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

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Abstract

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.

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Acknowledgments

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.

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Authors and Affiliations

  1. Division of Child Neurology, Department of Neurology, Lucile Packard Children’s Hospital at Stanford, Stanford University, 750 Welch Road, Suite 317, Palo Alto, CA, 94304, USA

    Sébastien Perreault, Paul G. Fisher & Sonia Partap

  2. Department of Neurosurgery, Lucile Packard Children’s Hospital at Stanford, Stanford University, Palo Alto, CA, 94304, USA

    Robert M. Lober & Paul G. Fisher

  3. Department of Pathology, Lucile Packard Children’s Hospital at Stanford, Stanford University, Palo Alto, CA, 94304, USA

    Hannes Vogel

  4. Department of Radiology, Lucile Packard Children’s Hospital at Stanford, Stanford University, Palo Alto, CA, 94304, USA

    Kristen W. Yeom

  5. Department of Pediatrics, Lucile Packard Children’s Hospital at Stanford, Stanford University, Palo Alto, CA, 94304, USA

    Paul G. Fisher

  6. Department of Human Biology, Lucile Packard Children’s Hospital at Stanford, Stanford University, Palo Alto, CA, 94304, USA

    Paul G. Fisher

  7. Division of Neurology, CHU Sainte-Justine, Montreal, QC, H3T 1C5, Canada

    Sébastien Perreault

  8. Division of Hematology-Oncology, CHU Sainte-Justine, Montreal, QC, H3T 1C5, Canada

    Anne-Sophie Carret, Guohua Zhang & Linda Hershon

  9. Department of Radiology, CHU Sainte-Justine, Montreal, QC, H3T 1C5, Canada

    Jean-Claude Décarie

Authors
  1. Sébastien Perreault
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  2. Robert M. Lober
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  3. Anne-Sophie Carret
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  4. Guohua Zhang
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  5. Linda Hershon
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  6. Jean-Claude Décarie
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  7. Hannes Vogel
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  8. Kristen W. Yeom
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  9. Paul G. Fisher
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  10. Sonia Partap
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Correspondence to Sébastien Perreault.

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Perreault, S., Lober, R.M., Carret, AS. et al. Surveillance imaging in children with malignant CNS tumors: low yield of spine MRI. J Neurooncol 116, 617–623 (2014). https://doi.org/10.1007/s11060-013-1347-4

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  • DOI: https://doi.org/10.1007/s11060-013-1347-4

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