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Gonçalves FG, Zandifar A, Ub Kim JD, Tierradentro-García LO, Ghosh A, Khrichenko D, Andronikou S, Vossough A. Application of Apparent Diffusion Coefficient Histogram Metrics for Differentiation of Pediatric Posterior Fossa Tumors : A Large Retrospective Study and Brief Review of Literature. Clin Neuroradiol 2022; 32:1097-1108. [PMID: 35674799 DOI: 10.1007/s00062-022-01179-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/08/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aimed to evaluate the application of apparent diffusion coefficient (ADC) histogram analysis to differentiate posterior fossa tumors (PFTs) in children. METHODS A total of 175 pediatric patients with PFT, including 75 pilocytic astrocytomas (PA), 59 medulloblastomas, 16 ependymomas, and 13 atypical teratoid rhabdoid tumors (ATRT), were analyzed. Tumors were visually assessed using DWI trace and conventional MRI images and manually segmented and post-processed using parametric software (pMRI). Furthermore, tumor ADC values were normalized to the thalamus and cerebellar cortex. The following histogram metrics were obtained: entropy, minimum, 10th, and 90th percentiles, maximum, mean, median, skewness, and kurtosis to distinguish the different types of tumors. Kruskal Wallis and Mann-Whitney U tests were used to evaluate the differences. Finally, receiver operating characteristic (ROC) curves were utilized to determine the optimal cut-off values for differentiating the various PFTs. RESULTS Most ADC histogram metrics showed significant differences between PFTs (p < 0.001) except for entropy, skewness, and kurtosis. There were significant pairwise differences in ADC metrics for PA versus medulloblastoma, PA versus ependymoma, PA versus ATRT, medulloblastoma versus ependymoma, and ependymoma versus ATRT (all p < 0.05). Our results showed no significant differences between medulloblastoma and ATRT. Normalized ADC data showed similar results to the absolute ADC value analysis. ROC curve analysis for normalized ADCmedian values to thalamus showed 94.9% sensitivity (95% CI: 85-100%) and 93.3% specificity (95% CI: 87-100%) for differentiating medulloblastoma from ependymoma. CONCLUSION ADC histogram metrics can be applied to differentiate most types of posterior fossa tumors in children.
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Affiliation(s)
- Fabrício Guimarães Gonçalves
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alireza Zandifar
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Jorge Du Ub Kim
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Adarsh Ghosh
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dmitry Khrichenko
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Savvas Andronikou
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Arastoo Vossough
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Sathyakumar K, Mani S, Pathak GH, Prabhu K, Chacko AG, Chacko G. Neuroimaging of pediatric infratentorial tumors and the value of diffusion-weighted imaging (DWI) in determining tumor grade. Acta Radiol 2021; 62:533-540. [PMID: 32539423 DOI: 10.1177/0284185120933219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) provides information about the cellular density of tumors. This feature is useful in grading and identifying different tumor types. PURPOSE To assess the value of diffusion restriction and apparent diffusion coefficient (ADC) values in differentiating pediatric infratentorial tumors. MATERIAL AND METHODS This was a retrospective review of the magnetic resonance imaging (MRI) of 82 children (age range 1-16 years) with infratentorial tumors. Histopathological grading after surgical excision/biopsy was categorized as low grade (WHO grades I and II) (n = 31; 29 pilocytic astrocytomas, 2 ependymomas) and high grade (WHO grade III and IV) (n = 51; 40 medulloblastomas, 8 anaplastic ependymomas, 1 anaplastic astrocytoma, 2 atypical rhabdoid teratoid tumors [ATRT]). MRI features and ADC values were compared among tumor types and grades using a two-tailed t test, Mann-Whitney U test for continuous data and Chi-square test for categorical variables. RESULTS Diffusion restriction and low ADC value was a feature of high-grade tumors (P<0.001). The mean ADC values of the low-grade and high-grade tumors were 1.567 × 10-3mm2/s and 0.661 × 10-3mm2/s, respectively. Using 0.9 × 10-3mm2/s as the cut-off value, the sensitivity, specificity, positive and negative predictive values for differentiating the grades was 87%, 100%, 100%, and 81.8%, respectively. Significant differences were found between the mean ADC values of the individual tumor types (P<0.05), except between medulloblastoma and ATRT. CONCLUSION ADC values and visual assessment of diffusion restriction are useful in tumor grading. The individual tumor types can be identified by an algorithmic approach, using DWI in conjunction with other described MRI features.
