Bartels Ute, Shroff Manohar, Sung Lillian, Dag-Ellams Ugo, Laperriere Normand, Rutka James, Bouffet Eric
Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.
Cancer. 2006 Sep 15;107(6):1340-7. doi: 10.1002/cncr.22129.
The purpose of the current study was to describe the usefulness of spinal magnetic resonance imaging (MRI) in children with medulloblastoma or primitive neuroectodermal tumor (PNET) of the posterior fossa.
Children consecutively diagnosed with medulloblastoma/PNET and followed in the Hospital for Sick Children/Toronto were identified. A homogenous cohort of children treated with craniospinal irradiation as part of their initial treatment was considered. Contrast-enhanced spinal MRIs done concomitantly with cranial MRIs (doublets) were reviewed. Recurrence was defined as any new abnormal lesion (in the brain or in the spine) in symptomatic or asymptomatic patients. Doublets after the first recurrence were excluded in the final analysis. The utility of a spinal MRI in the presence of a negative cranial MRI was assessed.
In all, 73 patients (21 females and 52 males; median age, 6.6 years, median follow-up time, 4.3 years) had at least 1 evaluable doublet during the follow-up period. Since concomitant cranial and spinal MRI was introduced as the standard evaluation for medulloblastoma/PNET in 1991, 286 doublets were evaluable. Fourteen spinal MRIs and 25 cranial MRIs showed new nodular or leptomeningeal lesions. In 2 patients, repeat MRIs ruled out recurrence (false-positive). All confirmed spinal recurrences were associated with intracranial recurrence. Of 261 doublets with negative cranial MRI, no new lesion was identified on spinal MRI.
An absence of progression on cranial MRI is highly predictive of absence of progression on spinal MRI. There is little evidence that surveillance spinal MRI (in children who underwent craniospinal radiation as part of their initial treatment) improves the detection of recurrences in children with medulloblastoma.
本研究的目的是描述脊髓磁共振成像（MRI）在患有髓母细胞瘤或后颅窝原始神经外胚层肿瘤（PNET）的儿童中的作用。
确定在多伦多病童医院连续诊断为髓母细胞瘤/PNET并接受随访的儿童。考虑将接受颅脊髓照射作为初始治疗一部分的同质儿童队列。回顾了与头颅MRI同时进行的增强脊髓MRI（双联检查）。复发定义为有症状或无症状患者出现任何新的异常病变（在脑或脊髓中）。最终分析中排除首次复发后的双联检查。评估头颅MRI阴性时脊髓MRI的作用。
总共73例患者（21例女性和52例男性；中位年龄6.6岁，中位随访时间4.3年）在随访期间至少有1次可评估的双联检查。自1991年将同时进行头颅和脊髓MRI作为髓母细胞瘤/PNET的标准评估以来，有286次双联检查可评估。14次脊髓MRI和25次头颅MRI显示出新的结节状或软脑膜病变。2例患者经重复MRI排除复发（假阳性）。所有确诊的脊髓复发均与颅内复发相关。在261次头颅MRI阴性的双联检查中，脊髓MRI未发现新病变。
头颅MRI无进展高度预示脊髓MRI无进展。几乎没有证据表明（作为初始治疗一部分接受颅脊髓放疗的儿童）监测脊髓MRI能改善髓母细胞瘤患儿复发的检测。
