This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fouladi, M. Articles by Heideman, R. L. Search for Related Content PubMed PubMed Citation Articles by Fouladi, M. Articles by Heideman, R. L.

Comparison of CSF Cytology and Spinal Magnetic Resonance Imaging in the Detection of Leptomeningeal Disease in Pediatric Medulloblastoma or Primitive Neuroectodermal Tumor

From the Departments of Hematology-Oncology, Radiation Oncology, Pathology and Laboratory Medicine, Biostatistics and Epidemiology, and Radiology, St Jude Children's Research Hospital; and Departments of Pediatrics, Radiation Oncology, and Radiology, University of Tennessee, College of Medicine, Memphis, TN.

Address reprint requests to Maryam Fouladi, MD, St Jude Children's Research Hospital; Department of Hematology-Oncology, St Jude Children's Research Hospital, 332 N Lauderdale, Memphis, TN 38105; email maryam.fouladi{at}stjude.org

PURPOSE: Leptomeningeal disease (LMD) significantly affects the prognosis and treatment of pediatric patients with medulloblastoma or primitive neuroectodermal tumor (PNET). Examination of CSF for malignant cells, detection of LMD on spinal magnetic resonance imaging (MRI), or both are the methods routinely used to diagnose LMD. A recent study suggested 100% correlation between CSF and MRI findings in children with medulloblastoma. To determine the validity of this hypothesis, we compared the rate of detection of LMD between concurrent lumbar CSF cytology and spinal MRI performed at diagnosis in patients with medulloblastoma or PNET.

PATIENTS AND METHODS: As a part of diagnostic staging, 106 consecutive patients newly diagnosed with medulloblastoma or PNET were evaluated with concurrent lumbar CSF cytology and spinal MRI. CSF cytology was examined for the presence of malignant cells and spinal MRI was reviewed independently for the presence of LMD.

RESULTS: Thirty-four patients (32%) were diagnosed with LMD based on CSF cytology, spinal MRI, or both. There were 21 discordant results. Nine patients (8.5%) with positive MRI had negative CSF cytology. Twelve patients (11.3%) with positive CSF cytology had negative MRIs. The exact 95% upper bounds on the proportion of patients with LMD whose disease would have gone undetected using either CSF cytology or MRI as the only diagnostic modality were calculated at 14.4% and 17.7%, respectively.

CONCLUSION: With the use of either CSF cytology or spinal MRI alone, LMD would be missed in up to 14% to 18% of patients with medulloblastoma or PNET. Thus, both CSF cytology and spinal MRI should routinely be used to diagnose LMD in patients with medulloblastoma or PNET.

This article has been cited by other articles:

				F. Yang, T. E. Van Meter, R. Buettner, M. Hedvat, W. Liang, C. M. Kowolik, N. Mepani, J. Mirosevich, S. Nam, M. Y. Chen, et al. Sorafenib inhibits signal transducer and activator of transcription 3 signaling associated with growth arrest and apoptosis of medulloblastomas Mol. Cancer Ther., November 1, 2008; 7(11): 3519 - 3526. [Abstract] [Full Text] [PDF]

				V. Oyharcabal-Bourden, C. Kalifa, J.C. Gentet, D. Frappaz, C. Edan, P. Chastagner, E. Sariban, A. Pagnier, A. Babin, F. Pichon, et al. Standard-Risk Medulloblastoma Treated by Adjuvant Chemotherapy Followed by Reduced-Dose Craniospinal Radiation Therapy: A French Society of Pediatric Oncology Study J. Clin. Oncol., July 20, 2005; 23(21): 4726 - 4734. [Abstract] [Full Text] [PDF]

				K. K. Koeller and E. J. Rushing From the Archives of the AFIP: Medulloblastoma: A Comprehensive Review with Radiologic-Pathologic Correlation RadioGraphics, November 1, 2003; 23(6): 1613 - 1637. [Abstract] [Full Text] [PDF]

				S. P. Meyers, S. L. Wildenhain, J.-K. Chang, E. C. Bourekas, P. F. Beattie, D. N. Korones, D. Davis, I. F. Pollack, and R. A. Zimmerman 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., October 1, 2000; 21(9): 1757 - 1765. [Abstract] [Full Text]