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Affiliation(s)
- Kirthi Sathyakumar
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sunithi Mani
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Krishna Prabhu
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ari George Chacko
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
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Abstract
Magnetic resonance spectroscopy (MRS), being able to identify and measure some brain components (metabolites) in pathologic lesions and in normal-appearing tissue, offers a valuable additional diagnostic tool to assess several pediatric neurological diseases. In this review we will illustrate the basic principles and clinical applications of brain proton (H1; hydrogen) MRS (H1MRS), by now the only MRS method widely available in clinical practice. Performing H1MRS in the brain is inherently less complicated than in other tissues (e.g., liver, muscle), in which spectra are heavily affected by magnetic field inhomogeneities, respiration artifacts, and dominating signals from the surrounding adipose tissues. H1MRS in pediatric neuroradiology has some advantages over acquisitions in adults (lack of motion due to children sedation and lack of brain iron deposition allow optimal results), but it requires a deep knowledge of pediatric pathologies and familiarity with the developmental changes in spectral patterns, particularly occurring in the first two years of life. Examples from our database, obtained mainly from a 1.5 Tesla clinical scanner in a time span of 15 years, will demonstrate the efficacy of H1MRS in the diagnosis of a wide range of selected pediatric pathologies, like brain tumors, infections, neonatal hypoxic-ischemic encephalopathy, metabolic and white matter disorders.
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Affiliation(s)
- Roberto Liserre
- Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Lorenzo Pinelli
- Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Roberto Gasparotti
- Neuroradiology Unit, Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Gupta T, Sarkar C, Rajshekhar V, Chatterjee S, Shirsat N, Muzumdar D, Pungavkar S, Chinnaswamy G, Jalali R. Indian Society of Neuro-Oncology consensus guidelines for the contemporary management of medulloblastoma. Neurol India 2017; 65:315-332. [DOI: 10.4103/0028-3886.201841] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Manias KA, Gill SK, MacPherson L, Foster K, Oates A, Peet AC. Magnetic resonance imaging based functional imaging in paediatric oncology. Eur J Cancer 2016; 72:251-265. [PMID: 28011138 DOI: 10.1016/j.ejca.2016.10.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/26/2016] [Accepted: 10/30/2016] [Indexed: 12/16/2022]
Abstract
Imaging is central to management of solid tumours in children. Conventional magnetic resonance imaging (MRI) is the standard imaging modality for tumours of the central nervous system (CNS) and limbs and is increasingly used in the abdomen. It provides excellent structural detail, but imparts limited information about tumour type, aggressiveness, metastatic potential or early treatment response. MRI based functional imaging techniques, such as magnetic resonance spectroscopy, diffusion and perfusion weighted imaging, probe tissue properties to provide clinically important information about metabolites, structure and blood flow. This review describes the role of and evidence behind these functional imaging techniques in paediatric oncology and implications for integrating them into routine clinical practice.
