Journal of Neuro-Oncology

, Volume 116, Issue 3, pp 617–623 | Cite as

Surveillance imaging in children with malignant CNS tumors: low yield of spine MRI

  • Sébastien PerreaultEmail author
  • Robert M. Lober
  • Anne-Sophie Carret
  • Guohua Zhang
  • Linda Hershon
  • Jean-Claude Décarie
  • Hannes Vogel
  • Kristen W. Yeom
  • Paul G. Fisher
  • Sonia Partap
Clinical Study


Magnetic resonance imaging (MRI) is routinely obtained in patients with central nervous system (CNS) tumors, but few studies have been conducted to evaluate this practice. We assessed the benefits of surveillance MRI and more specifically spine MRI in a contemporary cohort. We evaluated MRI results of children diagnosed with CNS tumors from January 2000 to December 2011. Children with at least one surveillance MRI following the diagnosis of medulloblastoma (MB), atypical teratoid rhabdoid tumor (ATRT), pineoblastoma (PB), supratentorial primitive neuroectodermal tumor, supratentorial high-grade glioma (World Health Organization grade III–IV), CNS germ cell tumors or ependymoma were included. A total of 2,707 brain and 1,280 spine MRI scans were obtained in 258 patients. 97 % of all relapses occurred in the brain and 3 % were isolated to the spine. Relapse was identified in 226 (8 %) brain and 48 (4 %) spine MRI scans. The overall rate of detecting isolated spinal relapse was 9/1,000 and 7/1,000 for MB patients. MRI performed for PB showed the highest rate for detecting isolated spinal recurrence with 49/1,000. No initial isolated spinal relapse was identified in patients with glioma, supratentorial primitive neuroectodermal tumor and ATRT. Isolated spinal recurrences are infrequent in children with malignant CNS tumors and the yield of spine MRI is very low. Tailoring surveillance spine MRI to patients with higher spinal relapse risk such as PB, MB with metastatic disease and within 3 years of diagnosis could improve allocation of resources without compromising patient care.


MRI imaging Brain neoplasms Child Childhood medulloblastoma Pineoblastoma Primitive neuroectodermal tumor 



Sébastien Perreault is a Beverly and Bernard Wolfe Pediatric Neuro-Oncology fellow at Lucile Packard Children’s Hospital at Stanford University. He received Grants from Justine Lacoste Fundation and Fonds de Recherche en Santé du Québec (FRSQ) (Bourses de formation en recherche post-diplôme professionnel/Fellowship).

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

11060_2013_1347_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 12 kb)


