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Detection of cerebrospinal fluid metastasis: CT myelography or MR?
R Heinz1, D Wiener, H Friedman
1Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
Purpose:
To determine the sensitivity of contrast MR versus myelography followed by CT in the detection of cerebrospinal fluid metastases in children with primary central nervous system tumors.
Methods:
Thirty-three patients who had primary central nervous system malignancies had spinal MR with gadolinium within 2 weeks of a myelogram followed by CT. MR technique included T1-weighted image sequences of the entire spine with and without gadolinium. CT scans were routinely performed at T-12 to L-2, L-4 to S-1, and foramen magnum to C-2. All studies were reviewed blindly; the number, character, and location of all metastases was recorded and the results of the two studies compared. Cerebrospinal fluid cytologic findings were recorded for each patient, and compared with the results of the imaging studies.
Results:
Seven of the 33 patients had metastases detected; metastases were seen on both MR and myelography followed by CT. However, MR showed 24 lesions and myelography followed by CT showed only 15. When a lesion was seen on both MR and myelography followed by CT, the MR was usually more convincing. Superficial lesions seen on MR sometimes would be missed on myelography followed by CT. Both MR and myelography followed by CT were quite sensitive in the detection of small lesions (2 to 3 mm) when present on spinal nerve roots. Whereas MR showed multiple lesions not seen on myelography followed by CT, CT failed to show any metastases not seen on MR. Imaging studies showed metastases in 3 patients who had normal cytologic findings.
Conclusions:
MR shows significantly more cerebrospinal fluid metastases than myelography followed by CT.
Insights
Magnetic resonance imaging (MRI) detects more cerebrospinal fluid metastases in children with central nervous system tumors than myelography with CT scans. MRI offers a more sensitive imaging approach for detecting these metastases.
Area of Science:
- Pediatric Oncology
- Neuroradiology
- Neuro-oncology
Background:
- Accurate detection of cerebrospinal fluid (CSF) metastases is crucial for staging and treatment planning in pediatric central nervous system (CNS) tumors.
- Traditional imaging modalities like myelography followed by CT have limitations in visualizing disseminated tumor cells within the CSF.
Purpose of the Study:
- To compare the sensitivity of contrast-enhanced MRI with myelography followed by CT in detecting CSF metastases in pediatric CNS malignancies.
- To evaluate the diagnostic performance of each imaging technique for leptomeningeal carcinomatosis.
Main Methods:
- A cohort of 33 children with primary CNS malignancies underwent both spinal MRI with gadolinium and myelography followed by CT within a two-week interval.
- Both imaging studies were independently reviewed by blinded readers to identify and characterize CSF metastases.
- Results were correlated with CSF cytology findings.
Main Results:
- Contrast-enhanced MRI identified more metastatic lesions (24) compared to myelography followed by CT (15) across the seven patients with confirmed metastases.
- MRI provided more convincing visualization of lesions, particularly superficial ones, and detected multiple lesions not seen on CT.
- Both methods were sensitive for small lesions (2-3 mm) on nerve roots, but CT did not identify any lesions missed by MRI.
Conclusions:
- Contrast-enhanced MRI demonstrates superior sensitivity in detecting cerebrospinal fluid metastases in children with primary CNS tumors compared to myelography followed by CT.
- MRI is a more effective imaging modality for the comprehensive evaluation of leptomeningeal spread in pediatric neuro-oncology patients.
Related Concept Videos
01:24Magnetic Resonance Imaging
01:14Imaging Studies I: CT and MRI
Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...