Diffusion-weighted MRI for differentiation of neuroblastoma and ganglioneuroblastoma/ganglioneuroma

Gahr, Nina; Darge, Kassa; Hahn, Gabriele; Kreher, Björn W.; Buiren, Miriam von; Uhl, Markus

doi:10.1016/j.ejrad.2010.04.005

Cited by 66 publications

(54 citation statements)

References 15 publications

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“…Diffusion-weighted MRI (DWI) has, with some success, been introduced as an adjunct to pediatric oncological MR imaging protocols [9]. Preliminary results suggest that, based on apparent diffusion coefficient (ADC) values, DWI can indeed distinguish between NB, GNB and GN with some confidence [10,11]. Recent reports confirm these findings [12] and propose diagnostic value for detecting metastases [13] and for monitoring therapy response [14].…”

Section: Introductionsupporting

confidence: 64%

“…In a study on children with a variety of malignant and benign tumors of the abdomen, three cases of neuroblastoma imaged on a 1.5 T Magnetom Symphony scanner exhibited low mean ADC values of 0.70, 0.77 and 0.78, while an ADC cut-off value of 1.11 distinguished malignant and benign lesions with 100 % sensitivity and 79 % specificity [9]. Gahr et al recorded a mean ADC value of 0.81, ranging from 0.39 to 1.47, in 10 NB patients, while 4 GN and 2 GNB showed a mean ADC of 1.60, ranging from 1.13 to 1.99 [11]. A recent report on 24 children with 15 NB, 5 GNB and 4 GN observed a mean ADC of 0.869 in NB, 0.97 in GNB and 1.147 in GN with significant overlap and a proposed cut-off ADC value of 0.93 [12].…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Value of Diffusion-Weighted MRI for Tumor Characterization, Differentiation and Monitoring in Pediatric Patients with Neuroblastic Tumors

Neubauer

Müller

et al. 2017

Fortschr Röntgenstr

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ZUSAMMENFASSUNGZiel Untersucht wurde die diagnostische Aussagekraft der diffusionsgewichteten MRT (DWI) für die Tumorcharakterisierung, Tumordifferenzierung und Verlaufskontrolle bei Kindern mit extrakraniellen neuroblastischen Tumoren. Alle 29 Patienten (14 Mädchen, medianes Alter 3 Jahre) mit Neuroblastom (NB, n = 19), Ganglioneuroblastom (GNB, n = 4) und Ganglioneurom (GN, n = 6) This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. Material und Methoden ABSTR AC T PurposeWe explored the diagnostic value of diffusionweighted MRI (DWI) for tumor characterization, differentiation and therapy monitoring in pediatric patients with extracranial neuroblastic tumors. Materials and MethodsAll 29 patients (14 girls, median age: 3 years) with neuroblastoma (NB, n = 19), ganglioneuroblastoma (GNB, n = 4) and ganglioneuroma (GN, n = 6) who had had at least one in-house DWI examination since 2005 were identified and retrospectively analyzed. Two independent blinded readers measured ADC values (unit: 10−3 mm 2 /s) and signal intensity ratios (SIRs) of the primary tumor and, if applicable, of the tumor after chemotherapy, metastases and tumor relapse.Results The pre-treatment ADC was 0.90 ± 0.23 in NB/GNB and 1.70 ± 0.36 in GN without overlap between the two entities for both readers, 0.67 ± 0.14 in metastases and 0.72 ± 0.18 in tumor relapse. With chemotherapy, mean ADC increased to 1.54 ± 0.33 in NB/GNB and to 1.23 ± 0.27 in metastases (p < 0.05). The median SIRs of various tumor lesions vs. liver, vs. muscle tissue and vs. adjacent tissue were significantly higher on DWI (range: 2.4 -9.9) than on ce-T1w (range: 1.0 -1.8, all p < 0.05). The coefficient of variation (CV) was ≤ 8.0 % for ADC and ≤ 16.4 % for signal intensity data.Conclusion Based on mean ADC, DWI distinguishes between NB/GNB and GN with high certainty and provides plausible quantitative data on tumor response to therapy. Lesion conspicuity, as measured by SIR, is superior on DWI, compared to ce-T1w. DWI as a noninvasive, radiation-free and widely available imaging technique should be an integral part of MR imaging for neuroblastic tumors and should undergo prospective evaluation in multicenter studies. Key Points▪ DWI reliably distinguishes neuroblastoma/ganglioneuroblastoma from ganglioneuroma, based on the mean ADC. ▪ DWI provides plausible quantitative data on tumor response to chemotherapy. ▪ DWI offers highly superior lesion conspicuity compared to contrast-enhanced T1w imaging. ▪ DWI should be considered a standard for imaging neuro-

