Skip to main content

Advertisement

SpringerLink
Log in

MRI sequences and interslice gap influence leptomeningeal metastasis detection in children with brain tumors

  • Paediatric Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Code availability (software application or custom code)

Data were reviewed on PACS system no other software (commercial or in-house) was used.

References

  1. Maroldi R, Ambrosi C, Farina D (2005) Metastatic disease of the brain: extra-axial metastases (skull, dura, leptomeningeal) and tumour spread. Eur Radiol 15(3):617–626

    Article  Google Scholar 

  2. Terterov S et al (2010) Evaluation of intracranial cerebrospinal fluid cytology in staging pediatric medulloblastomas, supratentorial primitive neuroectodermal tumors, and ependymomas. J Neurosurg Pediatr 6(2):131–136

    Article  Google Scholar 

  3. Pang J, Banerjee A, Tihan T (2008) The value of tandem CSF/MRI evaluation for predicting disseminated disease in childhood central nervous system neoplasms. J Neurooncol 87(1):97–102

    Article  Google Scholar 

  4. Packer RJ et al (2006) Phase III study of craniospinal radiation therapy followed by adjuvant chemotherapy for newly diagnosed average-risk medulloblastoma. J Clin Oncol 24(25):4202–4208

    Article  CAS  Google Scholar 

  5. Fukuoka H et al (2010) Comparison of the added value of contrast-enhanced 3D fluid-attenuated inversion recovery and magnetization-prepared rapid acquisition of gradient echo sequences in relation to conventional postcontrast T1-weighted images for the evaluation of leptomeningeal diseases at 3T. AJNR Am J Neuroradiol 31(5):868–873

    Article  CAS  Google Scholar 

  6. Griffiths PD et al (2003) Contrast-enhanced fluid-attenuated inversion recovery imaging for leptomeningeal disease in children. AJNR Am J Neuroradiol 24(4):719–723

    PubMed  PubMed Central  Google Scholar 

  7. Kremer S et al (2006) Accuracy of delayed post-contrast FLAIR MR imaging for the diagnosis of leptomeningeal infectious or tumoral diseases. J Neuroradiol 33(5):285–291

    Article  CAS  Google Scholar 

  8. Mathews VP et al (1999) Brain: gadolinium-enhanced fast fluid-attenuated inversion-recovery MR imaging. Radiology 211(1):257–263

    Article  CAS  Google Scholar 

  9. Aboian MS et al (2018) Early detection of recurrent medulloblastoma: the critical role of diffusion-weighted imaging. Neurooncol Pract 5(4):234–240

    PubMed  PubMed Central  Google Scholar 

  10. Cho HH, et al. (2016) Free-breathing radial 3D fat-suppressed T1-Weighted gradient-echo sequence for contrast-enhanced pediatric spinal imaging: comparison with T1-weighted turbo spin-echo sequence. AJR Am J Roentgenol 1–6

  11. Harreld JH (2018) Comment on “Response assessment in medulloblastoma and leptomeningeal seeding tumors: recommendations from the Response Assessment in Pediatric Neuro-Oncology Committee.” Neuro Oncol 20(1):143–144

    Article  Google Scholar 

  12. Kralik SF et al (2017) Radiological diagnosis of drop metastases from paediatric brain tumours using combination of 2D and 3D MRI sequences. Clin Radiol 72(10):902.e13-902.e19

    Article  CAS  Google Scholar 

  13. Larsen DW, Teitelbaum GP, Norman D (1996) Cerebrospinal fluid flow artifact. A possible pitfall on fast-spin-echo MR imaging of the spine simulating intradural pathology. Clin Imaging 20(2):140–2

    Article  CAS  Google Scholar 

  14. Lisanti C et al (2007) Normal MRI appearance and motion-related phenomena of CSF. AJR Am J Roentgenol 188(3):716–725

    Article  Google Scholar 

  15. Shapiro MD (2006) MR imaging of the spine at 3T. Magn Reson Imaging Clin N Am 14(1):97–108

    Article  Google Scholar 

  16. McRobbie DWMEA, Graves MJ, Prince MR (2007) MRI from Picture to Proton (2nd Ed.). Cambridge University Press

  17. Ercan N et al (2004) Diagnostic value of contrast-enhanced fluid-attenuated inversion recovery MR imaging of intracranial metastases. AJNR Am J Neuroradiol 25(5):761–765

    PubMed  PubMed Central  Google Scholar 

  18. Harreld JH et al (2014) Elevated cerebral blood volume contributes to increased FLAIR signal in the cerebral sulci of propofol-sedated children. AJNR Am J Neuroradiol 35(8):1574–1579