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Affiliation(s)
- Karen A Manias
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Simrandip K Gill
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Lesley MacPherson
- Department of Radiology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Katharine Foster
- Department of Radiology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Adam Oates
- Department of Radiology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Andrew C Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
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Gaudino S, Russo R, Verdolotti T, Caulo M, Colosimo C. Advanced MR imaging in hemispheric low-grade gliomas before surgery; the indications and limits in the pediatric age. Childs Nerv Syst 2016; 32:1813-22. [PMID: 27659824 DOI: 10.1007/s00381-016-3142-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 06/05/2016] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Advanced magnetic resonance imaging (MRI) techniques is an umbrella term that includes diffusion (DWI) and diffusion tensor (DTI), perfusion (PWI), spectroscopy (MRS), and functional (fMRI) imaging. These advanced modalities have improved the imaging of brain tumors and provided valuable additional information for treatment planning. Despite abundant literature on advanced MRI techniques in adult brain tumors, few reports exist for pediatric brain ones, potentially because of technical challenges. REVIEW OF THE LITERATURE The authors review techniques and clinical applications of DWI, PWI, MRS, and fMRI, in the setting of pediatric hemispheric low-grade gliomas. PERSONAL EXPERIENCE The authors propose their personal experience to highlight benefits and limits of advanced MR imaging in diagnosis, grading, and presurgical planning of pediatric hemispheric low-grade gliomas. DISCUSSION Advanced techniques should be used as complementary tools to conventional MRI, and in theory, the combined use of the three techniques should ensure achieving the best results in the diagnosis of hemispheric low-grade glioma and in presurgical planning to maximize tumor resection and preserve brain function. FUTURE PERSPECTIVES In the setting of pediatric neurooncology, these techniques can be used to distinguish low-grade from high-grade tumor. However, these methods have to be applied on a large scale to understand their real potential and clinical relapse, and further technical development is required to reduce the excessive scan times and other technical limitations.
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Affiliation(s)
- Simona Gaudino
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy.
| | - Rosellina Russo
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy
| | - Tommaso Verdolotti
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Science, University "G. D'annunzio", Chieti, Italy
| | - Cesare Colosimo
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy
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Pierce T, Kranz PG, Roth C, Leong D, Wei P, Provenzale JM. Use of apparent diffusion coefficient values for diagnosis of pediatric posterior fossa tumors. Neuroradiol J 2014; 27:233-44. [PMID: 24750714 DOI: 10.15274/nrj-2014-10027] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/11/2014] [Indexed: 11/12/2022] Open
Abstract
We prospectively compared the ability of neuroradiologists to diagnose medulloblastoma with novice raters using only apparent diffusion coefficient (ADC) values measured on ADC maps. One hundred and three pediatric patients with pre-operative magnetic resonance imaging scans showing a posterior fossa tumor with histological verification were retrospectively identified from a ten-year period at a tertiary care medical center. A single observer measured the lowest ADC values in all tumors to determine the mean minimum ADC (ADCmin) value that provided greatest accuracy in distinguishing medulloblastomas from other tumors, which was determined to be 0.66×10(-3) mm(2)/s. Imaging studies, including ADC maps, from 90 patients were provided to two neuroradiologists, who provided a diagnosis, which was later dichotomized as medulloblastoma or other. Two medical students measured ADCmin within tumors and those with ADCmin < 0.66×10(-3) mm(2)/s were recorded as medulloblastoma; any other value was recorded as other. Diagnostic accuracy was measured. ADCmin values allowed a correct identification of lesions as either medulloblastoma or other in 91% of cases. After diagnoses by the two neuroradiologists were categorized as either medulloblastoma or other, their diagnoses were correct in 90% and 84% of cases, respectively. In 19 cases, at least one neuroradiologist was incorrect; the addition of ADC values to clinical interpretation would have allowed a correct diagnosis in 63% of such cases. Diagnostic accuracy based on ADC values by medical students was comparable to that of subspecialty-trained neuroradiologists. Our findings suggest that the addition of ADC values to standard film interpretation may improve the diagnostic rate for these tumors.
