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Limaye W, Ahmad T. Advanced MRI imaging techniques in pediatric brain tumors. Pediatr Radiol 2024:10.1007/s00247-024-05966-w. [PMID: 38913187 DOI: 10.1007/s00247-024-05966-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/14/2024] [Accepted: 05/29/2024] [Indexed: 06/25/2024]
Abstract
There is a diverse array of pediatric brain tumors with considerable associated morbidity. Like adult brain tumors, MRI serves as the primary imaging modality for pediatric brain tumors. In addition to standard sequences, more advanced MRI techniques can enhance the precision of diagnosis and assist in prognostication, and treatment planning. This paper discusses these various advanced techniques categorizing them into those that assist in identifying tissue characteristics, and those that evaluate the functional impact of tumors to aid in treatment planning.
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Affiliation(s)
- Warda Limaye
- Department of Radiology, Dalhousie University, Halifax, NS, Canada.
| | - Tahani Ahmad
- Department of Radiology, Dalhousie University, Halifax, NS, Canada.
- Department of Pediatric Radiology, IWK Health, Halifax, NS, Canada.
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2
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Wang YF, Yang YL, Yang SH, Peng SSF. Prognostic implications of distinctive imaging characteristics in primary intracranial germ cell tumors: A retrospective analysis. J Formos Med Assoc 2024:S0929-6646(24)00252-3. [PMID: 38821737 DOI: 10.1016/j.jfma.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/03/2024] [Accepted: 05/22/2024] [Indexed: 06/02/2024] Open
Abstract
PURPOSE Primary central nervous system (CNS) germ cell tumors (GCTs) are rare brain tumors that encompass two subtypes: germinomas and non-germinomatous germ cell tumors (NGGCTs), NGGCTs have less favorable outcome and require multi-modality treatment. Biopsy is recommended for disease diagnosis, the specimen may not adequately reflect the entire tumor. This study aimed to assess distinct imaging characteristics to differentiate between GCT subgroups and to identify possible initial image and subgroup features that influence survival. METHOD This retrospective study, conducted from January 2006 to March 2023, analyzed patient data and MRI findings of primary CNS GCTs. It evaluated tumor characteristics including cysts, seeding, multifocality, and hemorrhage. Tumor volumes and apparent diffusion coefficient (ADC) values of both tumoral and normal-appearing contralateral white matter were measured. These factors were correlated with overall and 5-year survival rates. RESULTS This study included 51 participants with CGTs, comprising 19 germinoma and 32 NGGCTs cases. GCTs with hemorrhage had worse overall (P = 0.03) and 5-year (P = 0.01) survival rates. No survival difference between germinoma and non-hemorrhagic NGGCT. NGGCTs were more likely to bleed (P < 0.001) than germ cell tumor, especially those with choriocarcinoma or yolk sac tumor components (P = 0.001). The ADC ratios of germinomas were significantly lower than those of NGGCTs (P = 0.03 for whole tumor; P < 0.01 or solid part), The ADC ratios of choriocarcinoma were also lower than mixed tumor (P = 0.01; P = 0.02). CONCLUSION Hemorrhage indicates worse prognosis. Intratumoral hemorrhage and ADC ratios differentiate germinoma from NGGCTs. Larger cohorts and advanced MR techniques are needed for future study.
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Affiliation(s)
- Yu-Fen Wang
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei City, 100, Taiwan, ROC.
| | - Yung-Li Yang
- Division of Pediatric Hematology and Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei City, 100, Taiwan, ROC.
| | - Shih-Hung Yang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei City, 100, Taiwan, ROC.
| | - Steven Shinn-Forng Peng
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei City, 100, Taiwan, ROC.
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3
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Kong X, Mao Y, Xi F, Li Y, Luo Y, Ma J. Nomograms Based on MRI Radiomics for Differential Diagnosis and Predicting BRAFV600E Expression in Pleomorphic Xanthoastrocytoma and Ganglioglioma. Acad Radiol 2024; 31:1069-1081. [PMID: 37741731 DOI: 10.1016/j.acra.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/25/2023]
Abstract
RATIONALE AND OBJECTIVES This study was designed to investigate the value of nomograms based on MRI radiomics and clinical semantic features in identifying pleomorphic xanthoastrocytoma (PXA) and ganglioglioma (GG) as well as predicting BRAFV600E expression. MATERIALS AND METHODS This study included 265 patients histologically diagnosed with PXA (n = 113) and GG (n = 152). T1WI, T2WI, and CET1 sequences were utilized to extract radiomics features. Univariate analysis, Spearman correlation analysis, and the least absolute shrinkage and selection operator were used for dimensionality reduction and feature selection. Following this, logistic regression was utilized to establish the radiomics model. Univariate and multivariate analyses of clinical semantic features were applied, and clinical models were constructed. The nomograms were established by merging radiomics and clinical features. Furthermore, ROC curve analysis was used for examining the model performance, whereas the decision curve analysis (DCA) examined the clinical utility of the nomograms. RESULTS Nomograms achieved the best predictive efficacy compared to clinical and radiomics models alone. Concerning the differentiation between PXA and GG, the area under the curve (AUC) values of the nomogram were 0.879 (0.828-0.930) and 0.887 (0.805-0.969) for the training and testing cohorts, respectively. For predicting BRAFV600E expression, the AUC values of the nomogram were 0.873 (0.811-0.936) and 0.851 (0.740-0.963) for the training and testing cohorts, respectively. DCA confirmed the clinical utility of the nomograms. CONCLUSION Nomograms based on radiomics and clinical semantic features were noninvasive tools for differential diagnosis of PXA and GG and predicting BRAFV600E expression, which may be helpful for assessing patient prognosis and developing individualized treatment strategies.
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Affiliation(s)
- Xin Kong
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu Mao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fengjun Xi
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan Li
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuqi Luo
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun Ma
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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4
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Nafe R, Porto L, Samp PF, You SJ, Hattingen E. Adult-type and Pediatric-type Diffuse Gliomas : What the Neuroradiologist Should Know. Clin Neuroradiol 2023; 33:611-624. [PMID: 36941392 PMCID: PMC10449995 DOI: 10.1007/s00062-023-01277-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/03/2023] [Indexed: 03/22/2023]
Abstract
The classification of diffuse gliomas into the adult type and the pediatric type is the new basis for the diagnosis and clinical evaluation. The knowledge for the neuroradiologist should not remain limited to radiological aspects but should be based additionally on the current edition of the World Health Organization (WHO) classification of tumors of the central nervous system (CNS). This classification defines the 11 entities of diffuse gliomas, which are included in the 3 large groups of adult-type diffuse gliomas, pediatric-type diffuse low-grade gliomas, and pediatric-type diffuse high-grade gliomas. This article provides a detailed overview of important molecular, morphological, and clinical aspects for all 11 entities, such as typical genetic alterations, age distribution, variability of the tumor localization, variability of histopathological and radiological findings within each entity, as well as currently available statistical information on prognosis and outcome. Important differential diagnoses are also discussed.
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Affiliation(s)
- Reinhold Nafe
- Dept. Neuroradiology, Clinics of Johann Wolfgang-Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
| | - Luciana Porto
- Dept. Neuroradiology, Clinics of Johann Wolfgang-Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Patrick-Felix Samp
- Dept. Neuroradiology, Clinics of Johann Wolfgang-Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Se-Jong You
- Dept. Neuroradiology, Clinics of Johann Wolfgang-Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Elke Hattingen
- Dept. Neuroradiology, Clinics of Johann Wolfgang-Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
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5
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Plut D, Prutki M, Slak P. The Use of Contrast-Enhanced Ultrasound (CEUS) in the Evaluation of the Neonatal Brain. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1303. [PMID: 37628302 PMCID: PMC10453292 DOI: 10.3390/children10081303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/18/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023]
Abstract
In recent years, advancements in technology have allowed the use of contrast-enhanced ultrasounds (CEUS) with high-frequency transducers, which in turn, led to new possibilities in diagnosing a variety of diseases and conditions in the field of radiology, including neonatal brain imaging. CEUSs overcome some of the limitations of conventional ultrasounds (US) and Doppler USs. It allows the visualization of dynamic perfusion even in the smallest vessels in the whole brain and allows the quantitative analysis of perfusion parameters. An increasing number of articles are published on the topic of the use of CEUSs on children each year. In the area of brain imaging, the CEUS has already proven to be useful in cases with clinical indications, such as hypoxic-ischemic injuries, stroke, intracranial hemorrhages, vascular anomalies, brain tumors, and infections. We present and discuss the basic principles of the CEUS and its safety considerations, the examination protocol for imaging the neonatal brain, and current and emerging clinical applications.
