Central nervous system tumors: Radiologic pathologic correlation and diagnostic approach

Abstract

Objective:This study was conducted to formulate location-wise radiologic diagnostic algorithms and assess their concordance with the final histopathological diagnosis so as to evaluate their utility in a rural setting where only basic facilities are available.Materials and Methods:A retrospective analysis to assess the concordance of radiology (primarily MRI) with final histopathology report was done. Based on the most common incidence of tumor location and basic radiology findings, diagnostic algorithms were prepared.Results:For supratentorial intraaxial parenchymal location concordance was seen in all high-grade astrocytomas, low- and high-grade oligodendrogliomas, metastatic tumors, primitive neuroectodermal tumors, high-grade ependymomas, neuronal and mixed neuro-glial tumors and tumors of hematopoietic system. Lowest concordance was seen in low-grade astrocytomas. In the supratentorial intraaxial ventricular location, agreement was observed in choroid plexus tumors, ependymomas, low-grade astrocytomas and meningiomas; in the supratentorial extraaxial location, except for the lack of concordance in the only case of metastatic tumor, concordance was observed in meningeal tumors, tumors of the sellar region, tumors of cranial and paraspinal nerves; the infratentorial intraaxial parenchymal location showed agreement in low- as well as high-grade astrocytomas, metastatic tumors, high-grade ependymoma, embryonal tumors and hematopoietic tumors; in the infratentorial intraaxial ventricular location, except for the lack of concordance in one case of low-grade astrocytoma and two cases of medulloblastomas, agreement was observed in low- and high-grade ependymoma; infratentorial extraaxial tumors showed complete agreement in all tumors of cranial and paraspinal nerves, meningiomas, and hematopoietic tumors.Conclusion:A location-based approach to central nervous system (CNS) tumors is helpful in establishing an appropriate differential diagnosis.

Space occupying lesions of central nervous system: A radiological-histopathological correlation study

“…Haemopoetic tumors were least common neoplastic lesion in the present study. Pant I et al 4 and Tesfay M et al 10 documented similar observation in their study. Among nonneoplastic lesions, Cystic lesions were the most common lesion in most of the studies except Dogar T et al 2 in which inflammatory lesion was commonest nonneoplastic lesion.…”

“…Among neoplastic lesions, neuroepithelial tumors were commonest followed by meningeal tumors. Dogar T et al 2 and Pant I et al 4 documented similar observations in their studies. In contrast, Kaki RR et al, 9 Tesfay M et al 10 and Mahmoud MZ et al 11 found meningel tumor as the commonest neoplastic lesion in their study.…”

“…The reasons for misdiagnosis were mainly radiological similarity of the lesions and interfering factors like presence of haemorrhage, necrosis and edema. Pant I et al 4 had also analysed misdiagnosed cases in their study. Similar to the present study, Pant I et al 4 had documented that low grade astrocytoma and medulloblastomas were misdiagnosed as ependymoma.…”

“…Among nonneoplastic lesions, Cystic lesions were the most common lesion in most of the studies except Dogar T et al 2 in which inflammatory lesion was commonest nonneoplastic lesion. [ Table 3] Percentage Pant I et al [4] percentage Tesfay M et al [10] percentage Mahmoud MZ et al [11] Percentage Dogar T et al [2] Percentage Table 4. The reasons for misdiagnosis were mainly radiological similarity of the lesions and interfering factors like presence of haemorrhage, necrosis and edema.…”

“…3 Radiological findings can be used by pathologists to narrow down the differential diagnoses. 4 However, radiological diagnosis of SOL requires confirmation by histopathology. Radiological investigation is supportive for an accurate histopathological diagnosis.…”