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Section: Introductionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Diffusion-Weighted MRI for Tumor Characterization, Differentiation and Monitoring in Pediatric Patients with Neuroblastic Tumors

Neubauer

Müller

et al. 2017

Fortschr Röntgenstr

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“…Our significantly lower ADC values of NB were also lower than the mean ADC values of NBs in previous studies (9)(10)(11). In our study, one patient had a differentiated NB while the rest of the tumors were undifferentiated or poorly differentiated, which could explain the difference.…”

Section: Dwi For Differentiating Wilms Tumor From Neuroblastoma • 405contrasting

confidence: 45%

Diffusion-weighted MRI for differentiating Wilms tumor from neuroblastoma

Aslan

Aslan²,

Habibi³

et al. 2017

Diagn Interv Radiol

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“…The ADC values of malignant masses are relatively lower than those of benign masses, although overlapping ADC values of malignant and benign lesions have also been reported (1,(6)(7)(8)(9)(10)(11)(12). Currently, in children the assessment of solid tumors' response to chemotherapy is based on size reduction; but this method can be unreliable as a marker, as tumors that shrink substantially may still be composed mainly of malignant cells (13,14).…”

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Variations in apparent diffusion coefficient values following chemotherapy in pediatric neuroblastoma

Demır

Altınkaya²,

Koçer³

et al. 2015

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSEIn children the assessment of solid tumors' response to chemotherapy is based primarily on size reduction, which can be unreliable and a late marker, in the presence of necrosis. We aimed to establish whether apparent diffusion coefficient (ADC) values of childhood neuroblastomas show proportional changes in relation to chemotherapy response. METHODSWe evaluated 15 pediatric patients with abdominopelvic neuroblastomas, who had undergone MRI before and after chemotherapy. Two radiologists retrospectively analyzed all images by drawing a round uniform region-of-interest in the solid/contrast-enhancing portion of the lesions in consensus.The ADC values from pre-and postchemotherapy images were compared. RESULTSPostchemotherapy ADC values were significantly higher than those obtained before treatment (P < 0.05, for minimum, maximum, and median ADC values). CONCLUSIONOur results support diffusion-weighted MRI as a promising noninvasive biomarker of therapeutic responses. To the best of our knowledge, this is the first report to compare diffusionweighted imaging findings before and after chemotherapy in childhood neuroblastic tumors. The ADC values of malignant masses are relatively lower than those of benign masses, although overlapping ADC values of malignant and benign lesions have also been reported (1, 6-12). Currently, in children the assessment of solid tumors' response to chemotherapy is based on size reduction; but this method can be unreliable as a marker, as tumors that shrink substantially may still be composed mainly of malignant cells (13,14).Here, we aimed to evaluate whether ADC values in viable portions of childhood neuroblastomas show any changes depending on tumor cellularity before and after chemotherapy. We hypothesized that an increase in ADC values over the course of chemotherapy could be used as a noninvasive marker of therapy response. To the best of our knowledge, this is the first report to compare DW-MRI findings before and after chemotherapy in childhood neuroblastic tumors. Methods PatientsWe retrospectively screened pediatric patients who had neuroblastic tumors and received treatment at our hospital between January 2009 and August 2013. We found 36 pediatric patients who underwent routine protocol-driven MRI assessment for solid tumors. Out of this group we acquired data from children who had intra-abdominal neuroblastic tumors that were diagnosed histopathologically. Our institution generally prefers MRI over computed tomography; however, due to capacity and time restrictions, not all patients undergo MRI both at primary diagnosis and at postchemotherapy follow-up. Only those patients who underwent MRI before and after chemotherapy were included in this study. In addition, exclusion criteria included any oncological (chemotherapy or radiotherapy) or surgical treatment before initial imaging. Consequently, we evaluated 15 patients between 4-138 months of age (mean, 37.8 months) including five females and 10 males. Thirteen patients were Stage 4 and two patients w...

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Diffusion-weighted MRI for differentiation of neuroblastoma and ganglioneuroblastoma/ganglioneuroma

Cited by 66 publications

References 15 publications

Diagnostic Value of Diffusion-Weighted MRI for Tumor Characterization, Differentiation and Monitoring in Pediatric Patients with Neuroblastic Tumors

Diagnostic Value of Diffusion-Weighted MRI for Tumor Characterization, Differentiation and Monitoring in Pediatric Patients with Neuroblastic Tumors

Diffusion-weighted MRI for differentiating Wilms tumor from neuroblastoma

Variations in apparent diffusion coefficient values following chemotherapy in pediatric neuroblastoma

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