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Affiliation(s)
- Domen Plut
- Clinical Radiology Institute, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Maja Prutki
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Peter Slak
- Clinical Radiology Institute, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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6
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Younes SW, Charoenkijkajorn C, Pakravan M, Mortensen PW, Rivera AL, Britz GW, Wong MS, Lee AG. Papilledema as the Presenting Sign of Pineal Ganglioglioma. J Neuroophthalmol 2023:00041327-990000000-00397. [PMID: 37418610 DOI: 10.1097/wno.0000000000001931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Affiliation(s)
- Sami W Younes
- Department of Ophthalmology (SWY, AGL), University of Texas Medical Branch, Galveston, Texas; Department of Ophthalmology (CC, MP, PWM, AGL), Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Departments of Pathology and Genomic Medicine (ALR) and Neurosurgery (GWB, MSW), Houston Methodist Hospital, Houston, Texas; Departments of Ophthalmology, Neurology, and Neurosurgery (AGL), Weill Cornell Medicine, New York, New York; University of Texas MD Anderson Cancer Center (AGL), Houston, Texas; Texas A and M College of Medicine (AGL), Bryan, Texas; and Department of Ophthalmology (AGL), The University of Iowa Hospitals and Clinics, Iowa City, Iowa
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7
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Khalili N, Kazerooni AF, Familiar A, Haldar D, Kraya A, Foster J, Koptyra M, Storm PB, Resnick AC, Nabavizadeh A. Radiomics for characterization of the glioma immune microenvironment. NPJ Precis Oncol 2023; 7:59. [PMID: 37337080 DOI: 10.1038/s41698-023-00413-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023] Open
Abstract
Increasing evidence suggests that besides mutational and molecular alterations, the immune component of the tumor microenvironment also substantially impacts tumor behavior and complicates treatment response, particularly to immunotherapies. Although the standard method for characterizing tumor immune profile is through performing integrated genomic analysis on tissue biopsies, the dynamic change in the immune composition of the tumor microenvironment makes this approach not feasible, especially for brain tumors. Radiomics is a rapidly growing field that uses advanced imaging techniques and computational algorithms to extract numerous quantitative features from medical images. Recent advances in machine learning methods are facilitating biological validation of radiomic signatures and allowing them to "mine" for a variety of significant correlates, including genetic, immunologic, and histologic data. Radiomics has the potential to be used as a non-invasive approach to predict the presence and density of immune cells within the microenvironment, as well as to assess the expression of immune-related genes and pathways. This information can be essential for patient stratification, informing treatment decisions and predicting patients' response to immunotherapies. This is particularly important for tumors with difficult surgical access such as gliomas. In this review, we provide an overview of the glioma microenvironment, describe novel approaches for clustering patients based on their tumor immune profile, and discuss the latest progress on utilization of radiomics for immune profiling of glioma based on current literature.
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Affiliation(s)
- Nastaran Khalili
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anahita Fathi Kazerooni
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, PA, USA
- AI2D Center for AI and Data Science for Integrated Diagnostics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ariana Familiar
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Debanjan Haldar
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Institute of Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adam Kraya
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jessica Foster
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Mateusz Koptyra
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Phillip B Storm
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adam C Resnick
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ali Nabavizadeh
- Center for Data-Driven Discovery in Biomedicine (D3b), 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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8
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Phuttharak W, Wannasarnmetha M, Lueangingkasut P, Waraasawapati S, Mukherji SK. Differentiation between germinoma and other pineal region tumors using diffusion-and susceptibility-weighted MRI. Eur J Radiol 2023; 159:110663. [PMID: 36584565 DOI: 10.1016/j.ejrad.2022.110663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/26/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the effectiveness of diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) for differentiation between germinoma and other pineal region tumors. METHOD This retrospective study consisted of 72 patients with pathologically proven pineal region tumors between January 2010 and August 2020. Tumors were classified as germinomas (40), non-germinomatous germ cell tumors (11) (NGGCT), pineal parenchymal tumors (10) (PPT), and other types of tumors (11). Visual scale score, ADC values and SWI intratumoral susceptibility signal (ITSS) score were analyzed and compared to histopathology data. RESULTS The mean apparent diffusion coefficient (ADCmean) and minimum apparent diffusion coefficient (ADCmin) ratio of germinoma were significantly lower than NGGCT. ADCmean or ADCmin cut-off ratio of ≤ 1.48 or ≤ 1.32 allowed for discrimination between germinoma and NGGCT with sensitivity and specificity of 100 % and 63.6 %. An ADCmin cut-off ratio of ≥ 0.93 allowed for discrimination between germinoma and PPT with sensitivity and specificity of 60 % and 80.0 %. ADCmin cut-off ratio of ≤ 1.15 allowed for discrimination of germinoma from other types of tumors with sensitivity and specificity of 87.5 % and 54.5 %. CONCLUSIONS ADC ratio can differentiate germinoma from other types of pineal region tumors. Our initial results suggest that ITSS score was not significantly correlated with specific histology subtype.
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Affiliation(s)
- Warinthorn Phuttharak
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Mix Wannasarnmetha
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
| | - Peerawit Lueangingkasut
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sakda Waraasawapati
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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Spennato P, De Martino L, Russo C, Errico ME, Imperato A, Mazio F, Miccoli G, Quaglietta L, Abate M, Covelli E, Donofrio V, Cinalli G. Tumors of Choroid Plexus and Other Ventricular Tumors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:175-223. [PMID: 37452939 DOI: 10.1007/978-3-031-23705-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Tumors arising inside the ventricular system are rare but represent a difficult diagnostic and therapeutic challenge. They usually are diagnosed when reaching a big volume and tend to affect young children. There is a wide broad of differential diagnoses with significant variability in anatomical aspects and tumor type. Differential diagnosis in tumor type includes choroid plexus tumors (papillomas and carcinomas), ependymomas, subependymomas, subependymal giant cell astrocytomas (SEGAs), central neurocytomas, meningiomas, and metastases. Choroid plexus tumors, ependymomas of the posterior fossa, and SEGAs are more likely to appear in childhood, whereas subependymomas, central neurocytomas, intraventricular meningiomas, and metastases are more frequent in adults. This chapter is predominantly focused on choroid plexus tumors and radiological and histological differential diagnosis. Treatment is discussed in the light of the modern acquisition in genetics and epigenetics of brain tumors.
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Affiliation(s)
- Pietro Spennato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy.
| | - Lucia De Martino
- Department of Pediatric Oncology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Carmela Russo
- Department of Neuroradiology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Maria Elena Errico
- Department of Pathology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Alessia Imperato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
| | - Federica Mazio
- Department of Neuroradiology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Giovanni Miccoli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
| | - Lucia Quaglietta
- Department of Pediatric Oncology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Massimo Abate
- Department of Pediatric Oncology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Eugenio Covelli
- Department of Neuroradiology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Vittoria Donofrio
- Department of Pathology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
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10
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Nguyen AM, Huynh NT, Nguyen TTP. Intraoperative cortical and subcortical stimulation for lesions related to eloquent motor cortex and corticospinal tract in a developing country. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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11
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MR Imaging of Pediatric Brain Tumors. Diagnostics (Basel) 2022; 12:diagnostics12040961. [PMID: 35454009 PMCID: PMC9029699 DOI: 10.3390/diagnostics12040961] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 02/04/2023] Open
Abstract
Primary brain tumors are the most common solid neoplasms in children and a leading cause of mortality in this population. MRI plays a central role in the diagnosis, characterization, treatment planning, and disease surveillance of intracranial tumors. The purpose of this review is to provide an overview of imaging methodology, including conventional and advanced MRI techniques, and illustrate the MRI appearances of common pediatric brain tumors.
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12
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Paun L, Lavé A, Patet G, Bartoli A. Supratentorial Pediatric Midline Tumors and Tumor-like Lesions: Clinical Spectrum, Natural History and Treatment Options. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040534. [PMID: 35455578 PMCID: PMC9032564 DOI: 10.3390/children9040534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 04/10/2023]
Abstract
Childhood Central Nervous System tumors account for 25% of all pediatric tumors. Large availability and broadening of indications to imaging has made incidental findings more common. Among these, midline lesions have different clinical relevance depending on their intrinsic pattern of behaviour and on their specific location. In this narrative review we describe the natural history and treatment options of midline lesions in children.
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13
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Zhang M, Tam L, Wright J, Mohammadzadeh M, Han M, Chen E, Wagner M, Nemalka J, Lai H, Eghbal A, Ho CY, Lober RM, Cheshier SH, Vitanza NA, Grant GA, Prolo LM, Yeom KW, Jaju A. Radiomics Can Distinguish Pediatric Supratentorial Embryonal Tumors, High-Grade Gliomas, and Ependymomas. AJNR Am J Neuroradiol 2022; 43:603-610. [PMID: 35361575 PMCID: PMC8993189 DOI: 10.3174/ajnr.a7481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/25/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Pediatric supratentorial tumors such as embryonal tumors, high-grade gliomas, and ependymomas are difficult to distinguish by histopathology and imaging because of overlapping features. We applied machine learning to uncover MR imaging-based radiomics phenotypes that can differentiate these tumor types. MATERIALS AND METHODS Our retrospective cohort of 231 patients from 7 participating institutions had 50 embryonal tumors, 127 high-grade gliomas, and 54 ependymomas. For each tumor volume, we extracted 900 Image Biomarker Standardization Initiative-based PyRadiomics features from T2-weighted and gadolinium-enhanced T1-weighted images. A reduced feature set was obtained by sparse regression analysis and was used as input for 6 candidate classifier models. Training and test sets were randomly allocated from the total cohort in a 75:25 ratio. RESULTS The final classifier model for embryonal tumor-versus-high-grade gliomas identified 23 features with an area under the curve of 0.98; the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 0.85, 0.91, 0.79, 0.94, and 0.89, respectively. The classifier for embryonal tumor-versus-ependymomas identified 4 features with an area under the curve of 0.82; the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 0.93, 0.69, 0.76, 0.90, and 0.81, respectively. The classifier for high-grade gliomas-versus-ependymomas identified 35 features with an area under the curve of 0.96; the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 0.82, 0.94, 0.82, 0.94, and 0.91, respectively. CONCLUSIONS In this multi-institutional study, we identified distinct radiomic phenotypes that distinguish pediatric supratentorial tumors, high-grade gliomas, and ependymomas with high accuracy. Incorporation of this technique in diagnostic algorithms can improve diagnosis, risk stratification, and treatment planning.
