .003) and overall survival ( P  = .002) were longer in the matrix-rich type group than in the cell-dense type group. REN was a risk factor for progression-free survival (hazard ratio  = 10.24; 95% CI, 1.73–60.79); RT2 was a protective factor for overall survival (hazard ratio  = 0.33; 95% CI, 0.12–0.87); and REN was a risk factor for overall survival (hazard ratio = 4.76; 95% CI, 1.51–15.01).

CONCLUSIONS: The difference in MR imaging signal intensity in chordomas can be explained by electron microscopic features. Both signal intensity ratios and electron microscopic features may be prognostic factors.

CDT
:   cell-dense type
MRT
:   matrix-rich type
OS
:   overall survival
PFS
:   progression-free survival
RT1, RT2, and REN
:   ratios of tumor-to-pons signal intensity in the T1 FLAIR sequence, T2 sequence, and enhanced T1 FLAIR sequence, respectively." />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node75166--5" data-node-nid="75166" id="top-node-75166--61833424937" data-pisa="ajnr;41/5/852" data-pisa-master="ajnr;ajnr.A6557" data-apath="/ajnr/41/5/852.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Head &amp; Neck</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">MRI Signal Intensity and Electron Ultrastructure Classification Predict the Long-Term Outcome of Skull Base Chordomas</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J. Bai</span>, <span class="highwire-citation-author" data-delta="1">J. Shi</span>, <span class="highwire-citation-author" data-delta="2">S. Zhang</span>, <span class="highwire-citation-author" data-delta="3">C. Zhang</span>, <span class="highwire-citation-author" data-delta="4">Y. Zhai</span>, <span class="highwire-citation-author" data-delta="5">S. Wang</span>, <span class="highwire-citation-author" data-delta="6">M. Li</span>, <span class="highwire-citation-author" data-delta="7">C. Li</span>, <span class="highwire-citation-author" data-delta="8">P. Zhao</span>, <span class="highwire-citation-author" data-delta="9">S. Geng</span>, <span class="highwire-citation-author" data-delta="10">S. Gui</span>, <span class="highwire-citation-author" data-delta="11">L. Jing</span> and <span class="highwire-citation-author" data-delta="12">Y. Zhang</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2020,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">852-858; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6557 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-75166--61833424937" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J. Bai </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery (J.B., P.Z., S. Geng, S. Gui, Y. Zhang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Beijing Neurosurgical Institute (J.B., S.Z., C.Z., Y. Zhai, S.W., M.L., C.L., Y. Zhang), Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>c</span>China National Clinical Research Center for Neurological Diseases (J.B., P.Z., S. Geng, S. Gui, Y. Zhang), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BBai%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Bai%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BBai%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-0790-2069" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Bai</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J. Shi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Neurosurgery (J.S.), Tsinghua University Yuquan Hospital, Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BShi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Shi%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BShi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-7994-982X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Shi</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">S. Zhang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Beijing Neurosurgical Institute (J.B., S.Z., C.Z., Y. Zhai, S.W., M.L., C.L., Y. Zhang), Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Neurosurgery (S.Z.), Anshan Central Hospital, Anshan, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BZhang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zhang%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BZhang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-8019-0523" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Zhang</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">C. Zhang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Beijing Neurosurgical Institute (J.B., S.Z., C.Z., Y. Zhai, S.W., M.L., C.L., Y. Zhang), Capital Medical University, Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BZhang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zhang%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BZhang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4346-1299" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Zhang</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Y. Zhai </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Beijing Neurosurgical Institute (J.B., S.Z., C.Z., Y. Zhai, S.W., M.L., C.L., Y. Zhang), Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>f</span>Department of Neurosurgery (Y. Zhai), First Affiliated Hospital, Zhengzhou University, Zhengzhou, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.%2BZhai%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zhai%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AY.%2BZhai%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-4876-8487" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y. Zhai</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">S. Wang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Beijing Neurosurgical Institute (J.B., S.Z., C.Z., Y. Zhai, S.W., M.L., C.L., Y. Zhang), Capital Medical University, Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BWang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wang%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BWang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4092-5596" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Wang</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">M. Li </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Beijing Neurosurgical Institute (J.B., S.Z., C.Z., Y. Zhai, S.W., M.L., C.L., Y. Zhang), Capital Medical University, Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BLi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Li%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BLi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-8382-1124" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Li</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">C. Li </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Beijing Neurosurgical Institute (J.B., S.Z., C.Z., Y. Zhai, S.W., M.L., C.L., Y. Zhang), Capital Medical University, Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BLi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Li%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BLi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-8468-8249" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Li</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">P. Zhao </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery (J.B., P.Z., S. Geng, S. Gui, Y. Zhang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>c</span>China National Clinical Research Center for Neurological Diseases (J.B., P.Z., S. Geng, S. Gui, Y. Zhang), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.%2BZhao%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zhao%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AP.%2BZhao%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-6216-3858" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for P. Zhao</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">S. Geng </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery (J.B., P.Z., S. Geng, S. Gui, Y. Zhang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>c</span>China National Clinical Research Center for Neurological Diseases (J.B., P.Z., S. Geng, S. Gui, Y. Zhang), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BGeng%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Geng%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BGeng%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6773-8777" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Geng</a></li></ul></div><div class="author-tooltip-10"><div class="author-tooltip-name">S. Gui </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery (J.B., P.Z., S. Geng, S. Gui, Y. Zhang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>c</span>China National Clinical Research Center for Neurological Diseases (J.B., P.Z., S. Geng, S. Gui, Y. Zhang), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BGui%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Gui%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BGui%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-3638-2018" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Gui</a></li></ul></div><div class="author-tooltip-11"><div class="author-tooltip-name">L. Jing </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>g</span>Department of Health Statistics (L.J.), Shanxi Medical University, Taiyuan, China.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=L.%2BJing%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Jing%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AL.%2BJing%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-7734-7016" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for L. Jing</a></li></ul></div><div class="author-tooltip-12"><div class="author-tooltip-name">Y. Zhang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery (J.B., P.Z., S. Geng, S. Gui, Y. Zhang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Beijing Neurosurgical Institute (J.B., S.Z., C.Z., Y. Zhai, S.W., M.L., C.L., Y. Zhang), Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>c</span>China National Clinical Research Center for Neurological Diseases (J.B., P.Z., S. Geng, S. Gui, Y. Zhang), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.%2BZhang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zhang%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AY.%2BZhang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-8583-2580" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y. Zhang</a></li></ul></div></div></div>  </div>

  
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      <div class="highwire-cite-title">MRI Signal Intensity and Electron Ultrastructure Classification Predict the Long-Term Outcome of Skull Base Chordomas</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Bai</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Shi</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Zhang</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Zhang</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Zhai</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Wang</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Li</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Li</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Zhao</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Geng</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Gui</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Jing</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Zhang</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2020, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">852-858; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6557 </span></div>
  
  
  
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      <div class="highwire-cite-title">MRI Signal Intensity and Electron Ultrastructure Classification Predict the Long-Term Outcome of Skull Base Chordomas</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Bai</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Shi</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Zhang</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Zhang</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Zhai</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Wang</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Li</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Li</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Zhao</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Geng</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Gui</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Jing</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Zhang</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2020, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">852-858; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6557 </span></div>
  
  
  
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