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Affiliation(s)
| | - Peter G Kranz
- Department of Radiology, Duke University Medical Center; Durham, NC, USA
| | - Christopher Roth
- Department of Radiology, Duke University Medical Center; Durham, NC, USA
| | | | - Peter Wei
- Duke University School of Medicine; Durham, NC, USA
| | - James M Provenzale
- Duke-NUS Graduate Medical School; Singapore - Departments of Radiology and Imaging Sciences, Oncology and Biomedical Engineering, Emory University School of Medicine; Atlanta, GA, USA
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de Fatima Vasco Aragao M, Law M, Batista de Almeida D, Fatterpekar G, Delman B, Bader AS, Pelaez M, Fowkes M, Vieira de Mello R, Moraes Valenca M. Comparison of perfusion, diffusion, and MR spectroscopy between low-grade enhancing pilocytic astrocytomas and high-grade astrocytomas. AJNR Am J Neuroradiol 2014; 35:1495-502. [PMID: 24699088 DOI: 10.3174/ajnr.a3905] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The differentiation of pilocytic astrocytomas and high-grade astrocytomas is sometimes difficult. There are limited comparisons in the literature of the advanced MR imaging findings of pilocytic astrocytomas versus high-grade astrocytomas. The purpose of this study was to assess the MR imaging, PWI, DWI, and MR spectroscopy characteristics of pilocytic astrocytomas compared with high-grade astrocytomas. MATERIALS AND METHODS Sixteen patients with pilocytic astrocytomas and 22 patients with high-grade astrocytomas (8-66 years of age; mean, 36 ± 17 years) were evaluated by using a 1.5T MR imaging unit. MR imaging, PWI, DWI, and MR spectroscopy were used to determine the differences between pilocytic astrocytomas and high-grade astrocytomas. The sensitivity, specificity, and the area under the receiver operating characteristic curve of all analyzed parameters at respective cutoff values were determined. RESULTS The relative cerebral blood volume values were significantly lower in pilocytic astrocytomas compared with the high-grade astrocytomas (1.4 ± 0.9 versus 3.3 ± 1.4; P = .0008). The ADC values were significantly higher in pilocytic astrocytomas compared with high-grade astrocytomas (1.5 × 10(-3) ± 0.4 versus 1.2 × 10(-3) ± 0.3; P = .01). The lipid-lactate in tumor/creatine in tumor ratios were significantly lower in pilocytic astrocytomas compared with high-grade astrocytomas (8.3 ± 11.2 versus 43.3 ± 59.2; P = .03). The threshold values ≥1.33 for relative cerebral blood volume provide sensitivity, specificity, positive predictive values, and negative predictive values of 100%, 67%, 87%, and 100%, respectively, for differentiating high-grade astrocytomas from pilocytic astrocytomas. The optimal threshold values were ≤1.60 for ADC, ≥7.06 for lipid-lactate in tumor/creatine in tumor, and ≥2.11 for lipid-lactate in tumor/lipid-lactate in normal contralateral tissue. CONCLUSIONS Lower relative cerebral blood volume and higher ADC values favor a diagnosis of pilocytic astrocytoma, while higher lipid-lactate in tumor/creatine in tumor ratios plus necrosis favor a diagnosis of high-grade astrocytomas.
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Affiliation(s)
- M de Fatima Vasco Aragao
- From the Departments of Radiology (M.d.F.V.A., D.B.d.A., B.D., A.S.B., M.P.)Centro Diagnóstico Multimagem (M.d.F.V.A.), Recife, BrazilDepartment of Neuropsychiatry and Behavioral Studies (M.d.F.V.A., M.M.V.), Federal University of Pernambuco, Recife, Brazil
| | - M Law
- Department of Radiology (M.L.), University of Southern California, Los Angeles, California
| | | | - G Fatterpekar
- Department of Radiology (G.F.), New York University Langone Medical Center, New York, New York
| | - B Delman
- From the Departments of Radiology (M.d.F.V.A., D.B.d.A., B.D., A.S.B., M.P.)
| | - A S Bader
- From the Departments of Radiology (M.d.F.V.A., D.B.d.A., B.D., A.S.B., M.P.)
| | - M Pelaez
- From the Departments of Radiology (M.d.F.V.A., D.B.d.A., B.D., A.S.B., M.P.)