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Affiliation(s)
- M Zhang
- From the Departments of Neurosurgery (M.Z.)
| | - L Tam
- Stanford University School of Medicine (L.T.), Stanford, California
| | - J Wright
- Department of Radiology (J.W.).,Department of Radiology (J.W.), Harborview Medical Center, Seattle, Washington
| | - M Mohammadzadeh
- Department of Radiology (M.M.), Tehran University of Medical Sciences, Tehran, Iran
| | - M Han
- Department of Pediatrics (M.H.), Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - E Chen
- Departments of Clinical Radiology & Imaging Sciences (E.C., C.Y.H.), Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - M Wagner
- Department of Diagnostic Imaging (M.W.), The Hospital for Sick Children, Ontario, Canada
| | - J Nemalka
- Division of Pediatric Neurosurgery (J.N., S.H.C.), Department of Neurosurgery, Huntsman Cancer Institute, Intermountain Healthcare Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - H Lai
- Department of Radiology (H.L., A.E.), CHOC Children's Hospital of Orange County California, University of California, Irvine, California
| | - A Eghbal
- Department of Radiology (H.L., A.E.), CHOC Children's Hospital of Orange County California, University of California, Irvine, California
| | - C Y Ho
- Departments of Clinical Radiology & Imaging Sciences (E.C., C.Y.H.), Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - R M Lober
- Division of Neurosurgery (R.M.L.), Dayton Children's Hospital, Dayton, Ohio; Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - S H Cheshier
- Division of Pediatric Neurosurgery (J.N., S.H.C.), Department of Neurosurgery, Huntsman Cancer Institute, Intermountain Healthcare Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - N A Vitanza
- Division of Pediatric Hematology/Oncology (N.A.V.), Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - G A Grant
- Neurosurgery (G.A.G., L.M.P.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - L M Prolo
- Neurosurgery (G.A.G., L.M.P.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - K W Yeom
- Departments of Radiology (K.W.Y.)
| | - A Jaju
- Department of Medical Imaging (A.J.), Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Saeed M, Ahsan M, Ur Rahman A, Saeed MH, Mehmood A. An application of neutrosophic hypersoft mapping to diagnose brain tumor and propose appropriate treatment. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2021. [DOI: 10.3233/jifs-210482] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Brain tumors are one of the leading causes of death around the globe. More than 10 million people fall prey to it every year. This paper aims to characterize the discussions related to the diagnosis of tumors with their related problems. After examining the side effects of tumors, it encases similar indications, and it is hard to distinguish the precise type of tumors with their seriousness. Since in practical assessment, the indeterminacy and falsity parts are frequently dismissed, and because of this issue, it is hard to notice the precision in the patient’s progress history and cannot foresee the period of treatment. The Neutrosophic Hypersoft set (NHS) and the NHS mapping with its inverse mapping has been design to overcome this issue since it can deal with the parametric values of such disease in more detail considering the sub-parametric values; and their order and arrangement. These ideas are capable and essential to analyze the issue properly by interfacing it with scientific modeling. This investigation builds up a connection between symptoms and medicines, which diminishes the difficulty of the narrative. A table depending on a fuzzy interval between [0, 1] for the sorts of tumors is constructed. The calculation depends on NHS mapping to adequately recognize the disease and choose the best medication for each patient’s relating sickness. Finally, the generalized NHS mapping is presented, which will encourage a specialist to extricate the patient’s progress history and to foresee the time of treatment till the infection is relieved.
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Affiliation(s)
- Muhammad Saeed
- Department of Mathematics, University of Management and Technology, Lahore, Punjab, Pakistan
| | - Muhammad Ahsan
- Department of Mathematics, University of Management and Technology, Lahore, Punjab, Pakistan
| | - Atiqe Ur Rahman
- Department of Mathematics, University of Management and Technology, Lahore, Punjab, Pakistan
| | - Muhammad Haris Saeed
- Department of Chemistry, University of Management and Technology, Lahore, Punjab, Pakistan
| | - Asad Mehmood
- Department of Mathematics, University of Management and Technology, Lahore, Punjab, Pakistan
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15
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Ferreira Furtado LM, Da Costa Val Filho JA, Rodrigues da Costa GA, Gouvea Braga PS. Pleomorphic Xanthoastrocytoma of the Frontal Lobe in a Child: A Rare Entity. Cureus 2021; 13:e15566. [PMID: 34131549 PMCID: PMC8195545 DOI: 10.7759/cureus.15566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pleomorphic xanthoastrocytoma (PXA) is an infrequent neoplasm that affects children less commonly than adults. In this case report, a four-year-old boy presented with focal seizures has diagnosed with this tumor in the frontal lobe. Complete surgical resection was achieved, and histopathological features of PXA grade II were observed. During follow-up, the patient showed improvement of the focal seizures. In spite of the pleomorphic features, the PXA had a favorable prognosis.
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16
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Gumede NP, Langa SM, Enicker B. MRI characteristics of intracranial masses in the paediatric population of KwaZulu-Natal: A neuroimaging-based study. SA J Radiol 2021; 25:2042. [PMID: 34192072 PMCID: PMC8182454 DOI: 10.4102/sajr.v25i1.2042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/15/2021] [Indexed: 11/01/2022] Open
Abstract
Background MRI is the imaging modality of choice for the assessment of intracranial masses in children. Imaging is vital in planning further management. Objectives The purpose of this study was to describe the common intracranial masses and their imaging characteristics in the paediatric population referred to Inkosi Albert Luthuli Central Hospital for MRI of the brain. Method We retrospectively reviewed the medical records of paediatric patients (aged from birth to 18 years) who underwent MRI investigations for intracranial masses between January 2010 and December 2016. Results A total of 931 MRI brain scans were performed. One hundred and seven scans met the inclusion criteria, of which 92 were primary brain tumours and 15 were inflammatory masses. The majority were females (56%). The mean age was 12 ± 4.52 (range of 3-18 years). The most common presenting symptom was seizures (70/107, 65.4%). We categorised the masses according to supra- and infratentorial compartments. The most common site for masses was the supratentorial compartment (n = 56, 52%). The most common masses in the supratentorial compartment were craniopharyngiomas (14/45, 31.1%), whilst in the infratentorial compartment, the most common masses were medulloblastomas (24/47, 51.1%). Conclusion In our series, the supratentorial compartment was the commonest site for intracranial masses. The most common tumour in the infratentorial compartment was medulloblastoma. This information is vital in formulating differential diagnoses of intracranial masses.
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Affiliation(s)
- Nompumelelo P Gumede
- Department of Radiology, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sithembiso M Langa
- Department of Radiology, Jackpersad and Partners Inc., Durban, South Africa
| | - Basil Enicker
- Department of Neurosurgery, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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17
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Li W, Kong X, Ma J. Imaging diagnosis of basal ganglia germ cell tumors: subtype features subtype imaging features of GCTs. Br J Radiol 2021; 94:20201453. [PMID: 33914622 DOI: 10.1259/bjr.20201453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the subtype imaging features of basal ganglia germ cell tumors (GCTs). METHODS Clinical and imaging data of 33 basal ganglia GCTs were retrospectively analyzed, including 17 germinomas and 16 mixed germ cell tumors (MGCTs). RESULTS The cyst/mass ratio of germinomas (0.53 ± 0.32) was higher than that of MGCTs (0.28 ± 0.19, p = 0.030). CT density of the solid part of germinomas (41.47 ± 5.22 Hu) was significantly higher than that of MGCTs (33.64 ± 3.75 Hu, p < 0.001), while apparent diffusion coefficients (ADC, ×10-3 mm2/s) value of the solid part was significantly lower in geminomas (0.86 ± 0.27 ×10-3 mm2/s) than in MGCTs (1.42 ± 0.39 ×10-3 mm2/s, p < 0.001). MGCTs were more common with intratumoral hemorrhage (68.75% vs 11.76%, p = 0.01), T1 hyperintense foci (68.75% vs 5.88%, p < 0.001) and calcification (64.29% vs 20.00%, p = 0.025) than germinomas. There was no significant difference in internal capsule involvement between the two subtypes (p = 0.303), but Wallerian degeneration was more common in germinomas than in MGCTs (70.59% vs 25.00%, p = 0.015). CONCLUSION The subtypes of GCT have different imaging features. Tumoral cystic-solidity, heterogeneity, ADC value, CT density, and Wallerian degeneration are helpful to differentiate germinomas and MGCTs in basal ganglia. ADVANCES IN KNOWLEDGE The subtypes of GCT have different histological characteristics, leading to various imaging findings. The imaging features of GCT subtypes in basal ganglia may aid clinical diagnosis and treatment.
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Affiliation(s)
- Wei Li
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Kong
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun Ma
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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18
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Bag AK, Chiang J, Patay Z. Radiohistogenomics of pediatric low-grade neuroepithelial tumors. Neuroradiology 2021; 63:1185-1213. [PMID: 33779771 PMCID: PMC8295117 DOI: 10.1007/s00234-021-02691-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/10/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE In addition to histology, genetic alteration is now required to classify many central nervous system (CNS) tumors according to the most recent World Health Organization CNS tumor classification scheme. Although that is still not the case for classifying pediatric low-grade neuroepithelial tumors (PLGNTs), genetic and molecular features are increasingly being used for making treatment decisions. This approach has become a standard clinical practice in many specialized pediatric cancer centers and will likely be more widely practiced in the near future. This paradigm shift in the management of PLGNTs necessitates better understanding of how genetic alterations influence histology and imaging characteristics of individual PLGNT phenotypes. METHODS The complex association of genetic alterations with histology, clinical, and imaging of each phenotype of the extremely heterogeneous PLGNT family has been addressed in a holistic approach in this up-to-date review article. A new imaging stratification scheme has been proposed based on tumor morphology, location, histology, and genetics. Imaging characteristics of each PLGNT entity are also depicted in light of histology and genetics. CONCLUSION This article reviews the association of specific genetic alteration with location, histology, imaging, and prognosis of a specific tumor of the PLGNT family and how that information can be used for better imaging of these tumors.
