Abstract
Identifying drop metastases to the spine from pediatric brain tumors is crucial to treatment and prognosis. MRI is currently the gold standard for identifying drop metastases, more sensitive than CSF cytology, but imaging is not uncommonly inconclusive. Although diffusion‐weighted imaging (DWI) of the brain is very useful in the evaluation of hypercellular tumors, DWI of the spine has not been clinically useful in children because of susceptibility artifacts and lack of spatial resolution. A new technique, readout-segmented echo planar imaging (EPI), has improved these images, allowing for identification of hypercellular drop metastases. We report a case that illustrates the utility of spine DWI in the detection of metastatic disease in children with primary central nervous system (CNS) tumors. This case suggests that DWI of the spine with readout-segmented EPI should be included in the evaluation for drop metastases.
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Ketonen L, Hiwatashi A, Sidhu R (2005) Pediatric brain and spine: an atlas of MRI and spectroscopy. Springer, Berlin, p 167
Moffat BA, Chenevert TL, Lawrence TS et al (2005) Functional diffusion map: a noninvasive MRI biomarker for early stratification of clinical brain tumor response. Proc Natl Acad Sci USA 102:5524–5529
Jaremko JL, Jans LB, Coleman LT et al (2010) Value and limitations of diffusion-weighted imaging in grading and diagnosis of pediatric posterior fossa tumors. AJNR 31:1613–1616
Tortori-Donati P, Rossi A (2005) Pediatric neuroradiology head neck and spine. Springer, Berlin, pp 1620–1621, 1073–1091
Harrison SK, Ditchfield MR, Waters K (1998) Correlation of MRI and CSF cytology in the diagnosis of medulloblastoma spinal metastases. Pediatr Radiol 28:571–574
Saritas EU, Cunningham CH, Lee JH et al (2008) DWI of the spinal cord with reduced FOV single-shot EPI. Magn Reson Med 60:468–473
Tanenbaum LN (2011) Diffusion imaging of the spine. Appl Radiol 4:9–15
Porter DA, Heidemann RM (2009) High resolution diffusion-weighted imaging using readout-segmented echo-planar imaging, parallel imaging and a two-dimensional navigator-based reacquisition. Magn Reson Med 62:468–475
Acknowledgement
We are grateful to Thorsten Feiweier of Siemens Healthcare, Erlangen, Germany, for providing the diffusion-encoding module used in this study.
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Hayes, L.L., Jones, R.A., Palasis, S. et al. Drop metastases to the pediatric spine revealed with diffusion-weighted MR imaging. Pediatr Radiol 42, 1009–1013 (2012). https://doi.org/10.1007/s00247-011-2295-9
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DOI: https://doi.org/10.1007/s00247-011-2295-9