| | - M Fowkes
- Pathology (M.F.), Mount Sinai School of Medicine, New York, New York
| | - R Vieira de Mello
- Department of Pathology (R.V.d.M.), Federal University of Pernambuco, Recife, Brazil
| | - M Moraes Valenca
- Department of Neuropsychiatry and Behavioral Studies (M.d.F.V.A., M.M.V.), Federal University of Pernambuco, Recife, Brazil
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Pierce TT, Provenzale JM. Evaluation of apparent diffusion coefficient thresholds for diagnosis of medulloblastoma using diffusion-weighted imaging. Neuroradiol J 2014; 27:63-74. [PMID: 24571835 DOI: 10.15274/nrj-2014-10007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 12/16/2013] [Indexed: 02/04/2023] Open
Abstract
We assess a diffusion-weighted imaging (DWI) analysis technique as a potential basis for computer-aided diagnosis (CAD) of pediatric posterior fossa tumors. A retrospective medical record search identified 103 children (mean age: 87 months) with posterior fossa tumors having a total of 126 preoperative MR scans with DWI. The minimum ADC (ADCmin) and normalized ADC (nADC) values [ratio of ADCmin values in tumor compared to normal tissue] were measured by a single observer blinded to diagnosis. Receiver operating characteristic (ROC) curves were generated to determine the optimal threshold for which the nADC and ADCmin values would predict tumor histology. Inter-rater reliability for predicting tumor type was evaluated using values measured by two additional observers. At histology, ten tumor types were identified, with astrocytoma (n=50), medulloblastoma (n=33), and ependymoma (n=9) accounting for 89%. Mean ADCmin (0.54 × 10(-3) mm(2)/s) and nADC (0.70) were lowest for medulloblastoma. Mean ADCmin (1.28 × 10(-3) mm(2)/s) and nADC (1.64) were highest for astrocytoma. For the ROC analysis, the area under the curve when discriminating medulloblastoma from other tumors using nADC was 0.939 and 0.965 when using ADCmin. The optimal ADCmin threshold was 0.66 × 10(-3) mm(2)/s, which yielded an 86% positive predictive value, 97% negative predictive value, and 93% accuracy. Inter-observer variability was very low, with near perfect agreement among all observers in predicting medulloblastoma. Our data indicate that both ADCmin and nADC could serve as the basis for a CAD program to distinguish medulloblastoma from other posterior fossa tumors with a high degree of accuracy.
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Affiliation(s)
| | - James M Provenzale
- Department of Radiology, Duke University Medical Center; Durham, NC, USA, - Departments of Radiology and Imaging Sciences, Oncology and Biomedical Engineering, Emory University School of Medicine; Atlanta, GA, USA
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Porto L, Jurcoane A, Schwabe D, Kieslich M, Hattingen E. Differentiation between high and low grade tumours in paediatric patients by using apparent diffusion coefficients. Eur J Paediatr Neurol 2013; 17:302-7. [PMID: 23273960 DOI: 10.1016/j.ejpn.2012.12.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 12/03/2012] [Accepted: 12/09/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study was performed to confirm the hypothesis that pre-operative apparent diffusion coefficient (ADC) can be used to distinguish between "low grade" and "high grade" tumours in paediatric patients. MATERIAL AND METHODS ADC values were retrospectively evaluated in thirty-six paediatric brain tumours. Twenty-one children with low grade brain tumours (12 WHO I astrocytomas, 1 giant cell tumour, 1 pilomyxoid astrocytoma, 4 WHO II astrocytomas, 2 craniopharyngiomas and 1 ganglioglioma) and 15 children with high grade brain tumours (6 medulloblastomas, 3 WHO III ependymomas, 1 PNET, 1 malignant rhabdoid tumour, 1 malignant germ cell tumour, 1 WHO III astrocytoma, 1 WHO IV astrocytoma, 1 rhabdomyosarcoma metastasis) were included in this study. Minimum and mean ADC values were compared between low grade and high grade tumours and cut-off values were evaluated. RESULTS The cut-off values to differentiate low and high grade paediatric brain tumours were 0.7 × 10(-3) mm(2)/s and 1.0 × 10(-3) mm(2)/s for minimum ADC and average ADC values respectively. All but one high grade infratentorial ependymoma showed significantly lower ADC values than low grade brain tumours in children. CONCLUSION Combining the information obtained from conventional MR imaging with the ADC values may increase the accuracy of pre-operative differentiation between low grade and high grade paediatric tumours. Cut-off values can help to discern low from high grade tumours. However, it has to be considered that there is a substantial overlap between tumour types previously described in the literature.