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Affiliation(s)
- Asim K Bag
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN, 38105, USA.
| | - Jason Chiang
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Zoltan Patay
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN, 38105, USA
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19
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Testud B, Brun G, Varoquaux A, Hak JF, Appay R, Le Troter A, Girard N, Stellmann JP. Perfusion-weighted techniques in MRI grading of pediatric cerebral tumors: efficiency of dynamic susceptibility contrast and arterial spin labeling. Neuroradiology 2021; 63:1353-1366. [PMID: 33506349 DOI: 10.1007/s00234-021-02640-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/06/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE Dynamic susceptibility contrast (DSC) and arterial spin labeling (ASL) perfusion MRI are applied in pediatric brain tumor grading, but their value for clinical daily practice remains unclear. We explored the ability of ASL and DSC to distinguish low- and high-grade lesions, in an unselected cohort of pediatric cerebral tumors. METHODS We retrospectively compared standard perfusion outcomes including blood volume, blood flow, and time parameters from DSC and ASL at 1.5T or 3T MRI scanners of 46 treatment-naive patients by drawing ROI via consensus by two neuroradiologists on the solid portions of every tumor. The discriminant abilities of perfusion parameters were evaluated by receiver operating characteristic (ROC) over the entire cohort and depending on the tumor location and the magnetic field. RESULTS ASL and DSC parameters showed overall low to moderate performances to distinguish low- and high-grade tumors (area under the curve: between 0.548 and 0.697). Discriminant abilities were better for tumors located supratentorially (AUC between 0.777 and 0.810) than infratentorially, where none of the metrics reached significance. We observed a better differentiation between low- and high-grade cancers at 3T than at 1.5-T. For infratentorial tumors, time parameters from DSC performed better than the commonly used metrics (AUC ≥ 0.8). CONCLUSION DSC and ASL show moderate abilities to distinguish low- and high-grade brain tumors in an unselected cohort. Absolute value of K2, TMAX, tMIP, and normalized value of TMAX of the DSC appear as an alternative to conventional parameters for infratentorial tumors. Three Tesla evaluation should be favored over 1.5-Tesla.
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Affiliation(s)
- B Testud
- Department of Diagnostic and Interventional Neuroradiology, APHM La Timone, 264 Saint Pierre Street, 13385, CEDEX 05, Marseille, France.
| | - G Brun
- Department of Diagnostic and Interventional Neuroradiology, APHM La Timone, 264 Saint Pierre Street, 13385, CEDEX 05, Marseille, France
| | - A Varoquaux
- APHM La Conception, Department of Medical Imaging, Aix Marseille Université, Marseille, France
| | - J F Hak
- Department of Diagnostic and Interventional Neuroradiology, APHM La Timone, 264 Saint Pierre Street, 13385, CEDEX 05, Marseille, France
| | - R Appay
- Department of Pathology and Neuropathology, APHM La Timone, Marseille, France.,Aix-Marseille Univ, CNRS, INP, Inst Neurophysiopathol, Marseille, France
| | - A Le Troter
- Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France.,APHM La Timone, CEMEREM, Marseille, France
| | - N Girard
- Department of Diagnostic and Interventional Neuroradiology, APHM La Timone, 264 Saint Pierre Street, 13385, CEDEX 05, Marseille, France.,Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France
| | - J P Stellmann
- Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France.,APHM La Timone, CEMEREM, Marseille, France
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20
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Intracranial calcifications in childhood: Part 2. Pediatr Radiol 2020; 50:1448-1475. [PMID: 32642802 DOI: 10.1007/s00247-020-04716-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/03/2020] [Accepted: 05/12/2020] [Indexed: 02/08/2023]
Abstract
This article is the second of a two-part series on intracranial calcification in childhood. In Part 1, the authors discussed the main differences between physiological and pathological intracranial calcification. They also outlined histological intracranial calcification characteristics and how these can be detected across different neuroimaging modalities. Part 1 emphasized the importance of age at presentation and intracranial calcification location and proposed a comprehensive neuroimaging approach toward the differential diagnosis of the causes of intracranial calcification. Pathological intracranial calcification can be divided into infectious, congenital, endocrine/metabolic, vascular, and neoplastic. In Part 2, the chief focus is on discussing endocrine/metabolic, vascular, and neoplastic intracranial calcification etiologies of intracranial calcification. Endocrine/metabolic diseases causing intracranial calcification are mainly from parathyroid and thyroid dysfunction and inborn errors of metabolism, such as mitochondrial disorders (MELAS, or mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes; Kearns-Sayre; and Cockayne syndromes), interferonopathies (Aicardi-Goutières syndrome), and lysosomal disorders (Krabbe disease). Specific noninfectious causes of intracranial calcification that mimic TORCH (toxoplasmosis, other [syphilis, varicella-zoster, parvovirus B19], rubella, cytomegalovirus, and herpes) infections are known as pseudo-TORCH. Cavernous malformations, arteriovenous malformations, arteriovenous fistulas, and chronic venous hypertension are also known causes of intracranial calcification. Other vascular-related causes of intracranial calcification include early atherosclerosis presentation (children with risk factors such as hyperhomocysteinemia, familial hypercholesterolemia, and others), healed hematoma, radiotherapy treatment, old infarct, and disorders of the microvasculature such as COL4A1- and COL4A2-related diseases. Intracranial calcification is also seen in several pediatric brain tumors. Clinical and familial information such as age at presentation, maternal exposure to teratogens including viruses, and association with chromosomal abnormalities, pathogenic genes, and postnatal infections facilitates narrowing the differential diagnosis of the multiple causes of intracranial calcification.
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Jumah F, Rallo MS, Quinoa T, Raju B, Narayan V, Gupta G, Nanda A. Incidental Brain Tumors in the Pediatric Population: A Systematic Review and Reappraisal of Literature. World Neurosurg 2020; 139:121-131. [PMID: 32165344 DOI: 10.1016/j.wneu.2020.02.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/28/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Management of incidental asymptomatic brain tumors in children is controversial due to lack of clear evidence-based guidelines. We present this systematic review in an attempt to highlight an optimal treatment paradigm. METHODS This systematic review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Databases were searched up to August 2019 using the keywords "incidental," "brain tumor," and "pediatric." Our main focus was on brain lesions suspected for neoplasm, diagnosed incidentally on neuroimaging in an otherwise asymptomatic patient <18 years old. Cystic, vascular, and inflammatory brain lesions were excluded. RESULTS Fourteen studies comprising 308 patients were included. All cases were diagnosed using magnetic resonance imaging. The most common indications for imaging were headache (93; 30%) and trauma (72; 23%). Lesion distribution was supratentorial (179; 58%), infratentorial (121; 40%), and intraventricular (8; 3%). Of 308 cases, 243 (79%) were managed with neuroradiological surveillance and 57 (19%) by upfront surgical excision. Of those managed conservatively, 177 (73%) remained stable within a mean follow-up of 30 months, 54 (22%) progressed, and 12 (5%) spontaneously regressed. Meanwhile, upfront excision achieved complete remission in all 57 cases over a mean follow-up of 68.3 months. CONCLUSION A small body of evidence has emerged, highlighting the marked heterogeneity and contradictory results between the available studies, limiting our ability to draw solid conclusions. At this point, the decision between surgery and "watchful waiting" should be tailored on an individual patient basis depending on suspicion of malignancy, clinical or radiologic progression, and parental preference.
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Affiliation(s)
- Fareed Jumah
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School University Hospital, New Brunswick, New Jersey, USA
| | - Michael S Rallo
- Robert Wood Johnson Medical School-Rutgers, New Brunswick, New Jersey, USA
| | - Travis Quinoa
- Robert Wood Johnson Medical School-Rutgers, New Brunswick, New Jersey, USA
| | - Bharath Raju
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School University Hospital, New Brunswick, New Jersey, USA
| | - Vinayak Narayan
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School University Hospital, New Brunswick, New Jersey, USA
| | - Gaurav Gupta
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School University Hospital, New Brunswick, New Jersey, USA
| | - Anil Nanda
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School University Hospital, New Brunswick, New Jersey, USA.
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Chen C, Ren CP, Zhao RC, Ding JW, Cheng JL. Histogram Analysis Parameters ADC for Distinguishing Ventricular Neoplasms of Ependymoma, Choroid Plexus Papilloma, and Central Neurocytoma. Med Sci Monit 2019; 25:5886-5891. [PMID: 31390342 PMCID: PMC6693364 DOI: 10.12659/msm.915398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background To determine if histograms of ADC can be used to differentiate ventricular ependymomas, choroid plexus papillomas (CPPs), and central neurocytomas (CNCs). Material/Methods We retrospectively reviewed records from 185 patients from 1 January 2014 to 1 November 2018. We finally included a total of 60 patients: 36 (60.00%) had histologically confirmed ependymomas, 10 (16.67%) had CPPs, and 14 (23.33%) had CNCs, as determined by routine MRI scanning at 3.0T. The ADC histogram features were derived and then compared by Kruskal-Wallis test (they were not normally distributed). Bonferroni test was used to compare the 2 groups and then we determined the ROC. Results Ependymomas had significantly higher mean, perc.01%, perc.10%, perc.50%, perc.90%, and perc.99% than CNCs. Ependymomas had significantly lower skewness than CNCs. Histogram metrics derived from mean, perc.01%, perc.10%, perc.50%, and perc.90% were significantly lower in the CNCs group than in the CPPs group. CPPs showed significantly lower skewness than CNCs. A threshold value of 86.50 for perc.50% to predict ependymomas from CNCs was estimated (AUC=0.97, sensitivity=97.20%, specificity=85.70%). Optimal diagnostic performance to predict CPPs from CNCs (AUC=0.96, sensitivity=100.00%, specificity=85.70%) was obtained when setting Perc.50%=84.00 as the threshold value. Conclusions The ADC histogram analysis may help to discriminate ependymomas, CPPs, and CNCs.
