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MR Characteristics of Malignant Spinal Cord Astrocytomas in Children

Published online by Cambridge University Press:  02 December 2014

Abhaya V. Kulkarni ,
Derek C. Armstrong  and
James M. Drake
Abhaya V. Kulkarni
Affiliation:
Divisions of Neurosurgery and Neuroradiology, Hospital for Sick Children, University of Toronto, Toronto, Canada
Derek C. Armstrong
Affiliation:
Divisions of Neurosurgery and Neuroradiology, Hospital for Sick Children, University of Toronto, Toronto, Canada
James M. Drake
Affiliation:
Divisions of Neurosurgery and Neuroradiology, Hospital for Sick Children, University of Toronto, Toronto, Canada
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Abstract

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Objective:

Malignant spinal cord astrocytomas are rare tumors and their specific MR characteristics have not been previously described. We present a detailed MR analysis of four children with malignant astrocytoma.

Methods:

A review of the clinical database at the Hospital for Sick Children, Toronto revealed four patients with histologically-verified malignant spinal cord astrocytomas (WHO Grade 3 or 4) with pre-operative MR available for retrospective review.

Results:

There were three boys and one girl with a mean age at presentation of four years (range 7 months - 12 years). Mean duration of symptoms prior to presentation was six weeks (range 3 days - 5 months). Pre-operative MR analysis revealed that all tumors were located in the cervical or cervico-thoracic regions and expanded the cord over an average of 6.5 vertebral levels. The signal was usually hypointense on T1-weighted and hyperintense or mixed intensity on T2-weighted images. In the three cases where gadolinium was given, all demonstrated enhancement (one rim enhancement with a discrete border and two with inhomogeneous central enhancement). One tumor appeared to be exophytic, one had a significant cystic component, and none showed evidence of hemorrhage. Pre-operative leptomeningeal spread of tumor was documented in two of four cases and involved intracranial spread in both cases.

Conclusion:

There did not appear to be any specific MR characteristics to help differentiate a malignant astrocytoma from a low-grade tumor, except for the high rate of leptomeningeal spread at presentation. It is recommended that full neuraxis MR imaging be performed pre-operatively in children in whom a rapidly progressive clinical course suggests a malignant lesion. This will likely have a high positive yield and provide valuable information prior to surgical intervention.

Résumé

RÉSUMÉObjectif:

Les astrocytomes malins de la moelle épinière sont des tumeurs rares et leurs caractéristiques spécifiques à l’imagerie par résonance magnétique (IRM) n’ont jamais été décrites. Nous présentons une analyse détaillée des caractéristiques à l’IRM d’un astrocytome malin chez 4 enfants.

Méthodes:

Une revue de la base de donees cliniques de l’Hôpital pour enfants malades de Toronto a révélé l’existence de 4 patients présentant un astrocytome malin de la moelle épinière vérifié par histologie (OMS grade 3 ou 4) qui avaient des données IRM préopératoires disponibles pour une revue rétrospective des cas.

Résultats:

Il s’agissait de 3 garçons et de 1 fille dont l’âge moyen au moment de la consultation était de 4 ans (de 7 mois à 12 ans). La durée moyenne des symptômes avant la consultation était de 6 semaines (de 3 jours à 5 mois). L’IMR préopératoire a révélé que toutes les tumeurs étaient localisées dans la région cervicale ou cervico-thoracique et s’étendaient en moyenne sur une longueur de 6.5 vertèbres. Le signal était habituellement hypointense sur les images pondérées en T1 et hyperintense ou d’intensité mixe sur celles pondérées en T2. Chez les 3 cas où on a administré du gadolinium, on a observé un rehaussement (1 avec rehaussement du périmètre avec une bordure discrète et 2 avec un rehaussement central non homogène) Une tumeur semblait exophytique, une avait une composante kystique importante et aucune ne manifestait de signe d’hémorragie. Un envahissement des leptoméninges par la tumeur a été documenté chez 2 des 4 cas et comportait un envahissement intracrânien dans les deux cas.

Conclusions:

Il ne semblait pas y avoir de caractéristiques spécifiques à l’IRM pour aider à différencier l’astrocytome malin d’une tumeur de faible malignité à part le taux élevé d’envahissement des leptoméninges au moment de la consultation. Il est recommandé de procéder à l’IRM de l’encéphale et de la moelle épinière avant la chirurgie chez les enfants qui présentent une évolution clinique rapide suggérant une lésion maligne. Cette investigation aura vraisemblablement un taux élevé de résultats positifs et fournira de l’information importante avant la chirurgie.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 26 , Issue 4 , November 1999 , pp. 290 - 293
Copyright
Copyright © The Canadian Journal of Neurological 1999

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