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Affiliation(s)
- Luciana Porto
- Neuroradiology Department of the Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
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Craig E, Connolly D, Griffiths P, Raghavan A, Lee V, Batty R. MRI protocols for imaging paediatric brain tumours. Clin Radiol 2012; 67:829-32. [DOI: 10.1016/j.crad.2012.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 03/15/2012] [Accepted: 03/27/2012] [Indexed: 10/28/2022]
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Gimi B, Cederberg K, Derinkuyu B, Gargan L, Koral KM, Bowers DC, Koral K. Utility of apparent diffusion coefficient ratios in distinguishing common pediatric cerebellar tumors. Acad Radiol 2012; 19:794-800. [PMID: 22513110 DOI: 10.1016/j.acra.2012.03.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 02/28/2012] [Accepted: 03/02/2012] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to identify clinically useful tumor/normal brain apparent diffusion coefficient (ADC) ratios for distinguishing common pediatric cerebellar tumors. MATERIALS AND METHODS Review of medical records revealed 79 patients with cerebellar tumors who underwent preoperative magnetic resonance imaging, including diffusion-weighted imaging sequences, and surgery. There were 31 pilocytic astrocytomas, 27 medulloblastomas, 14 ependymomas, and seven atypical teratoid/rhabdoid tumors. ADC values were measured by placing regions of interest on the solid tumor and normal brain parenchyma by two reviewers. Tumor/normal brain ADC ratios were calculated. RESULTS Mean ADC values of the pilocytic astrocytomas were greater than those of ependymomas, whose mean ADC values were greater than those of medulloblastomas and atypical teratoid/rhabdoid tumors. Using a tumor/normal brain ADC ratio threshold of 1.70 to distinguish pilocytic astrocytomas from ependymomas, sensitivity of 92% and specificity of 79% were achieved. A tumor/normal brain ADC ratio threshold of 1.20 enabled the sorting of ependymomas from medulloblastomas with sensitivity of 93% and specificity of 88%. CONCLUSIONS Tumor/normal brain ADC ratios allow the distinguishing of common pediatric cerebellar tumors.
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Abstract
Lateral ventricular neoplasms are rare, and account for 50% of all intraventricular tumors in adults and 25% in children. Although these neoplasms are easily detected with computed tomography (CT) and magnetic resonance imaging (MRI), both techniques are relatively unspecific in identifying the type of tumor. However, few imaging patterns are specific for a particular pathological process and useful conclusions can be made from the morphological appearance of the lesion, its location and enhancement pattern. The aim of this article was to review and illustrate the CT and MRI findings of a wide spectrum of tumors of the lateral ventricle. We reviewed choroid plexus tumors, meningioma, subependymal giant cell astrocytoma, central neurocytoma, and less frequent lesion such as lymphoma and metastases.
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Ji YM, Geng DY, Huang BC, Li YX, Ren G, Zhu L. Value of Diffusion-Weighted Imaging in Grading Tumours Localized in the Fourth Ventricle Region by Visual and Quantitative Assessments. J Int Med Res 2011; 39:912-9. [PMID: 21819724 DOI: 10.1177/147323001103900325] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study investigated visual and quantitative assessment of diffusion-weighted imaging (DWI) for grading tumours localized in the fourth ventricle region. Patients were diagnosed histopathologically and classified into two groups: those with high-grade (World Health Organization [WHO] grades III and IV) and those with low-grade tumours (benign, WHO grades I and II). DWI signal intensity was described using a five-point scale. Minimum apparent diffusion coefficient (ADC) values were obtained from areas with the lowest signal. The mean signal intensity was significantly higher in high-grade than in low-grade tumours. The mean minimum ADC value was significantly lower in high-grade than low-grade tumours. Marked hyperintensity had sensitivity, specificity, positive predictive value and negative predictive value of 89.7%, 100%, 100% and 94.2%, respectively, when used as a diagnostic tool for high-grade tumours compared with 96.6%, 97.9%, 96.6% and 97.9%, respectively, when using a minimum ADC of 0.9 × 10−3 mm2/s as a diagnostic marker. It was concluded that DWI is helpful in predicting the grades of tumours in the fourth ventricle region.