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Affiliation(s)
- Chen Chen
- Department of Magnetic Resonance Imaging (MRI), First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Cui-Ping Ren
- Department of Magnetic Resonance Imaging (MRI), First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Rui-Chen Zhao
- Department of Magnetic Resonance Imaging (MRI), First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Jiang-Wei Ding
- Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Jing-Liang Cheng
- Department of Magnetic Resonance Imaging (MRI), First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
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Hales PW, d'Arco F, Cooper J, Pfeuffer J, Hargrave D, Mankad K, Clark C. Arterial spin labelling and diffusion-weighted imaging in paediatric brain tumours. NEUROIMAGE-CLINICAL 2019; 22:101696. [PMID: 30735859 PMCID: PMC6365981 DOI: 10.1016/j.nicl.2019.101696] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/16/2019] [Accepted: 01/27/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Diffusion- and perfusion-weighted MRI are valuable tools for measuring the cellular and vascular properties of brain tumours. This has been well studied in adult patients, however, the biological features of childhood brain tumours are unique, and paediatric-focused studies are less common. We aimed to assess the diagnostic utility of apparent diffusion coefficient (ADC) values derived from diffusion-weighted imaging (DWI) and cerebral blood flow (CBF) values derived from arterial spin labelling (ASL) in paediatric brain tumours. METHODS We performed a meta-analysis of published studies reporting ADC and ASL-derived CBF values in paediatric brain tumours. Data were combined using a random effects model in order to define typical parameter ranges for different histological tumour subtypes and WHO grades. New data were also acquired in a 'validation cohort' at our institution, in which ADC and CBF values in treatment naïve paediatric brain tumour patients were measured, in order to test the validity of the findings from the literature in an un-seen cohort. ADC and CBF quantification was performed by two radiologists via manual placement of tumour regions of interest (ROIs), in addition to an automated approach to tumour ROI placement. RESULTS A total of 14 studies met the inclusion criteria for the meta-analysis, constituting data acquired in 542 paediatric patients. Parameters of interest were based on measurements from ROIs placed within the tumour, including mean and minimum ADC values (ADCROI-mean, ADCROI-min) and the maximum CBF value normalised to grey matter (nCBFROI-max). After combination of the literature data, a number of histological tumour subtype groups showed significant differences in ADC values, which were confirmed, where possible, in our validation cohort of 32 patients. In both the meta-analysis and our cohort, diffuse midline glioma was found to be an outlier among high-grade tumour subtypes, with ADC and CBF values more similar to the low-grade tumours. After grouping patients by WHO grade, significant differences in grade groups were found in ADCROI-mean, ADCROI-min, and nCBFROI-max, in both the meta-analysis and our validation cohort. After excluding diffuse midline glioma, optimum thresholds (derived from ROC analysis) for separating low/high-grade tumours were 0.95 × 10-3 mm2/s (ADCROI-mean), 0.82 × 10-3 mm2/s (ADCROI-min) and 1.45 (nCBFROI-max). These thresholds were able to identify low/high-grade tumours with 96%, 83%, and 83% accuracy respectively in our validation cohort, and agreed well with the results from the meta-analysis. Diagnostic power was improved by combining ADC and CBF measurements from the same tumour, after which 100% of tumours in our cohort were correctly classified as either low- or high-grade (excluding diffuse midline glioma). CONCLUSION ADC and CBF values are useful for differentiating certain histological subtypes, and separating low- and high-grade paediatric brain tumours. The threshold values presented here are in agreement with previously published studies, as well as a new patient cohort. If ADC and CBF values acquired in the same tumour are combined, the diagnostic accuracy is optimised.
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Affiliation(s)
- Patrick W Hales
- Developmental Imaging & Biophysics Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, United Kingdom.
| | - Felice d'Arco
- Great Ormond Street Children's Hospital, Great Ormond St, London WC1N 3JH, United Kingdom
| | - Jessica Cooper
- Great Ormond Street Children's Hospital, Great Ormond St, London WC1N 3JH, United Kingdom
| | - Josef Pfeuffer
- Siemens Healthcare GmbH, MR Application Development, Erlangen, Germany
| | - Darren Hargrave
- Great Ormond Street Children's Hospital, Great Ormond St, London WC1N 3JH, United Kingdom
| | - Kshitij Mankad
- Great Ormond Street Children's Hospital, Great Ormond St, London WC1N 3JH, United Kingdom
| | - Chris Clark
- Developmental Imaging & Biophysics Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, United Kingdom
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Muly S, Liu S, Lee R, Nicolaou S, Rojas R, Khosa F. MRI of intracranial intraventricular lesions. Clin Imaging 2018; 52:226-239. [DOI: 10.1016/j.clinimag.2018.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 05/26/2018] [Accepted: 07/23/2018] [Indexed: 01/25/2023]
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25
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She D, Liu J, Zeng Z, Xing Z, Cao D. Diagnostic accuracy of diffusion weighted imaging for differentiation of supratentorial pilocytic astrocytoma and pleomorphic xanthoastrocytoma. Neuroradiology 2018; 60:725-733. [PMID: 29797290 PMCID: PMC5996010 DOI: 10.1007/s00234-018-2036-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/14/2018] [Indexed: 12/20/2022]
Abstract
Purpose Supratentorial pilocytic astrocytoma (PA) may mimic pleomorphic xanthoastrocytoma (PXA) on conventional MR imaging, and a differentiation is clinically important because of distinct recurrence rate and anaplastic transformation rate. The purpose of this study was to investigate the diagnostic potential of diffusion-weighted imaging (DWI) in differentiating supratentorial PA from PXA. Methods We retrospectively reviewed DWI and conventional MR imaging of 16 patients with supratentorial PA and 8 patients with PXA. Variables of mean ADC values (ADCmean) and minimum ADC values (ADCmin) were calculated from the ROIs containing the contrast-enhancing lesion on DWI. ADCmean values and ADCmin values were compared among all supratentorial PA and PXA as well as between the subgroup of lobar PA and PXA by using an unpaired Student’s t test. The optimum threshold, sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve (AUC) were determined. Results Both ADCmean values (1542 ± 186 vs 1084 ± 201 × 10−6 mm2/s; P < 0.001) and ADCmin values (1355 ± 183 vs 988 ± 180 × 10−6 mm2/s; P < 0.001) were significantly higher in supratentorial PA compared with PXA. The ADCmean values and ADCmin values were also significantly higher in lobar PA than those in PXA. The ADCmean values were useful for differentiating supratentorial PA from PXA, with a threshold value of > 1189.8 × 10−6 mm2/s (sensitivity, 93.8%; specificity, 100%). The optimal threshold values of > 1189.8 × 10−6 mm2/s for ADCmean values provide sensitivity and specificity of 85.7 and 100%, respectively, for discriminating lobar PA from PXA. The optimum threshold value for ADCmin was > 1063.5 × 10−6 mm2/s. Conclusion DWI is helpful in characterization and differentiation of supratentorial PA from PXA. Electronic supplementary material The online version of this article (10.1007/s00234-018-2036-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dejun She
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, 350005, Fuzhou, Fujian, People's Republic of China
| | - Jianyi Liu
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, 350005, Fuzhou, Fujian, People's Republic of China
| | - Z Zeng
- Department of Medical Imaging Technology, College of Medical Technology and Engineering, Fujian Medical University, 350108, Fuzhou, Fujian, People's Republic of China
| | - Z Xing
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, 350005, Fuzhou, Fujian, People's Republic of China
| | - Dairong Cao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, 350005, Fuzhou, Fujian, People's Republic of China.
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Park ES, Park JB, Ra YS. Pediatric Glioma at the Optic Pathway and Thalamus. J Korean Neurosurg Soc 2018; 61:352-362. [PMID: 29742884 PMCID: PMC5957311 DOI: 10.3340/jkns.2018.0040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/15/2018] [Accepted: 03/29/2018] [Indexed: 11/27/2022] Open
Abstract
Gliomas are the most common pediatric tumors of the central nervous system. In this review, we discuss the clinical features, treatment paradigms, and evolving concepts related to two types of pediatric gliomas affecting two main locations: the optic pathway and thalamus. In particular, we discuss recently revised pathologic classification, which adopting molecular parameter. We believe that our review contribute to the readers' better understanding of pediatric glioma because pediatric glioma differs in many ways from adult glioma according to the newest advances in molecular characterization of this tumor. A better understanding of current and evolving issues in pediatric glioma is needed to ensure effective management decision.
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Affiliation(s)
- Eun Suk Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jun Bum Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Young-Shin Ra
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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27
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Presutto E, Chappell M, Fullmer J, Ezhapilli S. Posterior fossa medulloblastoma in an atypical extra-axial location: A case report. Radiol Case Rep 2018; 13:365-370. [PMID: 29904474 PMCID: PMC5999935 DOI: 10.1016/j.radcr.2018.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/04/2018] [Indexed: 12/12/2022] Open
Abstract
Medulloblastoma is the most common posterior fossa tumor of childhood typically within the fourth ventricle. However, extra-axial medulloblastoma in posterior fossa is an uncommon diagnosis. We report a case in a 33-month-old male who presented with repeated complaints of abdominal pain, intermittent emesis, and diarrhea, and diagnosed with right cerebellar extra-axial medulloblastoma, which was surgically resected. Majority of the reported extra-axial medulloblastoma in posterior fossa in the United States are located in the cerebellopontine angle. However, to the best of our knowledge, our case is the first to document medulloblastoma occurring exclusively in the cerebellar hemispheric extra-axial space rather than the cerebellopontine angle. Although the diagnosis can present as a radiological dilemma, a systematic multimodality imaging approach can aid in narrowing the differential diagnosis and timely management. In this case report, we will discuss the imaging characteristics, differential diagnosis, and management strategies, alongside a brief review of the world literature of extra-axial medulloblastoma.
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Affiliation(s)
- Elizabeth Presutto
- SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Matthew Chappell
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Joseph Fullmer
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Sajeev Ezhapilli
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
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Pediatric Basal Ganglia Region Tumors: Clinical and Radiologic Features Correlated with Histopathologic Findings. World Neurosurg 2017; 103:504-516. [PMID: 28408259 DOI: 10.1016/j.wneu.2017.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/30/2017] [Accepted: 04/01/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE To summarize the clinical and radiologic features of pediatric basal ganglia region tumors (PBGRT) in correlation with their histopathologic findings to reduce inappropriate surgery and identify tumors that can benefit from maximal safe resection. METHODS The records of 35 children with PBGRT treated in our hospital from December 2011 to December 2015 were analyzed retrospectively. The clinical and radiologic features of these tumors were summarized and correlated with their histopathologic diagnosis. RESULTS Our series included 15 astrocytomas and 11 germ cell tumors (GCTs). Basal ganglia astrocytomas were characterized by various clinical presentations and an ill-circumscribed mass with the involvement of surrounding structures on neuroimaging and mostly occurred in the first decade of life (n = 10; 66.7%). Basal ganglia GCT mostly occurred in the second decade of life (n = 8; 72.7%) with hemiparesis as the most common symptom (n = 9; 81.8%). The tumors were located predominantly in the caput of caudate nucleus (n = 8; 72.7%) with hemiatrophy as the typical sign (n = 8; 72.7%). Occasionally, other tumors also could occur in this region, including primitive neuroectodermal tumor (n = 1), atypical teratoid/rhabdoid tumor (n = 1), anaplastic ependymoma (n = 1), lymphoma (n = 1), extraventricular neurocytoma (n = 1), gangliogliomas (n = 2), oligodendroglioma (n = 1), and dysembryoplastic neuroepithelial tumor (n = 1). CONCLUSIONS Astrocytoma and GCT are the most common PBGRTs. Low-grade astrocytomas could benefit from maximal surgical resection, whereas GCTs merit neoadjuvant chemoradiation therapy followed by second-look surgery. We advocate routine testing of tumor markers and analysis of their clinical and radiologic features to optimize the therapeutic strategy.
