Spinal cord imaging is essential to the workup and staging of newly diagnosed brain tumors in kids, as detection of metastases can dramatically affect therapy.  In a recent publication in the American Journal of Neuroradiology, collaborators from the Massachusetts General Hospital compared routine postcontrast T1-weighted imaging, the standard of care for detecting spinal metastases, to balanced steady-state free precession (CISS/FIESTA/3D Driven Equilibrium Radiofrequency Reset Pulse) imaging in patients with primary brain tumors.

Balanced steady-state free precession (bSSFP), a heavily fluid-weighted sequence, provides high contrast resolution and is regularly utilized in the evaluation of cranial nerves and aqueductal stenosis, among other indications.  They concluded that bSSFP imaging increased sensitivity for drop metastases, particularly metastases <3mm and non-enhancing metastases (a bane to the neuroradiologist!).  Furthermore, bSSFP decreased incorrect classification of prominent vessels along the surface of the spinal cord and adjacent nerve roots as tumor.

David Mirsky MD


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