Abstract
Leptomeningeal spread of childhood primary central nervous system (CNS) neoplasms, also known as leptomeningeal disease (LMD), significantly affects prognosis and treatment. Lumbar cerebrospinal fluid (CSF) cytology and spinal magnetic resonance imaging (MRI) are considered critical for diagnosis of LMD. It has been suggested that either CSF cytology or spinal MRI alone would miss LMD in up to 18% of children with CNS neoplasms. To determine the rate of LMD and the concordance of these two tests at our institution, we analyzed the results of concurrent CSF cytology and spinal MRI (tandem CSF/MRI) performed at the UCSF Pediatric Neuro-oncology Division. We identified all patients who underwent tandem CSF and MRI analysis during their treatment between 1990 and 2005. There were 127 tandem analyses from 78 patients, of which 115 were concordant. Among the remaining 12 discordant tandem analyses, spinal MRI was positive and CSF was negative for tumor in 8 patients, while CSF was positive and spinal MRI was normal in four others. In all discordant cases, positive spinal MRI was often associated with aggressive disease. Positive CSF cytology correlated with aggressive disease only in one patient who had evidence of disseminated intracranial tumor on MRI. In the absence of intracranial tumor spread or LMD on MRI, a positive CSF cytology did not correlate with aggressive disease or recurrence. Even though the number of cases is limited, our findings suggest that a positive CSF cytology with no other corroborating evidence of tumor spread or recurrence should be interpreted with caution.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Packer RJ, Schut L, Siegel KR (1987) Dissemination of primary central nervous system tumors of childhood: incidence and clinical implications. Prog Exp Tumor Res 30:206–214
Mazzola CA, Pollack IF (2003) Medulloblastoma. Curr Treat Options Neurol 5:189–198
Koeller KK, Rushing EJ (2003) From the archives of the AFIP: medulloblastoma: a comprehensive review with radiologic-pathologic correlation. Radiographics 23:1613–1637
Miralbell R, Bieri S, Huguenin P, Feldges A, Morin AM, Garcia E, Wagner HP, Wacker P, von der Weid N (1999) Prognostic value of cerebrospinal fluid cytology in pediatric medulloblastoma. Swiss Pediatric Oncology Group. Ann Oncol 10:239–241
Glass JP, Melamed M, Chernik NL, Posner JB (1979) Malignant cells in cerebrospinal fluid (CSF): the meaning of a positive CSF cytology. Neurology 29:1369–1375
Fouladi M, Gajjar A, Boyett JM, Walter AW, Thompson SJ, Merchant TE, Jenkins JJ, Langston JW, Liu A, Kun LE, Heideman RL (1999) Comparison of CSF cytology and spinal magnetic resonance imaging in the detection of leptomeningeal disease in pediatric medulloblastoma or primitive neuroectodermal tumor. J Clin Oncol 17:3234–3237
Straathof CS, de Bruin HG, Dippel DW, Vecht CJ (1999) The diagnostic accuracy of magnetic resonance imaging and cerebrospinal fluid cytology in leptomeningeal metastasis. J Neurol 246:810–814
Meyers SP, Wildenhain SL, Chang JK, Bourekas EC, Beattie PF, Korones DN, Davis D, Pollack IF, Zimmerman RA (2000) Postoperative evaluation for disseminated medulloblastoma involving the spine: contrast-enhanced MR findings, CSF cytologic analysis, timing of disease occurrence, and patient outcomes. AJNR Am J Neuroradiol 21:1757–1765
Griffiths PD, Coley SC, Romanowski CA, Hodgson T, Wilkinson ID (2003) Contrast-enhanced fluid-attenuated inversion recovery imaging for leptomeningeal disease in children. AJNR Am J Neuroradiol 24:719–723
Poltinnikov IM, Merchant TE (2006) CSF cytology has limited value in the evaluation of patients with ependymoma who have MRI evidence of metastasis. Pediatr Blood Cancer 47:169–173
Chamberlain MC (1995) A review of leptomeningeal metastases in pediatrics. J Child Neurol 10:191–199
Ayan I, Kebudi R, Bayindir C, Darendeliler E (1997) Microscopic local leptomeningeal invasion at diagnosis of medulloblastoma. Int J Radiat Oncol Biol Phys 39:461–466
Zeltzer PM, Boyett JM, Finlay JL, Albright AL, Rorke LB, Milstein JM, Allen JC, Stevens KR, Stanley P, Li H, Wisoff JH, Geyer JR, McGuire-Cullen P, Stehbens JA, Shurin SB, Packer RJ (1999) Metastasis stage, adjuvant treatment, and residual tumor are prognostic factors for medulloblastoma in children: conclusions from the Children’s Cancer Group 921 randomized phase III study. J Clin Oncol 17:832–845
Gomori JM, Heching N, Siegal T (1998) Leptomeningeal metastases: evaluation by gadolinium enhanced spinal magnetic resonance imaging. J Neurooncol 36:55–60
Fairbanks VF, Folger WN (1990) Cost containment, quality assurance, and physician microscopy of cerebrospinal fluid with normal cell counts. Analysis of 1,677 consecutive specimens. Am J Clin Pathol 94:67–72
Saunders DE, Hayward RD, Phipps KP, Chong WK, Wade AM (2003) Surveillance neuroimaging of intracranial medulloblastoma in children: how effective, how often, and for how long? J Neurosurg 99:280–286
Hurwitz MD, Burger PC, Goldthwaite PT, Tihan T, Wharam MD, Fisher PG (2001) Prognostic implications for gadolinium enhancement of the meninges in low-grade astrocytomas of childhood. Pediatr Neurosurg 34:88–93
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pang, J., Banerjee, A. & Tihan, T. The value of tandem CSF/MRI evaluation for predicting disseminated disease in childhood central nervous system neoplasms. J Neurooncol 87, 97–102 (2008). https://doi.org/10.1007/s11060-007-9493-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11060-007-9493-1