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Abstract
A review of pediatric pineal region tumors is provided with emphasis on advanced imaging techniques. The 3 major categories of pineal region tumors include germ cell tumors, pineal parenchymal tumors, and tumors arising from adjacent structures such as tectal astrocytomas. The clinical presentation, biochemical markers, and imaging of these types of tumors are reviewed.
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Causil LD, Ames R, Puac P, Castillo M. Adult Brain Tumors and Pseudotumors: Interesting (Bizarre) Cases. Neuroimaging Clin N Am 2017; 26:667-689. [PMID: 27712799 DOI: 10.1016/j.nic.2016.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Some brain tumors results are interesting due to their rarity at presentation and overwhelming imaging characteristics, posing a diagnostic challenge in the eyes of any experienced neuroradiologist. This article focuses on the most important features regarding epidemiology, location, clinical presentation, histopathology, and imaging findings of cases considered "bizarre." A review of the most recent literature dealing with these unusual tumors and pseudotumors is presented, highlighting key points related to the diagnosis, treatments, outcomes, and differential diagnosis.
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Affiliation(s)
- Lazaro D Causil
- Neuroradiology Section, Department of Radiology, University of North Carolina School of Medicine, Room 3326, Old Infirmary Building, Manning Drive, Chapel Hill, NC 27599-7510, USA.
| | - Romy Ames
- Neuroradiology Section, Department of Radiology, University of North Carolina School of Medicine, Room 3326, Old Infirmary Building, Manning Drive, Chapel Hill, NC 27599-7510, USA
| | - Paulo Puac
- Neuroradiology Section, Department of Radiology, University of North Carolina School of Medicine, Room 3326, Old Infirmary Building, Manning Drive, Chapel Hill, NC 27599-7510, USA
| | - Mauricio Castillo
- Department of Radiology, University of North Carolina School of Medicine, Room 3326, Old Infirmary Building, Manning Drive, Chapel Hill, NC 27599-7510, USA
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Zamora C, Huisman TA, Izbudak I. Supratentorial Tumors in Pediatric Patients. Neuroimaging Clin N Am 2017; 27:39-67. [DOI: 10.1016/j.nic.2016.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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32
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Lequin M, Hendrikse J. Advanced MR Imaging in Pediatric Brain Tumors, Clinical Applications. Neuroimaging Clin N Am 2017; 27:167-190. [DOI: 10.1016/j.nic.2016.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11C-Methionine positron emission tomography delineates non-contrast enhancing tumor regions at high risk for recurrence in pediatric high-grade glioma. J Neurooncol 2017; 132:163-170. [DOI: 10.1007/s11060-016-2354-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
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34
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Goo HW, Ra YS. Advanced MRI for Pediatric Brain Tumors with Emphasis on Clinical Benefits. Korean J Radiol 2017; 18:194-207. [PMID: 28096729 PMCID: PMC5240497 DOI: 10.3348/kjr.2017.18.1.194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 08/17/2016] [Indexed: 12/19/2022] Open
Abstract
Conventional anatomic brain MRI is often limited in evaluating pediatric brain tumors, the most common solid tumors and a leading cause of death in children. Advanced brain MRI techniques have great potential to improve diagnostic performance in children with brain tumors and overcome diagnostic pitfalls resulting from diverse tumor pathologies as well as nonspecific or overlapped imaging findings. Advanced MRI techniques used for evaluating pediatric brain tumors include diffusion-weighted imaging, diffusion tensor imaging, functional MRI, perfusion imaging, spectroscopy, susceptibility-weighted imaging, and chemical exchange saturation transfer imaging. Because pediatric brain tumors differ from adult counterparts in various aspects, MRI protocols should be designed to achieve maximal clinical benefits in pediatric brain tumors. In this study, we review advanced MRI techniques and interpretation algorithms for pediatric brain tumors.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Young-Shin Ra
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
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35
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Zamora C, Castillo M. Sellar and Parasellar Imaging. Neurosurgery 2016; 80:17-38. [DOI: 10.1093/neuros/nyw013] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 10/18/2016] [Indexed: 11/13/2022] Open
Abstract
Abstract
The skull base is a complex anatomical region that harbors many important neurovascular structures in a relatively confined space. The pathology that can develop at this site is varied, and many disease processes may present with similar clinical and neuroimaging findings. While computed tomography maintains a role in the evaluation of many entities and can, for instance, delineate osseous erosion with great detail and characterize calcified tumor matrices, magnetic resonance imaging (MRI) is the mainstay in the neuroimaging assessment of most pathology occurring at the skull base. Various MRI sequences have proven to be robust tools for tissue characterization and can provide information on the presence of lipids, paramagnetic and diamagnetic elements, and tumor cellularity, among others. In addition, currently available MRI techniques are able to generate high spatial resolution images that allow visualization of cranial nerves and their involvement by adjacent pathology. The information obtained from such examinations may aid in the distinction of these disease processes and in the accurate delineation of their extent prior to biopsy or treatment planning.
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Dangouloff-Ros V, Deroulers C, Foissac F, Badoual M, Shotar E, Grévent D, Calmon R, Pagès M, Grill J, Dufour C, Blauwblomme T, Puget S, Zerah M, Sainte-Rose C, Brunelle F, Varlet P, Boddaert N. Arterial Spin Labeling to Predict Brain Tumor Grading in Children: Correlations between Histopathologic Vascular Density and Perfusion MR Imaging. Radiology 2016; 281:553-566. [DOI: 10.1148/radiol.2016152228] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Coppola A, Tramontano V, Basaldella F, Arcaro C, Squintani G, Sala F. Intra-operative neurophysiological mapping and monitoring during brain tumour surgery in children: an update. Childs Nerv Syst 2016; 32:1849-59. [PMID: 27659828 DOI: 10.1007/s00381-016-3180-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 07/05/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Over the past decade, the reluctance to operate in eloquent brain areas has been reconsidered in the light of the advent of new peri-operative functional neuroimaging techniques and new evidence from neuro-oncology. To maximise tumour resection while minimising morbidity should be the goal of brain surgery in children as much as it is in adults, and preservation of brain functions is critical in the light of the increased survival and the expectations in terms of quality of life. DISCUSSION Intra-operative neurophysiology is the gold standard to localise and preserve brain functions during surgery and is increasingly used in paediatric neurosurgery. Yet, the developing nervous system has peculiar characteristics in terms of anatomical and physiological maturation, and some technical aspects need to be tailored for its use in children, especially in infants. This paper will review the most recent advances in the field of intra-operative neurophysiology (ION) techniques during brain surgery, focussing on those aspects that are relevant to the paediatric neurosurgery practice.
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Affiliation(s)
- Angela Coppola
- Pediatric Neurosurgery, Institute of Neurosurgery, University Hospital, Verona, Italy
| | | | | | - Chiara Arcaro
- Division of Neurology, University Hospital, Verona, Italy
| | | | - Francesco Sala
- Pediatric Neurosurgery, Institute of Neurosurgery, University Hospital, Verona, Italy. .,Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Catford S, Wang YY, Wong R. Pituitary stalk lesions: systematic review and clinical guidance. Clin Endocrinol (Oxf) 2016; 85:507-21. [PMID: 26950774 DOI: 10.1111/cen.13058] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 03/01/2016] [Accepted: 03/04/2016] [Indexed: 12/15/2022]
Abstract
The spectrum of pituitary stalk (PS) pathology is vast, presenting a diagnostic challenge. Published large series of PS lesions demonstrate neoplastic conditions are most frequent, followed by inflammatory, infectious and congenital diseases. Inflammatory pathologies however, account for the majority of PS lesions in published small case series and case reports. Physicians must be familiar with the major differential diagnoses and necessary investigations. A comprehensive history and thorough clinical examination is critical. Although magnetic resonance imaging of the PS in disease is nonspecific, associated intracranial features may narrow the differential diagnosis. Initial investigations include basic pathology and computer tomography imaging of the neck, chest, abdomen and pelvis. Further investigations should be guided by the clinical context. PS biopsy should be considered when a diagnosis is regarded essential in centres where an experienced neurosurgeon is available. Treatment is dependent on the underlying disease process and may necessitate pituitary hormone replacement.
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Affiliation(s)
- Sarah Catford
- Department of Endocrinology and Diabetes, Western Health, Melbourne, Vic., Australia.
| | - Yi Yuen Wang
- Department of Neurosurgery and Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Vic., Australia
| | - Rosemary Wong
- Department of Endocrinology and Diabetes, Western Health, Melbourne, Vic., Australia
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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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Domínguez-Pinilla N, Martínez de Aragón A, Diéguez Tapias S, Toldos O, Hinojosa Bernal J, Rigal Andrés M, González-Granado L. Evaluating the apparent diffusion coefficient in MRI studies as a means of determining paediatric brain tumour stages. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2014.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Chang PT, Yang E, Swenson DW, Lee EY. Pediatric Emergency Magnetic Resonance Imaging: Current Indications, Techniques, and Clinical Applications. Magn Reson Imaging Clin N Am 2016; 24:449-80. [PMID: 27150329 DOI: 10.1016/j.mric.2015.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
MR imaging plays an important role in the detection and characterization of several pediatric disease entities that can occur in the emergent setting because of its cross-sectional imaging capability, lack of ionizing radiation exposure, and superior soft tissue contrast. In the age of as low as reasonably achievable, these advantages have made MR imaging an increasingly preferred modality for diagnostic evaluations even in time-sensitive settings. In this article, the authors discuss the current indications, techniques, and clinical applications of MR imaging in the evaluation of pediatric emergencies.
