PEDIATRIC POSTERIOR MIDLINE LUMPS: CNS MALFORMATIONS OR MASQUERADING DISEASE - MRI INSIGHT

Abstract

Introduction:

Central nervous system malformations are frequently encountered anomalies owing to derangements in the neurulation process of spinal in the embryonic period. These are broadly categorized into 1) open spinal dysraphism and 2) closed spinal dysraphism, based on skin/sub cutaneous tissues coverage. Masquerading diseases may present with similar clinical presentation.  Neuro-imaging plays an essential role in differentiating between neural tube defects and mimicking disease hence facilitate appropriate diagnosis and pre-surgical planning.

Objective:

To assess the frequency of congenital central nervous system (CNS) malformations and masquerading diseases in the pediatric patients presenting with congenital posterior midline lumps at the head, neck and back using MRI brain and spine in the Diagnostic Radiology department of the National institute of child health.

Methods:

Design: This is a descriptive, retrospective cross-sectional analysis.

Setting: Radiology department of National Institute of Child Health (NICH).

 Electronic data from November 2021 to October 2022 of MRI brain and spine of pediatric patients below 15 years presented with congenital posterior midline lumps were collected and analyzed on SPSS version 26.

Results:

Total 201 pediatric patients were evaluated. There was a balanced gender distribution between male 91(45%) and female 110(54.7%). The most common presenting complaint was congenital lumbar posterior midline lump. Myelomeningocele was the most common diagnosis (61.2%) followed by Lipomyelocele and lipomyelomeningocoele (4%). Notably, the most common association was found to be hydrocephalus (38.8%), syrinx (23.9%) and tethered cord (20.9%). Most prevalent masquerading disease was sacrococcygeal teratoma then macrocystic lymphatic malformation. Soft tissue hemangioma, hematoma and neurogenic tumor were also found in few patients.

Conclusion:

This study emphasizes the significance of neuroimaging detection of not only spinal dysraphism but other masquerading diseases as well. Early recognition of key imaging features of such malformations and mimicking diseases facilitates appropriate intervention hence plays a crucial role for therapeutic strategy and clinical outcome. 

Keywords: Frequency, CNS malformations, neuroimaging and spinal dysraphism.