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Affiliation(s)
- YM Ji
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - DY Geng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - BC Huang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - YX Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - G Ren
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - L Zhu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
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16
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Forbes JA, Reig AS, Smith JG, Jermakowicz W, Tomycz L, Shay SD, Sun DA, Wushensky CA, Pearson MM. Findings on preoperative brain MRI predict histopathology in children with cerebellar neoplasms. Pediatr Neurosurg 2011; 47:51-9. [PMID: 21921669 PMCID: PMC3219443 DOI: 10.1159/000329627] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 05/23/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The majority of pediatric patients with cerebellar neoplasms harbor pilocytic astrocytomas (PAs), medulloblastomas, or ependymomas. Knowledge of a preoperative likelihood of histopathology in this group of patients has the potential to influence many aspects of care. Previous studies have demonstrated hyperintensity on diffusion-weighted imaging to correlate with medulloblastomas. Recently, measurement of T(2)-weighted signal intensity (T2SI) was shown to be useful in identification of low-grade cerebellar neoplasms. The goal of this study was to assess whether objective findings on these MRI sequences reliably correlated with the underlying histopathology. METHODS We reviewed the radiologic findings of 50 pediatric patients who underwent resection of a cerebellar neoplasm since 2003 at our institution. Region of interest placement was used to calculate the relative diffusion-weighted signal intensity (rDWSI) and relative T2SI (rT2SI) of each neoplasm. RESULTS Tukey's multiple comparison test demonstrated medulloblastomas to have significantly higher rDWSIs than PAs/ependymomas, and PAs to have significantly higher rT2SIs than medulloblastomas/ependymomas. A simple method consisting of sequential measurement of rDWSI and rT2SI to predict histopathology was then constructed. Using this method, 39 of 50 (78%) tumors were accurately predicted. CONCLUSION Measurement of rDWSI and rT2SI using standard MRI of the brain can be used to predict histopathology with favorable accuracy in pediatric patients with cerebellar tumors.
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Affiliation(s)
- Jonathan A Forbes
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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17
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Raab P, Hattingen E, Franz K, Zanella FE, Lanfermann H. Cerebral gliomas: diffusional kurtosis imaging analysis of microstructural differences. Radiology 2010; 254:876-81. [PMID: 20089718 DOI: 10.1148/radiol.09090819] [Citation(s) in RCA: 288] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To characterize the non-Gaussian diffusion patterns of cerebral glioma microstructure with respect to the different glioma grades by using a new method called diffusional kurtosis (DK) imaging. MATERIALS AND METHODS In this study with institutional review board approval and patient consent, diffusional measures of mean kurtosis (MK), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) were compared prospectively. Data were normalized to the contralateral white matter. A Mann-Whitney test was used to compare each histologic glioma subtype regarding the diffusion measurements. Receiver operating characteristic curves were used to test for the parameter with the best sensitivity and specificity for glioma grade discrimination. RESULTS In 34 patients with cerebral gliomas (five World Health Organization [WHO] grade II astrocytomas, 13 WHO grade III astrocytomas, and 16 WHO grade IV glioblastomas multiforme), significantly different diffusion patterns were found among the three glioma groups. MK values increased with higher glioma malignancy, whereas ADCs tended to decrease with higher malignancy; FA values did not differ significantly among tumor groups. Significant differences between astrocytoma grades WHO II and WHO III were demonstrated only by DK values. Area under the receiver operating characteristic curve was highest for normalized MK (0.972) during testing to discriminate between low- and high-grade gliomas. CONCLUSION This study demonstrates specific diffusion patterns for low- and high-grade gliomas, showing that DK imaging is able to depict microstructural changes within glioma tissue and is able to help differentiate among glioma grades. (c) RSNA, 2010.
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Affiliation(s)
- Peter Raab
- Institute of Neuroradiology and Department of Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany.
