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Departments of Neurology (Dr. Kramer and Parker) and Radiology (Dr. Zimmerman), The Children's Hospital of Philadelphia. Philadelphia, PA, and the Department of Radiology (Drs. Rafto and Zimmerman), Hospital of the University of Pennsylvania, Philadelphia, PA.
We evaluated 17 children with primary intracranial neoplasms for subarachnoid metastatic disease (SAMD) using myelography with computed tomographic follow-up (Myelo + CT) and cerebrospinal fluid (CSF) histopathologic examination, as well as magnetic resonance imaging with gadolinium DTPA (MRI + Gd), between December 1988 and December 1989. There were 12 boys, and the median age was 5.7 years (range, 0.8 to 21.8 years). Tumor histology included 8 primitive neuroectodermal tumors (PNETs), 3 ependymomas, 2 low-grade astrocytomas, 1 anaplastic astrocytoma, 1 glioblastoma multiforme, 1 atypical rhabdoid tumor, and 1 malignant fibrous histiocytoma. Thirteen tumors originated in the posterior fossa, 2 were supratentorial, and 2 were in the spinal cord. The median interval between the 2 diagnostic tests was 2 days. MRI + Gd was positive in 11 (65%), Myelo + CT in 8 (47%), and CSF in 5 (29%) cases. MRI + Gd was superior in delineating spinal cord nodules and "sugar coating" whereas Myelo + CT more readily revealed nerve root sleeve filling defects. There was no case in which Myelo + CT was positive that MRI + Gd did not reveal SAMD. MRI + Gd is a safe, noninvasive test that should be used as the initial imaging modality for the presence of SAMD.
Address correspondence and reprint requests to Dr. Eric D. Kramer, Department of Neurology, Cooper Hospital/University Medical Center, Three Cooper Plaza, Suite 220, Camden, NJ 08103.
Received April 30, 1990. Accepted for publication in final form June 29. 1990
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