Use of T2 signal intensity of XXXX in pediatric @entity1 to guide preoperative staging of the neuraxis.

@entity1 @entity424 @entity5 @entity75 @entity6831 @entity2357 @entity17692 @entity2946 @entity34
OBJECT: The question of whether to obtain routine or selective preoperative imaging of the neuraxis in pediatric @entity1 with @entity17692 remains a controversial topic. Staging of the neuraxis is generally considered beneficial in @entity1 with @entity5 associated with an elevated risk of @entity6831 ( @entity6831 ). When these studies are obtained preoperatively, there is a decrease in the number of false-positive images related to debris in the immediate postoperative period. Additionally, knowledge of the extent of spread has the potential to affect the risk/benefit analysis of aggressive resection. Although the majority of pediatric neurosurgeons surveyed choose to obtain selective preoperative imaging of the neuraxis in cases of @entity17692 "with findings suggestive of high-grade pathology," an evidence-based protocol in the literature is lacking. The goal of this study was to assess radiological characteristics of @entity5 with an elevated risk of @entity6831 and identify a method to help guide preoperative imaging of the neuraxis. METHODS: The authors first reviewed the literature to gain an appreciation of the risk of @entity6831 of @entity17692 based on underlying histopathology and/or grade. Available evidence indicates preoperative imaging of the neuraxis in @entity1 with Grade I @entity5 to be of questionable utility. In contrast, evidence suggested that preoperative imaging of the neuraxis in @entity1 with @entity34 was clinically warranted. The authors then evaluated an extensive base of neuroradiological literature to identify possible MR imaging and/or CT findings with the potential to differentiate Grade I from higher-grade @entity5 in pediatric @entity1 . They analyzed the preoperative radiological findings in 50 pediatric @entity1 who had undergone craniotomy for resection of @entity17692 at Vanderbilt @entity1 's Hospital since 2003 with reference to 7 chosen radiological criteria. @entity2357 models were fit using radiological features to determine the best predictors of @entity5 . Receiver operating characteristic methods were used to identify diagnostic properties of the best predictors. RESULTS: The relative T2 signal intensity (RT2SI), an indirect measure of the water content of the solid component of the @entity5 , was best able to identify @entity5 with an elevated risk of @entity6831 . An RT2SI value of 0.71 was selected by the authors as the best operating point on the curve. Of the 31 @entity5 retrospectively designated as hypointense @entity75 (RT2SI  <= 0.71), 30 (97%) were Grade II or higher. All @entity2946 , @entity424 , and high-grade (Grades III and IV) @entity5 were hypointense @entity75 . Of the 19 T2-weighted hyperintense @entity5 (RT2SI > 0.71), 16 (84%) were Grade I and 3 were Grade II. CONCLUSIONS: Measurement of the RT2SI can help predict @entity5 at an elevated risk of leptomeningeal spread and guide staging of the neuraxis. Pediatric @entity1 with @entity17692 found to have an RT2SI of less than or equal to 0.71 are recommended for neuraxis imaging prior to surgery.
