title: Preferential sites of metastatic relapse on MRI of initially localized ependymoma in children.
abstract: OBJECTIVE
  Relapse of ependymoma in childhood portends a grave prognosis. While the detection of local recurrence is usually simple, spotting leptomeningeal metastasis might be challenging. We aimed to evaluate possible "hotspots" where metastasis tend to appear.
  
  
  METHODS
  Medical records and Magnetic Resonance (MR) studies of all patients diagnosed with brain ependymomas between the years 2000-2015 were reviewed.
  
  
  RESULTS
  Leptomeningeal spread was detected among 42% of relapsed patients. The most common sites were spine and hypothalamic area (26% each).
  
  
  CONCLUSIONS
  A meticulous assessment of the brain and spine including a thorough evaluation of the hypothalamic area is recommended.
authors.affiliation: Department of Radiology, Schneider Children's Medical Center of Israel, 14 Kaplan Street, PO Box 559, Petach Tikvah 49202, Israel. Electronic address: mikash1@clalit.org.il.
authors.forename: Mika Shapira
authors.initials: MS
authors.lastname: Rootman
authors.affiliation: Department of Radiology, Schneider Children's Medical Center of Israel, 14 Kaplan Street, PO Box 559, Petach Tikvah 49202, Israel.
authors.forename: Osnat
authors.initials: O
authors.lastname: Konen
authors.affiliation: Department of Pediatric Hematology-Oncology, Hadassah Hebrew-University Medical Center, Jerusalem, Israel, Kiryat Hadassah, PO Box 12000, Jerusalem, 91120, Israel.
authors.forename: Iris
authors.initials: I
authors.lastname: Fried
authors.affiliation: Hematology-Oncology Division, Schneider Children's Medical Center of Israel, Petach Tikva, Israel, 14 Kaplan Street, PO Box 559, Petach Tikvah 49202, Israel.
authors.forename: Helen
authors.initials: H
authors.lastname: Toledano
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology*; D001932:Brain Neoplasms / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004806:Ependymoma / Q000473:pathology*; D005260:Female; D006801:Humans; D007029:Hypothalamic Neoplasms / Q000556:secondary; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008577:Meningeal Neoplasms / Q000556:secondary*; D008578:Meninges / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011379:Prognosis; D012008:Recurrence; D013116:Spinal Cord / Q000473:pathology*; D013120:Spinal Cord Neoplasms / Q000556:secondary; D013131:Spine; D055815:Young Adult
keywords: Ependymoma; Hypothalamus; Leptomeningeal spread; Relapse; Spine