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Affiliation(s)
- Patricia T Chang
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Yang
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - David W Swenson
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Y Lee
- Division of Thoracic Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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BÖHRNSEN FLORIAN, ENDERS CHRISTINA, LUDWIG HANSCHRISTOPH, BRÜCK WOLFGANG, FÜZESI LASZLO, GUTENBERG ANGELIKA. Common molecularcytogenetic alterations in tumors originating from the pineal region. Oncol Lett 2015; 10:1853-1857. [PMID: 26622764 PMCID: PMC4533695 DOI: 10.3892/ol.2015.3383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 05/07/2015] [Indexed: 12/31/2022] Open
Abstract
Tumors of the pineal region (PR) are rare and can be subdivided into four main histomorphological groups: Pineal-parenchymal tumors (PPT), germ cell tumors (GCT), glial tumors and miscellaneous tumors. The appropriate pathological classification and grading of these malignancies is essential for determining the clinical management and prognosis. However, an early diagnosis is often delayed due to unspecific clinical symptoms, and histological support is not always decisive to identify the diversity of tumors of the PR. The present study aimed to characterize 18 tumors of the PR using comparative genomic hybridization. All the tumors were primarily surgically resected without any previous irradiation or chemotherapy. In addition to chromosomal aberrations in PPT and different GCTs of the PR, the present study described, for the first time, the chromosomal changes in a few rare entities (solitary-fibrous and neuroendocrine tumors) of the PR. The tumors in the study, regardless of histology and World Health Organization grade, were characterized by frequent gains at 7, 9q, 12q, 16p, 17 and 22q, and losses at 13q. While the detection of chromosomal aberrations in these tumors appears not to be indicative enough of histological entities and their grade of malignancy, the present data may be of use to select genes of interest for higher resolution genomic analyses.
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Affiliation(s)
- FLORIAN BÖHRNSEN
- Clinic of Oral and Maxillofacial Surgery, Georg-August University Göttingen, Göttingen D-37075, Germany
| | - CHRISTINA ENDERS
- Institute of Pathology, Georg-August University Göttingen, Göttingen D-37075, Germany
| | - HANS-CHRISTOPH LUDWIG
- Department of Neurosurgery, Georg-August University Göttingen, Göttingen D-37075, Germany
| | - WOLFGANG BRÜCK
- Institute of Neuropathology, Georg-August University Göttingen, Göttingen D-37075, Germany
| | - LASZLO FÜZESI
- Institute of Pathology, Georg-August University Göttingen, Göttingen D-37075, Germany
| | - ANGELIKA GUTENBERG
- Department of Neurosurgery, Georg-August University Göttingen, Göttingen D-37075, Germany
- Department of Neurosurgery, Johannes Gutenberg University, Mainz D-76726, Germany
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Furtwängler R, Yilmaz U. [Pediatric intracranial tumors : Principles of diagnostics and treatment]. Radiologe 2015; 54:754-63. [PMID: 25081917 DOI: 10.1007/s00117-014-2665-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pediatric intracranial tumors account for approximately 24% of childhood malignancies. Pathological entities and their frequencies differ significantly from adult intracranial tumors and have age-specific differences in the pediatric population itself. In Germany treatment and diagnosis must be carried out according to ongoing multicenter trials for therapy optimization and registers of the Gesellschaft für pädiatrische Onkologie und Hämatologie (GPOH, Society of Pediatric Oncology and Hematology) in specialized centers for pediatric oncology. In addition to the articles in this issue which focus on the radiological aspects of the different entities, this article provides an overview of the principles of diagnostics and treatment of pediatric intracranial tumors.
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Affiliation(s)
- R Furtwängler
- Klinik für pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
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44
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Mabray MC, Barajas RF, Cha S. Modern brain tumor imaging. Brain Tumor Res Treat 2015; 3:8-23. [PMID: 25977902 PMCID: PMC4426283 DOI: 10.14791/btrt.2015.3.1.8] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 03/17/2015] [Accepted: 03/17/2015] [Indexed: 12/16/2022] Open
Abstract
The imaging and clinical management of patients with brain tumor continue to evolve over time and now heavily rely on physiologic imaging in addition to high-resolution structural imaging. Imaging remains a powerful noninvasive tool to positively impact the management of patients with brain tumor. This article provides an overview of the current state-of-the art clinical brain tumor imaging. In this review, we discuss general magnetic resonance (MR) imaging methods and their application to the diagnosis of, treatment planning and navigation, and disease monitoring in patients with brain tumor. We review the strengths, limitations, and pitfalls of structural imaging, diffusion-weighted imaging techniques, MR spectroscopy, perfusion imaging, positron emission tomography/MR, and functional imaging. Overall this review provides a basis for understudying the role of modern imaging in the care of brain tumor patients.
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Affiliation(s)
- Marc C Mabray
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Ramon F Barajas
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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45
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Nowak J, Seidel C, Pietsch T, Alkonyi B, Fuss TL, Friedrich C, von Hoff K, Rutkowski S, Warmuth-Metz M. Systematic comparison of MRI findings in pediatric ependymoblastoma with ependymoma and CNS primitive neuroectodermal tumor not otherwise specified. Neuro Oncol 2015; 17:1157-65. [PMID: 25916887 DOI: 10.1093/neuonc/nov063] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/16/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Ependymoblastoma (EBL), ependymoma (EP), and primitive neuroectodermal tumors of the central nervous system not otherwise specified (CNS-PNET NOS) are pediatric brain tumors that can be differentiated by histopathology in the clinical setting. Recently, we described specific MRI features of EBL. In this study, we compare standardized MRI characteristics of EBL with EP and CNS-PNET NOS in a series comprising 22 patients in each group. METHODS All 66 centrally reviewed cases were obtained from the database of the German multicenter HIT trials. We systematically analyzed the initial MRI scans at diagnosis according to standardized criteria, and paired comparison was performed for EBL and EP, as well as for EBL and CNS-PNET NOS. RESULTS We found differences between EBL and EP regarding age at diagnosis, MR signal intensity, tumor margin and surrounding edema, presence and size of cysts, and contrast enhancement pattern. Although MRI appearance of EBL shares many features with CNS-PNET NOS, we revealed significant differences in terms of age at diagnosis, tumor volume and localization, tumor margins, edema, and contrast enhancement. CONCLUSION This is the first study that systematically compares multiple parameters of MRI in pediatric EBL with findings in EP and CNS-PNET NOS. Although a definite differentiation by means of MRI alone might not be feasible in the individual case, we identify significant differences between these tumor entities.
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Affiliation(s)
- Johannes Nowak
- Reference Center for Neuroradiology, University Hospital of Würzburg, Würzburg, Germany (J.N., C.S., B.A., M.W.-M.); Department of Radiology, University Hospital of Würzburg, Würzburg, Germany (J.N.); Department of Radiology, Pathology Research, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts (C.S., T.L.F.); Department of Neuropathology, Brain Tumor Reference Center, Bonn, Germany (T.P.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg- Eppendorf, Hamburg, Germany (C.F., K.v.H., S.R.); Division of Pediatric Oncology, Hematology and Hemostaseology, Department of Women's and Children's Health, University Hospital Leipzig, Leipzig, Germany (C.F.)
| | - Carolin Seidel
- Reference Center for Neuroradiology, University Hospital of Würzburg, Würzburg, Germany (J.N., C.S., B.A., M.W.-M.); Department of Radiology, University Hospital of Würzburg, Würzburg, Germany (J.N.); Department of Radiology, Pathology Research, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts (C.S., T.L.F.); Department of Neuropathology, Brain Tumor Reference Center, Bonn, Germany (T.P.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg- Eppendorf, Hamburg, Germany (C.F., K.v.H., S.R.); Division of Pediatric Oncology, Hematology and Hemostaseology, Department of Women's and Children's Health, University Hospital Leipzig, Leipzig, Germany (C.F.)
| | - Torsten Pietsch
- Reference Center for Neuroradiology, University Hospital of Würzburg, Würzburg, Germany (J.N., C.S., B.A., M.W.-M.); Department of Radiology, University Hospital of Würzburg, Würzburg, Germany (J.N.); Department of Radiology, Pathology Research, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts (C.S., T.L.F.); Department of Neuropathology, Brain Tumor Reference Center, Bonn, Germany (T.P.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg- Eppendorf, Hamburg, Germany (C.F., K.v.H., S.R.); Division of Pediatric Oncology, Hematology and Hemostaseology, Department of Women's and Children's Health, University Hospital Leipzig, Leipzig, Germany (C.F.)
| | - Balint Alkonyi
- Reference Center for Neuroradiology, University Hospital of Würzburg, Würzburg, Germany (J.N., C.S., B.A., M.W.-M.); Department of Radiology, University Hospital of Würzburg, Würzburg, Germany (J.N.); Department of Radiology, Pathology Research, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts (C.S., T.L.F.); Department of Neuropathology, Brain Tumor Reference Center, Bonn, Germany (T.P.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg- Eppendorf, Hamburg, Germany (C.F., K.v.H., S.R.); Division of Pediatric Oncology, Hematology and Hemostaseology, Department of Women's and Children's Health, University Hospital Leipzig, Leipzig, Germany (C.F.)
| | - Taylor Laura Fuss
- Reference Center for Neuroradiology, University Hospital of Würzburg, Würzburg, Germany (J.N., C.S., B.A., M.W.-M.); Department of Radiology, University Hospital of Würzburg, Würzburg, Germany (J.N.); Department of Radiology, Pathology Research, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts (C.S., T.L.F.); Department of Neuropathology, Brain Tumor Reference Center, Bonn, Germany (T.P.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg- Eppendorf, Hamburg, Germany (C.F., K.v.H., S.R.); Division of Pediatric Oncology, Hematology and Hemostaseology, Department of Women's and Children's Health, University Hospital Leipzig, Leipzig, Germany (C.F.)
