PURPOSE: The purpose of this study is to prospectively evaluate the effectiveness of MR perfusion imaging relative cerebral blood volume (rCBV) measurements in distinguishing low grade (slow growing) from high grade (fast growing) pediatric brain tumors. As brain tumors in children differ significantly from adult lesions, testing the utility of rCBV values as a biomarker for grading pediatric brain tumors is essential. METHODS: After IRB approval was obtained, 18 patients (ages 0 -20) (9 girls and 9 boys) with brain tumors were recruited. Two patients were excluded from the study because inadequate technically limited measurements were obtained. Therefore the rCBV values of 16 patients were measured and mapped. Tumors were classified as low grade (WHO I or II) or as high grade (WHO III or IV) based on histology and/or change in size during serial imaging. RESULTS: The rCBV of high grade tumors differed significantly from the values obtained for low grade lesions, except in the case of an outlying low grade juvenile pilocytic astrocytoma with a rCBV value approximately 1000 points higher than the values for high grade tumors. CONCLUSION: Because MR perfusion rCBV reflects cerebral hemodynamics at the microcirculation level we hypothesized that rCBV is proportional to the degree of tumor angiogenesis. The results of this study verify this hypothesis, except in the case of a highly vascular juvenile pilocytic astrocytoma (JPA) which exhibited an rCBV value even greater than that for high grade tumors. This may be related to the tendancy of JPAs to avidly enhance with contrast. In all other brain tumor cases, rCBV values served as an excellent biomarker for separating high grade from low grade brain neoplasms. Therefore, this study represents an important step toward applying rCBV values as a useful biomarker for distinguishing tumor grade in pediatric brain tumors. An 11-year old girl presented with headache and vomiting for several months. Neuroimaging revealed a lesion in the inferior right frontal lobe. The family declined surgical intervention and she was monitored by serial scans and clinical evaluation. Several years later the tumor showed progression on MRI scans. A subtotal resection was performed and the pathology was consistent with a papillary glioneuronal tumor (PGNT). Her symptoms resolved following surgery. PGNTs are rare neoplasms of the central nervous system which have been recently included as a distinct entity in the 2007 WHO classification. They are indolent tumors which show a biphasic pattern with both glial and neuronal differentiation. Though the morphological pattern is now well defined, to date the molecular pathogenesis remains unclear. Magnetic resonance imaging (MRI) findings for PGNT usually show a well-delineated solid mass located peri-ventricularly, with or without a cystic component, often with contrast enhancement, and presence of a mural nodule as was seen in our case. Our patient's tumor also showed evidence of diffusion restriction. To date use of magnetic resonance spectroscop...
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