title: Which MRI sequence of the spine best reveals bone-marrow metastases of neuroblastoma?
abstract: BACKGROUND
  MRI is an effective tool in evaluating bone marrow metastases. However, no study has defined which MRI sequences or image characteristics best correlate with bone-marrow metastases in neuroblastoma.
  
  
  OBJECTIVE
  To identify and refine MRI criteria and sequence selection for the diagnosis of bone-marrow metastases in children with neuroblastoma.
  
  
  METHODS
  Ninety-one children (mean age: 3.2 years; standard deviation: 2.8 years) enrolled in the RDOG IV study participated in our study. Forty-five children had bone metastases determined by bone-marrow aspiration or biopsy (n=4), radionuclide imaging (n=2), or both (n=39). Spine lesions were characterized using coronal T1-weighted (T1W) sagittal short tau inversion recovery (STIR) and coronal gadolinium-enhanced T1-weighted (GAD) MR sequences. Contingency table analysis was performed to determine which MRI sequences and characteristics were associated with metastases. The MRI criteria for metastatic disease were then developed for each imaging sequence. The sensitivity, specificity, predictive values, and accuracy of these criteria were determined for the whole group, children younger than 12 months old, and children 12 months and older.
  
  
  RESULTS
  The MR characteristics that had significant (P<or=0.05) associations with metastases were homogeneous low T1-signal intensity, homogeneous high STIR-signal intensity, and heterogeneous pattern on T1, STIR, or GAD. Homogeneous low T1-signal had the highest sensitivity (88%), but a specificity of 62% for detecting metastases. A heterogeneous pattern on GAD was highly specific (97%), but relatively insensitive (65%) for detecting metastases. These MR characteristics were most accurate in children 12 months and older.
  
  
  CONCLUSIONS
  The combination of non-contrast-enhanced T1W and GAD sequences can be used to determine the presence of spinal metastases in children with neuroblastoma, particularly those children who are 1 year and older.
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA. meyer@E-mail.chop.edu
authors.forename: James S
authors.initials: JS
authors.lastname: Meyer
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Siegel
authors.forename: Saleem O
authors.initials: SO
authors.lastname: Farooqui
authors.forename: Diego
authors.initials: D
authors.lastname: Jaramillo
authors.forename: Barry D
authors.initials: BD
authors.lastname: Fletcher
authors.forename: Fredric A
authors.initials: FA
authors.lastname: Hoffer
mesh_terms: D019046:Bone Marrow Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D002648:Child; D002675:Child, Preschool; D005260:Female; D050815:Fractures, Compression / Q000175:diagnosis / Q000473:pathology; D005682:Gadolinium; D018305:Ganglioneuroblastoma / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009447:Neuroblastoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement; D011857:Radiographic Image Interpretation, Computer-Assisted; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D019275:Radiopharmaceuticals; D005682:Gadolinium