Abstract
Though many pediatric brain tumors are diagnosed by head computed tomography (CT) performed for emergent indications such as vomiting, ataxia, or altered mental status, CT, even with intravenous contrast, is insufficient for tumor characterization or metastasis detection. CT also carries a low risk of radiation-induced secondary cancers; this risk increases with cumulative dose without a threshold effect (Miglioretti et al. 2013). Furthermore, the eye lens, which may be exposed to radiation with head CT, is sensitive to radiation-induced cataract formation at doses as low as 0.5 Sv (Fish et al. 2011). Magnetic resonance imaging (MRI) offers far superior tissue contrast without radiation, and is therefore the gold-standard for diagnosis of central nervous system (CNS) tumors and metastases. As technology advances, MRI becomes increasingly important in diagnosing metastasis, since it detects leptomeningeal metastatic disease in up to 50% of those with false-negative cerebrospinal fluid (CSF) examination and better correlates with survival than CSF results (Maroldi et al. 2005; Terterov et al. 2010; Pang et al. 2008). MRI is particularly important in children with ependymomas, in whom CSF may be negative despite the presence of extensive leptomeningeal involvement (Poltinnikov and Merchant 2006). It is therefore critical to optimize imaging for initial diagnosis and for detection of postsurgical resection residual tumor and leptomeningeal metastasis.
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Harreld, J.H. (2018). Imaging Children with CNS Tumors. In: Gajjar, A., Reaman, G., Racadio, J., Smith, F. (eds) Brain Tumors in Children. Springer, Cham. https://doi.org/10.1007/978-3-319-43205-2_4
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