| | - Carsten Friedrich
- Reference Center for Neuroradiology, University Hospital of Würzburg, Würzburg, Germany (J.N., C.S., B.A., M.W.-M.); Department of Radiology, University Hospital of Würzburg, Würzburg, Germany (J.N.); Department of Radiology, Pathology Research, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts (C.S., T.L.F.); Department of Neuropathology, Brain Tumor Reference Center, Bonn, Germany (T.P.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg- Eppendorf, Hamburg, Germany (C.F., K.v.H., S.R.); Division of Pediatric Oncology, Hematology and Hemostaseology, Department of Women's and Children's Health, University Hospital Leipzig, Leipzig, Germany (C.F.)
| | - Katja von Hoff
- Reference Center for Neuroradiology, University Hospital of Würzburg, Würzburg, Germany (J.N., C.S., B.A., M.W.-M.); Department of Radiology, University Hospital of Würzburg, Würzburg, Germany (J.N.); Department of Radiology, Pathology Research, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts (C.S., T.L.F.); Department of Neuropathology, Brain Tumor Reference Center, Bonn, Germany (T.P.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg- Eppendorf, Hamburg, Germany (C.F., K.v.H., S.R.); Division of Pediatric Oncology, Hematology and Hemostaseology, Department of Women's and Children's Health, University Hospital Leipzig, Leipzig, Germany (C.F.)
| | - Stefan Rutkowski
- Reference Center for Neuroradiology, University Hospital of Würzburg, Würzburg, Germany (J.N., C.S., B.A., M.W.-M.); Department of Radiology, University Hospital of Würzburg, Würzburg, Germany (J.N.); Department of Radiology, Pathology Research, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts (C.S., T.L.F.); Department of Neuropathology, Brain Tumor Reference Center, Bonn, Germany (T.P.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg- Eppendorf, Hamburg, Germany (C.F., K.v.H., S.R.); Division of Pediatric Oncology, Hematology and Hemostaseology, Department of Women's and Children's Health, University Hospital Leipzig, Leipzig, Germany (C.F.)
| | - Monika Warmuth-Metz
- Reference Center for Neuroradiology, University Hospital of Würzburg, Würzburg, Germany (J.N., C.S., B.A., M.W.-M.); Department of Radiology, University Hospital of Würzburg, Würzburg, Germany (J.N.); Department of Radiology, Pathology Research, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts (C.S., T.L.F.); Department of Neuropathology, Brain Tumor Reference Center, Bonn, Germany (T.P.); Department of Pediatric Hematology and Oncology, University Medical Center Hamburg- Eppendorf, Hamburg, Germany (C.F., K.v.H., S.R.); Division of Pediatric Oncology, Hematology and Hemostaseology, Department of Women's and Children's Health, University Hospital Leipzig, Leipzig, Germany (C.F.)
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Domínguez-Pinilla N, Martínez de Aragón A, Diéguez Tapias S, Toldos O, Hinojosa Bernal J, Rigal Andrés M, González-Granado LI. Evaluating the apparent diffusion coefficient in MRI studies as a means of determining paediatric brain tumour stages. Neurologia 2015; 31:459-65. [PMID: 25660185 DOI: 10.1016/j.nrl.2014.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 11/20/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The apparent diffusion coefficient (ADC) in MRI seems to be related to cellularity in brain tumours. Its utility as a tool for distinguishing between histological types and tumour stages remains controversial. PROCEDURES We retrospectively evaluated children diagnosed with CNS tumours between January 2008 and December 2013. Data collected were age, sex, histological diagnosis, and location of the tumour. We evaluated the ADC and ADC ratio and correlated those values with histological diagnoses. RESULTS The study included 55 patients with a median age of 6 years. Histological diagnoses were pilocytic astrocytoma (40%), anaplastic ependymoma (16.4%), ganglioglioma (10.9%), glioblastoma (7.3%), medulloblastoma (5.5%), and other (20%). Tumours could also be classified as low-grade (64%) or high-grade (36%). Mean ADC was 1.3 for low-grade tumours and 0.9 for high-grade tumours (p=.004). Mean ADC ratios were 1.5 and 1.2 for low and high-grade tumours respectively (p=.025). There were no significant differences in ADC/ADC ratio between different histological types. CONCLUSION ADC and ADC ratio may be useful in imaging-study based differential diagnosis of low and high-grade tumours, but they are not a substitute for an anatomical pathology study.
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Affiliation(s)
- N Domínguez-Pinilla
- Unidad de Hemato-Oncología Pediátrica, Hospital 12 de Octubre, Madrid, España.
| | | | - S Diéguez Tapias
- Unidad de Radiología Pediátrica, Hospital 12 de Octubre, Madrid, España
| | - O Toldos
- Unidad de Anatomía Patológica, Hospital 12 de Octubre, Madrid, España
| | - J Hinojosa Bernal
- Unidad de Neurocirugía Pediátrica, Hospital 12 de Octubre, Madrid, España
| | - M Rigal Andrés
- Unidad de Hemato-Oncología Pediátrica, Hospital 12 de Octubre, Madrid, España
| | - L I González-Granado
- Unidad de Hemato-Oncología Pediátrica, Unidad de Inmunodeficiencias Pediátricas, Hospital 12 de Octubre, Madrid, España
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Krishnan P, Muthusami P, Heyn C, Shroff M. Advances in pediatric neuroimaging. Indian J Pediatr 2015; 82:154-65. [PMID: 25557178 DOI: 10.1007/s12098-014-1657-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 12/03/2014] [Indexed: 12/19/2022]
Abstract
Conventional MRI protocols are an integral part of routine clinical imaging in pediatric patients. The advent of several newer MRI techniques provides crucial insight into the structural integrity and functional aspects of the developing brain, especially with the introduction of 3T MRI systems in clinical practice. The field of pediatric neuroimaging continues to evolve, with greater emphasis on high spatial resolution, faster scan time, as well as a quest for visualization of the functional aspects of the human brain. MR vendors are increasingly focusing on optimizing MR technology to make it suitable for children, in whom as compared to adults the head size is usually smaller and demonstrates inherent neuroanatomical differences relating to brain development. The eventual goal of these advances would be to evolve as potential biomarkers for predicting neurodevelopment outcomes and prognostication, in addition to their utility in routine diagnostic and therapeutic decision-making. Advanced MR techniques like diffusion tensor imaging, functional MRI, MR perfusion, spectroscopy, volumetric imaging and arterial spin labeling add to our understanding of normal brain development and pathophysiology of various neurological disease processes. This review is primarily focused on outlining advanced MR techniques and their current and potential pediatric neuroimaging applications as well as providing a brief overview of advances in hardware and machine design.
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Affiliation(s)
- Pradeep Krishnan
- Division of Pediatric Neuroradiology, Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada,
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49
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Imaging features of cerebral and spinal cystic echinococcosis. Radiol Med 2014; 120:458-65. [DOI: 10.1007/s11547-014-0475-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/11/2014] [Indexed: 12/28/2022]
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Moore W, Mathis D, Gargan L, Bowers DC, Klesse LJ, Margraf L, Koral K. Pleomorphic xanthoastrocytoma of childhood: MR imaging and diffusion MR imaging features. AJNR Am J Neuroradiol 2014; 35:2192-6. [PMID: 24994821 DOI: 10.3174/ajnr.a4011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Pleomorphic xanthoastrocytomas are rare astrocytic neoplasms of childhood and young adulthood. The purpose of this retrospective review was to evaluate MR imaging features of pediatric pleomorphic xanthoastrocytomas with an emphasis on diffusion MR imaging. MATERIALS AND METHODS Review of the neuro-oncology data base revealed 11 pediatric patients (range, 4.7-16.1 years) with pleomorphic xanthoastroacytomas with 9 of these patients having preoperative MR imaging available. Six patients had preoperative diffusion MR imaging. Demographics, histopathology slides, conventional imaging characteristics (location, cystic component, hemorrhage, enhancement, vasogenic edema, inner table scalloping), and ADC metrics (mean tumor ADC and tumor to normal brain ADC ratio) were evaluated. RESULTS Three pleomorphic xanthoastrocytomas had anaplastic features. Ten tumors were supratentorial. Two-thirds (6 of 9) of all tumors were either predominantly cystic or had cystic components, and three-fourths (6 of 8) of the supratentorial tumors had associated inner table scalloping. Seven of the 9 tumors had marked vasogenic edema (>10 mm). Mean tumoral ADC (n = 7) was 912 ± 219 × 10(-6) mm(2)/s (min-max: 617-1189). The tumor to normal brain ADC ratio was 1.14 ± 0.26 (min-max: 0.75-1.47). CONCLUSIONS Pleomorphic xanthoastrocytoma should be entertained in the differential diagnosis of peripheral supratentorial tumors that appear during childhood. Cysts, inner table scalloping, and marked vasogenic edema are relatively frequent features. Relatively low ADC values and ADC ratios are not uncommon in pleomorphic xanthoastrocytoma.
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Affiliation(s)
- W Moore
- From the Departments of Radiology (W.M., K.K.)
| | | | - L Gargan
- Neuro-Oncology (L.G.), Children's Medical Center, Dallas, Texas
| | - D C Bowers
- Pediatrics (D.C.B., L.J.K.), University of Texas Southwestern Medical Center, Dallas, Texas Pediatrics (D.C.B., L.J.K.)
| | - L J Klesse
- Pediatrics (D.C.B., L.J.K.), University of Texas Southwestern Medical Center, Dallas, Texas Pediatrics (D.C.B., L.J.K.)
| | - L Margraf
- Pathology (D.M., L.M.) Pathology (L.M.)
| | - K Koral
- From the Departments of Radiology (W.M., K.K.) Departments of Radiology (K.K.)
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