  1. 1.
    Bartels U, Shroff M, Sung L et al (2006) Role of spinal MRI in the follow-up of children treated for medulloblastoma. Cancer 107:1340–1347PubMedCrossRefGoogle Scholar
  2. 2.
    Torres CF, Rebsamen S, Silber JH et al (1994) Surveillance scanning of children with medulloblastoma. N Engl J Med 330:892–895PubMedCrossRefGoogle Scholar
  3. 3.
    Yalcin B, Buyukpamukcu M, Akalan N et al (2002) Value of surveillance imaging in the management of medulloblastoma. Med Pediatr Oncol 38:91–97PubMedCrossRefGoogle Scholar
  4. 4.
    Minn AY, Pollock BH, Garzarella L et al (2001) Surveillance neuroimaging to detect relapse in childhood brain tumors: a Pediatric Oncology Group study. J Clin Oncol 19:4135–4140PubMedGoogle Scholar
  5. 5.
    Steinbok P, Hentschel S, Cochrane DD, Kestle JR (1996) Value of postoperative surveillance imaging in the management of children with some common brain tumors. J Neurosurg 84:726–732PubMedCrossRefGoogle Scholar
  6. 6.
    Saunders DE, Hayward RD, Phipps KP et al (2003) Surveillance neuroimaging of intracranial medulloblastoma in children: how effective, how often, and for how long? J Neurosurg 99:280–286PubMedCrossRefGoogle Scholar
  7. 7.
    Seute T, Leffers P, ten Velde GP, Twijnstra A (2008) Detection of brain metastases from small cell lung cancer: consequences of changing imaging techniques (CT versus MRI). Cancer 112:1827–1834PubMedCrossRefGoogle Scholar
  8. 8.
    Kovanlikaya A, Karabay N, Çakmakçi H et al (2003) Surveillance imaging and cost effectivity in pediatric brain tumors. Eur J Radiol 47:188–192PubMedCrossRefGoogle Scholar
  9. 9.
    Brand WN, Schneider PA, Tokars RP (1987) Long-term results of a pilot study of low dose cranial-spinal irradiation for cerebellar medulloblastoma. Int J Radiat Oncol Biol Phys 13:1641–1645PubMedCrossRefGoogle Scholar
  10. 10.
    Yao MS, Mehta MP, Boyett JM et al (1997) The effect of M-stage on patterns of failure in posterior fossa primitive neuroectodermal tumors treated on CCG-921: a phase III study in a high-risk patient population. Int J Radiat Oncol Biol Phys 38:469–475PubMedCrossRefGoogle Scholar
  11. 11.
    Uehara K, Sasayama T, Miyawaki D et al (2012) Patterns of failure after multimodal treatments for high-grade glioma: effectiveness of MIB-1 labeling index. Radiat Oncol 7:104PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Sherriff J, Tamangani J, Senthil L et al (2013) Patterns of relapse in glioblastoma multiforme following concomitant chemoradiotherapy with temozolomide. Br J Radiol 86:20120414PubMedCrossRefGoogle Scholar
  13. 13.
    Heideman RL, Kuttesch J Jr, Gajjar AJ et al (1997) Supratentorial malignant gliomas in childhood: a single institution perspective. Cancer 80:497–504PubMedCrossRefGoogle Scholar
  14. 14.
    Vaidya SJ, Hargrave D, Saran F et al (2007) Pattern of recurrence in paediatric malignant glioma: an institutional experience. J Neurooncol 83:279–284PubMedCrossRefGoogle Scholar
  15. 15.
    Grabb PA, Albright AL, Pang D (1992) Dissemination of supratentorial malignant gliomas via the cerebrospinal fluid in children. Neurosurgery 30:64–71PubMedCrossRefGoogle Scholar
  16. 16.
    Hong TS, Mehta MP, Boyett JM et al (2004) Patterns of failure in supratentorial primitive neuroectodermal tumors treated in Children’s Cancer Group Study 921, a phase III combined modality study. Int J Radiat Oncol Biol Phys 60:204–213PubMedCrossRefGoogle Scholar
  17. 17.
    Timmermann B, Kortmann RD, Kuhl J et al (2002) Role of radiotherapy in the treatment of supratentorial primitive neuroectodermal tumors in childhood: results of the prospective German brain tumor trials HIT 88/89 and 91. J Clin Oncol 20:842–849PubMedCrossRefGoogle Scholar
  18. 18.
    Jakacki RI, Zeltzer PM, Boyett JM et al (1995) Survival and prognostic factors following radiation and/or chemotherapy for primitive neuroectodermal tumors of the pineal region in infants and children: a report of the Childrens Cancer Group. J Clin Oncol 13:1377–1383PubMedGoogle Scholar
  19. 19.
    Friedrich C, von Bueren AO, von Hoff K et al (2013) Treatment of young children with CNS-primitive neuroectodermal tumors/pineoblastomas in the prospective multicenter trial HIT 2000 using different chemotherapy regimens and radiotherapy. Neuro Oncol 15:224–234PubMedCrossRefGoogle Scholar
  20. 20.
    Chi SN, Zimmerman MA, Yao X et al (2009) Intensive multimodality treatment for children with newly diagnosed CNS atypical teratoid rhabdoid tumor. J Clin Oncol 27:385–389PubMedCrossRefGoogle Scholar
  21. 21.
    Athale UH, Duckworth J, Odame I, Barr R (2009) Childhood atypical teratoid rhabdoid tumor of the central nervous system: a meta-analysis of observational studies. J Pediatr Hematol Oncol 31:651–663PubMedCrossRefGoogle Scholar
  22. 22.
    Messahel B, Ashley S, Saran F et al (2009) Relapsed intracranial ependymoma in children in the UK: patterns of relapse, survival and therapeutic outcome. Eur J Cancer 45:1815–1823PubMedCrossRefGoogle Scholar
  23. 23.
    Alapetite C, Brisse H, Patte C et al (2010) Pattern of relapse and outcome of non-metastatic germinoma patients treated with chemotherapy and limited field radiation: the SFOP experience. Neuro Oncol 12:1318–1325PubMedCentralPubMedGoogle Scholar
  24. 24.
    Kamoshima Y, Sawamura Y, Ikeda J et al (2008) Late recurrence and salvage therapy of CNS germinomas. J Neurooncol 90:205–211PubMedCrossRefGoogle Scholar
  25. 25.
    Edwards AD, Arthurs OJ (2011) Paediatric MRI under sedation: is it necessary? What is the evidence for the alternatives? Pediatr Radiol 41:1353–1364PubMedCrossRefGoogle Scholar
  26. 26.
    Mellon RD, Simone AF, Rappaport BA (2007) Use of anesthetic agents in neonates and young children. Anesth Analg 104:509–520PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sébastien Perreault
    • 1
    • 7
    Email author
  • Robert M. Lober
    • 2
  • Anne-Sophie Carret
    • 8
  • Guohua Zhang
    • 8
  • Linda Hershon
    • 8
  • Jean-Claude Décarie
    • 9
  • Hannes Vogel
    • 3
  • Kristen W. Yeom
    • 4
  • Paul G. Fisher
    • 1
    • 2
    • 5
    • 6
  • Sonia Partap
    • 1
  1. 1.Division of Child Neurology, Department of Neurology, Lucile Packard Children’s Hospital at StanfordStanford UniversityPalo AltoUSA
  2. 2.Department of Neurosurgery, Lucile Packard Children’s Hospital at StanfordStanford UniversityPalo AltoUSA
  3. 3.Department of Pathology, Lucile Packard Children’s Hospital at StanfordStanford UniversityPalo AltoUSA
  4. 4.Department of Radiology, Lucile Packard Children’s Hospital at StanfordStanford UniversityPalo AltoUSA
  5. 5.Department of Pediatrics, Lucile Packard Children’s Hospital at StanfordStanford UniversityPalo AltoUSA
  6. 6.Department of Human Biology, Lucile Packard Children’s Hospital at StanfordStanford UniversityPalo AltoUSA
  7. 7.Division of NeurologyCHU Sainte-JustineMontrealCanada
  8. 8.Division of Hematology-OncologyCHU Sainte-JustineMontrealCanada
  9. 9.Department of RadiologyCHU Sainte-JustineMontrealCanada

Personalised recommendations