Julie H Harreld1,2,3, Ayaz Khan4, Jacqueline Angel1, Yuanyuan Han5, Yimei Li5, Amar Gajjar6, Zoltan Patay1. 1. Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN, 38015, USA. 2. Departmentof Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. 3. Geisel School of Medicine at Dartmouth College, Hanover, NH, USA. 4. Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN, 38015, USA. ayaz.khan@stjude.org. 5. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA. 6. Department of Neuro-Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
Abstract
PURPOSE: Accurate detection of leptomeningeal metastasis (LM) is critical for risk stratification and treatment of pediatric brain tumors. Poor-quality staging MRI has been associated with decreased survival in this population, but technical factors differentiating good from poor quality screening MRIs remain undefined. To test the hypothesis that key technical factors are associated with accurate MRI diagnosis of leptomeningeal metastasis in children with leptomeningeal seeding brain tumors. METHODS: MRIs acquired at outside facilities and repeated in our institution within 35 days for 75 children with leptomeningeal seeding tumors were assessed for slice thickness and gap; use of T2 FLAIR + Contrast, acquisition plane of 3DT1WI + Contrast (brain); axial T1 + Contrast sequence, and use of pre-contrast T1 images (spine). Reported findings were recorded as positive, negative, or equivocal for LM and classified as true positive (TP; unequivocal metastasis), false negative (FN; not reported), false positive (FP; resolved without treatment), or true negative. Wilcoxon signed-rank and Fisher's exact test were used to assess technical differences between TP and FN MRIs. RESULTS: Rate of LM detection was greater with smaller interslice gap in brain (P = 0.003) and spine (P = 0.002); use of T2 FLAIR + Contrast (P = 0.005) and sagittal plane for 3DT1WI + Contrast (P = 0.028) in brain; and use of alternatives to axial TSE/FSE in spine (P = 0.048). Slice thickness was not significant. Pre-contrast T1WI did not contribute to LM diagnosis in spine. CONCLUSION: Using post-contrast T2 FLAIR and sagittal 3DT1 in brain, small/no interslice gap, and avoiding TSE/FSE axials in spine may facilitate leptomeningeal metastasis detection in children with brain tumors.
PURPOSE: Accurate detection of leptomeningeal metastasis (LM) is critical for risk stratification and treatment of pediatric brain tumors. Poor-quality staging MRI has been associated with decreased survival in this population, but technical factors differentiating good from poor quality screening MRIs remain undefined. To test the hypothesis that key technical factors are associated with accurate MRI diagnosis of leptomeningeal metastasis in children with leptomeningeal seeding brain tumors. METHODS: MRIs acquired at outside facilities and repeated in our institution within 35 days for 75 children with leptomeningeal seeding tumors were assessed for slice thickness and gap; use of T2 FLAIR + Contrast, acquisition plane of 3DT1WI + Contrast (brain); axial T1 + Contrast sequence, and use of pre-contrast T1 images (spine). Reported findings were recorded as positive, negative, or equivocal for LM and classified as true positive (TP; unequivocal metastasis), false negative (FN; not reported), false positive (FP; resolved without treatment), or true negative. Wilcoxon signed-rank and Fisher's exact test were used to assess technical differences between TP and FN MRIs. RESULTS: Rate of LM detection was greater with smaller interslice gap in brain (P = 0.003) and spine (P = 0.002); use of T2 FLAIR + Contrast (P = 0.005) and sagittal plane for 3DT1WI + Contrast (P = 0.028) in brain; and use of alternatives to axial TSE/FSE in spine (P = 0.048). Slice thickness was not significant. Pre-contrast T1WI did not contribute to LM diagnosis in spine. CONCLUSION: Using post-contrast T2 FLAIR and sagittal 3DT1 in brain, small/no interslice gap, and avoiding TSE/FSE axials in spine may facilitate leptomeningeal metastasis detection in children with brain tumors.
Authors: Nil Ercan; Serap Gultekin; Halil Celik; Turgut E Tali; Yusuf A Oner; Gonca Erbas Journal: AJNR Am J Neuroradiol Date: 2004-05 Impact factor: 3.825
Authors: Paul D Griffiths; Stuart C Coley; Charles A J Romanowski; Tim Hodgson; Iain D Wilkinson Journal: AJNR Am J Neuroradiol Date: 2003-04 Impact factor: 3.825
Authors: Mariam S Aboian; Cassie N Kline; Yi Li; David A Solomon; Erin Felton; Anu Banerjee; Steve E Braunstein; Sabine Mueller; William P Dillon; Soonmee Cha Journal: Neurooncol Pract Date: 2018-02-17