OBJECTIVE: Malignant spinal cord astrocytomas are rare tumors and their specific MR characteristics have not been previously described. We present a detailed MR analysis of four children with malignant astrocytoma. METHODS: A review of the clinical database at the Hospital for Sick Children, Toronto revealed four patients with histologically-verified malignant spinal cord astrocytomas (WHO Grade 3 or 4) with pre-operative MR available for retrospective review. RESULTS: There were three boys and one girl with a mean age at presentation of four years (range 7 months-12 years). Mean duration of symptoms prior to presentation was six weeks (range 3 days-5 months). Pre-operative MR analysis revealed that all tumors were located in the cervical or cervico-thoracic regions and expanded the cord over an average of 6.5 vertebral levels. The signal was usually hypointense on T1-weighted and hyperintense or mixed intensity on T2-weighted images. In the three cases where gadolinium was given, all demonstrated enhancement (one rim enhancement with a discrete border and two with inhomogeneous central enhancement). One tumor appeared to be exophytic, one had a significant cystic component, and none showed evidence of hemorrhage. Pre-operative leptomeningeal spread of tumor was documented in two of four cases and involved intracranial spread in both cases. CONCLUSIONS: There did not appear to be any specific MR characteristics to help differentiate a malignant astrocytoma from a low-grade tumor, except for the high rate of leptomeningeal spread at presentation. It is recommended that full neuraxis MR imaging be performed pre-operatively in children in whom a rapidly progressive clinical course suggests a malignant lesion. This will likely have a high positive yield and provide valuable information prior to surgical intervention.
OBJECTIVE:Malignant spinal cord astrocytomas are rare tumors and their specific MR characteristics have not been previously described. We present a detailed MR analysis of four children with malignant astrocytoma. METHODS: A review of the clinical database at the Hospital for Sick Children, Toronto revealed four patients with histologically-verified malignant spinal cord astrocytomas (WHO Grade 3 or 4) with pre-operative MR available for retrospective review. RESULTS: There were three boys and one girl with a mean age at presentation of four years (range 7 months-12 years). Mean duration of symptoms prior to presentation was six weeks (range 3 days-5 months). Pre-operative MR analysis revealed that all tumors were located in the cervical or cervico-thoracic regions and expanded the cord over an average of 6.5 vertebral levels. The signal was usually hypointense on T1-weighted and hyperintense or mixed intensity on T2-weighted images. In the three cases where gadolinium was given, all demonstrated enhancement (one rim enhancement with a discrete border and two with inhomogeneous central enhancement). One tumor appeared to be exophytic, one had a significant cystic component, and none showed evidence of hemorrhage. Pre-operative leptomeningeal spread of tumor was documented in two of four cases and involved intracranial spread in both cases. CONCLUSIONS: There did not appear to be any specific MR characteristics to help differentiate a malignant astrocytoma from a low-grade tumor, except for the high rate of leptomeningeal spread at presentation. It is recommended that full neuraxis MR imaging be performed pre-operatively in children in whom a rapidly progressive clinical course suggests a malignant lesion. This will likely have a high positive yield and provide valuable information prior to surgical intervention.
Authors: O Moske-Eick; C A Taschner; S Krauss; J Kirschner; V van Velthoven; C Rottenburger; J Rössler; M Prinz Journal: Clin Neuroradiol Date: 2010-06 Impact factor: 3.649
Authors: Albert P Wong; Nader S Dahdaleh; Richard G Fessler; Stephanie C Melkonian; Yimo Lin; Zachary A Smith; Sandi K Lam Journal: J Neurooncol Date: 2013-09-29 Impact factor: 4.130
Authors: Atilla Arslanoglu; Bayram Cirak; Alena Horska; James Okoh; Tarik Tihan; Leslie Aronson; Anthony M Avellino; Peter C Burger; David M Yousem Journal: AJNR Am J Neuroradiol Date: 2003-10 Impact factor: 3.825