    Article  CAS  Google Scholar 

  19. Mori N et al (2009) The leptomeningeal “ivy sign” on fluid-attenuated inversion recovery MR imaging in Moyamoya disease: a sign of decreased cerebral vascular reserve? AJNR Am J Neuroradiol 30(5):930–935

    Article  CAS  Google Scholar 

  20. Kawashima M et al (2009) Unilateral hemispheric proliferation of ivy sign on fluid-attenuated inversion recovery images in moyamoya disease correlates highly with ipsilateral hemispheric decrease of cerebrovascular reserve. AJNR Am J Neuroradiol 30(9):1709–1716

    Article  CAS  Google Scholar 

  21. Elliott JM et al (2011) The pearls and pitfalls of magnetic resonance imaging for the spine. J Orthop Sports Phys Ther 41(11):848–860

    Article  Google Scholar 

  22. McRobbie DW, Moore EA, Graves MJ (2017) MRI from picture to proton. Third edition. Cambridge: University Printing House, Cambridge University Press. xix, 382 pages

  23. Warren KE, et al (2017) Response assessment in medulloblastoma and leptomeningeal seeding tumors: recommendations from the Response Assessment in Pediatric Neuro-Oncology Committee. Neuro Oncol

  24. Ganesan K, Bydder GM (2014) A prospective comparison study of fast T1 weighted fluid attenuation inversion recovery and T1 weighted turbo spin echo sequence at 3 T in degenerative disease of the cervical spine. Br J Radiol 87(1041):20140091

    Article  CAS  Google Scholar 

  25. Lavdas E et al (2014) Evaluation of fat saturation and contrast enhancement on T1-weighted FLAIR sequence of the spine at 3.0 T. Clin Imaging 38(4):428–33

    Article  Google Scholar 

  26. Lavdas E et al (2010) Comparison of T1-weighted fast spin-echo and T1-weighted fluid-attenuated inversion recovery images of the lumbar spine at 3.0 Tesla. Acta Radiol 51(3):290–5

    Article  Google Scholar 

  27. Shah KB et al (2011) Comparison of gadolinium-enhanced fat-saturated T1-weighted FLAIR and fast spin-echo MRI of the spine at 3 T for evaluation of extradural lesions. AJR Am J Roentgenol 197(3):697–703

    Article  Google Scholar 

  28. Buch K et al (2018) Balanced Steady-state free precession sequence (CISS/FIESTA/3D driven equilibrium radiofrequency reset pulse) increases the diagnostic yield for spinal drop metastases in children with brain tumors. AJNR Am J Neuroradiol 39(7):1355–1361

    Article  CAS  Google Scholar 

  29. Hayes LL et al (2012) Drop metastases to the pediatric spine revealed with diffusion-weighted MR imaging. Pediatr Radiol 42(8):1009–1013

    Article  Google Scholar 

Download references

Acknowledgements

The authors wish to thank Bogdan Mitrea for assistance with data collection.

Funding

Supported in part by Grant No. CA21765 from the National Cancer Institute and by the American Lebanese and Syrian Associated Charities.

Author information

Authors and Affiliations

  1. Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN, 38015, USA

    Julie H. Harreld, Ayaz Khan, Jacqueline Angel & Zoltan Patay

  2. Departmentof Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Julie H. Harreld

  3. Geisel School of Medicine at Dartmouth College, Hanover, NH, USA

    Julie H. Harreld

  4. Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Yuanyuan Han & Yimei Li

  5. Department of Neuro-Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Amar Gajjar

Authors
  1. Julie H. Harreld
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ayaz Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jacqueline Angel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuanyuan Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yimei Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Amar Gajjar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zoltan Patay
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Provided in separate document file.

Corresponding author

Correspondence to Ayaz Khan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

This study was performed with IRB approval and waiver of consent.

Consent for publication: not applicable

Our paper does not include any individual’s data in any form, so we do not need consent for publication.

Data access statement

The data that support the findings in this study are available upon reasonable request from the corresponding author (AK). The data are not publicly available due to privacy concerns.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This work was previously presented at the 2018 meeting of The Society for Pediatric Radiology in Nashville, TN.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 25.8 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Harreld, J.H., Khan, A., Angel, J. et al. MRI sequences and interslice gap influence leptomeningeal metastasis detection in children with brain tumors. Neuroradiology 64, 1447–1456 (2022). https://doi.org/10.1007/s00234-022-02928-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-022-02928-7

Keywords

Search

Navigation