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摘要

Bennett J, Ashmawy R, Ramaswamy V et al The clinical significance of equivocal findings on spinal MRI in children with medullobiastoma, Pediatr. Blood Cancer doi:10.1002/pbc.26472 (2017) (Epyb ahead of print). As clinicians, we are always challenged by MRI images and their reports when final medical decision implies patient prognosis and survival quality outcome as in the case of pediatric medulloblas-toma. The authors report their 15-year experience on the revision of 100 patients MRI with data about initial staging, subsequent treatment and follow-up. They reviewed 37 patients with normal spine MRI, 15 with surely spinal metastatic disease and 48 whose images were uncertain or as they define, 'equivocal'. Surprisingly, in the last cohort, more patients with sonic hedgehog subgroup medulloblastoma were represented. Sixty percent of these 48 patients received standard risk treatment without showing any different outcomes from those that were directly classified as not having spinal disease. The others had more clinical risk factors apart from spinal MRI uncertainties, therefore high-risk treatment choice depended on more than spinal suspicions. These equivocal findings, moreover, were not correlated to cephalospinal fluid cytologic positivity and could be an inflammatory reaction or secondary to pressure change after tumor presence and its removal. The conclusions of this paper are toward a more pragmatic and multidisciplinary way of making final staging diagnosis to skip from more intensive and unnecessary treatments that can injure patients without need.