Advanced multiparametric magnetic resonance imaging of multinodular and vacuolating neuronal tumor

Abstract

Background and purpose Multinodular and vacuolating neuronal tumor (MVNT) of the cerebrum is a rare brain lesion with suggestive imaging features. The aim of our study was to report the largest series of MVNTs so far and to evaluate the utility of advanced multiparametric magnetic resonance (MR) techniques. Methods This multicenter retrospective study was approved by our institutional research ethics board. From July 2014 to May 2019, two radiologists read in consensus the MR examinations of patients presenting with a lesion suggestive of an MVNT. They analyzed the lesions’ MR characteristics on structural images and advanced multiparametric MR imaging. Results A total of 64 patients (29 women and 35 men, mean age 44.2 ± 15.1 years) from 25 centers were included. Lesions were all hyperintense on fluid‐attenuated inversion recovery and T2‐weighted imaging without post‐contrast enhancement. The median relative apparent diffusion coefficient on diffusion‐weighted imaging was 1.13 [interquartile range (IQR), 0.2]. Perfusion‐weighted imaging showed no increase in perfusion, with a relative cerebral blood volume of 1.02 (IQR, 0.05) and a relative cerebral blood flow of 1.01 (IQR, 0.08). MR spectroscopy showed no abnormal peaks. Median follow‐up was 2 (IQR, 1.2) years, without any changes in size. Conclusions A comprehensive characterization protocol including advanced multiparametric magnetic resonance imaging sequences showed no imaging patterns suggestive of malignancy in MVNTs. It might be useful to better characterize MVNTs.

The 2021 World Health Organization Classification of Tumors of the Central Nervous System: What Neuroradiologists Need to Know

“…MR imaging features are virtually pathognomonic with clusters of T2-FLAIR hyperintense nodules (little bubbles) along the undersurface of the cerebral cortex and subcortical white matter. 30,31 MVNT-like lesions have also been reported in the posterior fossa. 32…”

Advanced multiparametric MRI and FDG-PET/CT in multinodular and vacuolating neuronal tumor: A pathologically confirmed case

“…Recently, advanced MR techniques including MRS, ADC, and perfusion-weighted imaging have been investigated for more definitive diagnosis [6 – 8] . It has been suggested that a comprehensive MR protocol should be performed to increase the diagnostic confidence of MVNT [7] .…”

“… [7] reported a large series of 64 patients with a lesion suggestive of MVNT using advanced MRI. They showed that the median relative ratios of ADC, CBF, and Cho/NAA were 1.13, 1.01, and 0.7, respectively, indicating no imaging patterns suggestive of malignancy in MVNT [7] . In our MVNT case, ADC and CBF support their results in that no restricted diffusion or hyperperfusion was seen.…”

New Imaging Features of Multinodular and Vacuolating Neuronal Tumor Revealed by Alcohol and Illicit Drugs Consumption

“…MRI lesions are described as multiple clustered nodules in the cortical–subcortical white matter, without peripheral edema or mass effect. The lesion is usually hypointense on T1, hyperintense on T2-weighted sequences, and hyperintense on FLAIR (nonhomogeneous in our case with hypointense nodules included), without restriction on diffusion-weighted (DWI), and no susceptibility on susceptibility-weighted imaging (SWI) or gradient recalled echo (GRE) sequences [ 9 , 10 ]. No contrast enhancement was found.…”