Imaging of pediatric spine and spinal cord tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee/ASPNR White Paper

Abstract

Childhood spinal tumors are rare. Tumors can involve the spinal cord, the meninges, bony spine, and the paraspinal tissue. Optimized imaging should be utilized to evaluate tumors arising from specific spinal compartments. This paper provides consensusbased recommendations for optimized imaging of tumors arising from specific spinal compartments at diagnosis, follow-up during and after therapy, and response assessment.

Diagnostic Excellence in Pediatric Spine Imaging: Using Contextualized Imaging Protocols

“…Most spinal imaging in our cohort was to screen for spinal metastatic disease in patients with brain tumors. The incidence of primary spinal cord tumors is only 10% of all pediatric CNS tumors [ 12 ]. Our spine MRI protocol for patients with CNS tumors follows evidence-based recommendations from experts in the field of pediatric oncologic imaging and are continually updated [ 12 , 13 ].…”

“…The incidence of primary spinal cord tumors is only 10% of all pediatric CNS tumors [ 12 ]. Our spine MRI protocol for patients with CNS tumors follows evidence-based recommendations from experts in the field of pediatric oncologic imaging and are continually updated [ 12 , 13 ]. Our contextualized modification of the CNS tumor imaging protocol entails a first-time CNS tumor imaging protocol with pre- and post-contrast imaging of the brain and post-contrast imaging of the spine, and continued omission of any pre-contrast spine imaging for follow-up exams.…”

Update on Pediatric Spine Imaging

“…Rigidity and contracture of the paravertebral muscles or progressive scoliosis with chronic back pain are associated symptoms with intramedullary neoplasm. 8,[44][45][46] Extramedullary tumors account for approximately two thirds of all intraspinal tumors and can be extradural (50%) or intradural (10-15%). Some examples are neuroblastoma, neurofibroma, and lymphoma.…”

“…FDG-PET/CT can be useful to assess for osseous or soft tissue metastasis. 46 MRI is the modality of choice for spinal tumors. Imaging typically includes T1-weighted images, fluid-sensitive, and post-gadolinium sequences.…”

“…Rigidity and contracture of the paravertebral muscles or progressive scoliosis with chronic back pain are associated symptoms with intramedullary neoplasm. 8 44 45 46…”