The clinical significance of equivocal findings on spinal MRI in children with medulloblastoma

The clinical significance of equivocal findings on spinal MRI in children with medulloblastoma
Children with medulloblastoma and spinal metastasis receive an increased dose of craniospinal irradiation (CSI). This article aimed to describe cases of equivocal abnormalities (nerve root clumping, linear vascular enhancement, nerve root enhancement and other vague findings) as they relate to prognosis. This is a single-centre, retrospective review.
Children ≥ 3 years of age diagnosed with medulloblastoma between 1988 and 2012 who were treated with upfront CSI were included. Blinded reviewers assessed the initial spinal MRI for equivocal findings.
100 patients were included, with equivocal findings in 48%. Most (94%) had MRI imaging preoperatively. A higher proportion of the sonic hedgehog (SHH) subgroup patients had equivocal findings (statistically significant). 5-year OS of children with equivocal findings did not differ from those with normal MRI findings (80 vs 84%).
Limitations of this study include retrospective nature and variety of treatment protocols across the time period, limiting comparison of survival outcomes. The imaging reviewers were not all radiologists although one radiologist reviewed each scan.
The presence of equivocal findings were not associated with worse OS compared to patients with normal MRIs, though the significance of the study results should be validated prospectively in the context of contemporary treatment protocols.