Cerebrospinal Fluid (CSF) Seeding from Pediatric Intra and Extra-Cranial Tumors: Optimization of the MRI Protocol

Background Cerebrospinal fluid (CSF) seeding is a way of spreading central nervous system (CNS) tumors by seeding cells along the CSF pathways. Early detection of CSF seedling is essential, and improved diagnostics may help these patients' prognoses. The objective of this study was to evaluate contrast-enhanced T1-weighted spine magnetic resonance imaging (MRI) with and without fat saturation (FS) in detecting and visualizing CSF seeding lesions. Methods A total of 49 pediatric cancer patients were included in this retrospective analysis, both sexes, with primary or secondary CNS tumors such as primary tumors of the brain and spine or secondary metastasis in the brain or spine from extra-cranial solid tumors who had positive CSF cytological analysis for seedling and available MRI studies. Results The contrast-enhanced T1-weighted sequence (T1WS) performed without FS yielded significantly better overall image quality and anatomical detail depiction than the sequence with FS (P < 0.001). The image artifact severity score and CSF seedling lesions degree of visibility score were significantly higher for the contrast enhanced (CE)-T1WS with FS than the CE-T1WS without FS (P < 0.001). Patients who had bulky disease were significantly more susceptible to develop adverse radiological outcomes than those patients who had bulky forms (P < 0.05). Conclusions The CE-T1WS without FS is an irreplaceable sequence in detection of CSF seedling lesion.