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18
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Jissendi Tchofo P, Balériaux D. Brain 1H-MR spectroscopy in clinical neuroimaging at 3T. J Neuroradiol 2009; 36:24-40. [DOI: 10.1016/j.neurad.2008.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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19
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Combaz X, Girard N, Scavarda D, Chapon F, Pineau S, Levrier O, Viout P, Confort-Gouny S. Imagerie des tumeurs cérébrales de l’enfant. J Neuroradiol 2008; 35:261-7. [DOI: 10.1016/j.neurad.2008.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2007] [Accepted: 03/05/2008] [Indexed: 10/22/2022]
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20
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Abstract
Central nervous system (CNS) tumors are the most common solid neoplasms in childhood and the second most common malignancies after leukemia in the pediatric age group. Supratentorial tumors are more common in children younger than 2 years old and in adolescents, whereas in patients between 2 and 12 years of age brain tumors originating in the posterior fossa dominate. This implies a relationship between the type of tumor, its location and the age of the patient, which has to be considered in differential diagnoses. Medulloblastoma represents the most common malignant brain tumor in childhood. In the posterior fossa medulloblastomas are approximately as frequent as astrocytomas. Supratentorial astrocytomas are by far the main tumor type. In this report some typical CNS neoplasms in children are discussed and their neuroradiological features are demonstrated.
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Affiliation(s)
- M Sinzig
- Kinderradiologie RZI , Landeskrankenhaus Klagenfurt, Klagenfurt, Osterreich.
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21
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Guzman R, Altrichter S, El-Koussy M, Gralla J, Weis J, Barth A, Seiler RW, Schroth G, Lövblad KO. Contribution of the apparent diffusion coefficient in perilesional edema for the assessment of brain tumors. J Neuroradiol 2008; 35:224-9. [PMID: 18420272 DOI: 10.1016/j.neurad.2008.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Diffusion-weighted MRI is sensitive to molecular motion and has been applied to the diagnosis of stroke. Our intention was to investigate its usefulness in patients with brain tumor and, in particular, in the perilesional edema. METHODS We performed MRI of the brain, including diffusion-weighted imaging and mapping of the apparent diffusion coefficient (ADC), in 16 patients with brain tumors (glioblastomas, low-grade gliomas and metastases). ADC values were determined by the use of regions of interest positioned in areas of high signal intensities as seen on T2-weighted images and ADC maps. Measurements were taken in the tumor itself, in the area of perilesional edema and in the healthy contralateral brain. RESULTS ADC mapping showed higher values of peritumoral edema in patients with glioblastoma (1.75 x 10(-3)mm(2)/s) and metastatic lesions (1.61 x 10(-3)mm(2)/s) compared with those who had low-grade glioma (1.40 x10(-3)mm(2)/s). The higher ADC values in the peritumoral zone were associated with lower ADC values in the tumor itself. CONCLUSIONS The higher ADC values in the more malignant tumors probably reflect vasogenic edema, thereby allowing their differentiation from other lesions.
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Affiliation(s)
- R Guzman
- Department of Neurosurgery, Inselspital, University of Berne, Berne, Switzerland
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22
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Oguz KK, Haliloglu G, Alehan D, Topcu M. Recurrent pseudotumoral hemicerebellitis: neuroimaging findings. Pediatr Radiol 2008; 38:462-6. [PMID: 18185927 DOI: 10.1007/s00247-007-0725-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 10/30/2007] [Accepted: 10/31/2007] [Indexed: 11/27/2022]
Abstract
We present the case of a 13-year-old girl with pseudotumoral hemicerebellitis that recurred 22 months after the first episode together with conventional MR imaging findings and diffusion-weighted imaging and MR spectroscopy findings. A mirror pattern of involvement was present with the contralateral hemisphere affected in the second episode. Recurrent hemicerebellitis is unique and recognition of the radiological findings allows accurate diagnosis that can be a challenge clinically.
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Affiliation(s)
- Kader K Oguz
- Department of Radiology, Faculty of Medicine, Hacettepe University, Sihhiye, 06100 Ankara, Turkey.
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