Postoperative Evaluation for Disseminated Medulloblastoma Involving the Spine: Contrast-enhanced MR Findings, CSF Cytologic Analysis, Timing of Disease Occurrence, and Patient Outcomes
Steven P. Meyers
,a,
Sarah L. Wildenhaina,
Ja-Kwei Changa,
Eric C. Bourekasa,
Paul F. Beattiea,
David N. Koronesa,
Denise Davisa,
Ian F. Pollacka and
Robert A. Zimmermana
a From the Departments of Radiology (S.P.M.), Orthopaedics (P.F.B.), and Pediatrics (D.N.K.), University of Rochester School of Medicine, Strong Memorial Hospital, Rochester, NY; the Departments of Radiology (D.D.) and Pediatric Neurosurgery (I.F.P.), University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA; the Department of Radiology (J-K.C.), SUNY Syracuse School of Medicine, Syracuse, NY; the Department of Radiology (E.C.B.), Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Cleveland, OH; and the Department of Radiology (R.A.Z.), Children's Hospital of Philadelphia, Philadelphia, PA.
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FIG 1. MR images of 26-year-old man with disseminated medulloblastoma, obtained 6 years after surgery and 3 years after biopsy-proven metastatic skeletal disease.
A, Sagittal (600/9 [TR/TE]) MR image with fat suppression shows thin linear contrast enhancement along the pial surface of the spinal cord (arrows). Multiple enhancing skeletal metastases are also present in multiple vertebral bodies. CSF cytologic analysis obtained within 13 days of MR imaging was positive for tumor cells.
B, Sagittal (600/9) MR images with fat suppression, obtained 2 months after A, shows progression of disseminated disease, with enhancing tumor surrounding the spinal cord and filling the thecal sac (arrows). Four of four CSF samples obtained within 8 days of this MR examination were negative for tumor cells. The patient died 6 months later.
FIG 2. MR image of a 16-year-old boy, obtained 3 years after surgery and 4 years prior to death.
Sagittal (600/20) MR image with fat suppression shows two nodular contrast-enhancing lesions (arrows) within the distal thecal sac. Contemporaneous CSF cytologic analysis was positive.
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FIG 3. MR images of a 7-year-old girl, obtained 3 years after surgery.
A, Coronal (533/17) MR image shows multiple, small, contrast-enhancing lesions within the thecal sac (arrows). Contemporaneous CSF cytologic analysis was positive for tumor cells.
B and C, Coronal (583/17) MR images (B) and sagittal (683/15) MR images (C), obtained 2.5 months after A, shows progression of disseminated disease, with amorphous moderately enhancing tumor filling the thecal sac. The patient died 1 month later.
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FIG 4. MR images of a 4-year-old boy, obtained 6 months after surgery (There were negative earlier imaging examinations).
A, Sagittal (600/15) fat-suppressed MR images shows thick, linear, enhancing tumor along the spinal cord and cauda equina (arrows). Contemporaneous CSF cytologic analysis was positive for tumor cells.
B, Axial (700/17) fat-suppressed MR images show amorphous prominently enhancing tumor filling the thecal sac. Contemporaneous CSF cytologic analysis was positive for tumor cells. The patient died 2 months later.
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FIG 5. MR images of a 7-year-old boy, obtained 3 days (A) and 17 days (B) after surgery.
A, Sagittal (500/11) MR image shows linear enhancement along the spinal cord (arrows).
B, Sagittal (500/11) MR images show resolution of the intrathecal enhancement, which represented subarachnoidal hemorrhage related to surgery. This patient has been disease-free 5 years after these images were obtained.
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FIG 6. Kaplan-Meier estimates of PFS, overall-survival distributions for the complete study group and patients with spinal tumor
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