The effect of semi-quantitative T1-perfusion parameters for the differentiation between pediatric medulloblastoma and ependymoma

2021

Front. Pediatr.

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Introduction: Arterial Spin Labeling (ASL), a perfusion assessment without using gadolinium-based contrast agents, is outstandingly advantageous for pediatric patients. The differentiation of medulloblastomas from pilocytic astrocytomas in children plays a significant role in determining treatment strategies and prognosis. This study aimed to assess the use of ASL parameters during the differentiation between pediatric medulloblastoma and pilocytic astrocytoma.Methods: The institutional review board of Children's Hospital 2 approved this prospective study. The brain magnetic resonance imaging (MRI) protocol, including axial three-dimensional (3D) pseudo-continuous ASL, was evaluated in 33 patients, who were divided into a medulloblastoma group (n = 25) and a pilocytic astrocytoma group (n = 8). The quantified region of interest (ROI) values for the tumors and the tumor to parenchyma ratios were collected and compared between the two groups. Receiver operating characteristic (ROC) curve analysis and the Youden index were utilized to identify the best cut-off, sensitivity, specificity, and area under the curve (AUC) values for significant ASL parameters.Results: The cerebral blood flow (CBF) and the ratio between the CBF of the tumor relative to that of the parenchyma (rCBF) values for medulloblastomas were significantly higher than those for pilocytic astrocytomas (p < 0.05). A cut-off value of 0.51 for rCBF was able to discriminate between medulloblastoma and pilocytic astrocytoma, generating a sensitivity of 88%, a specificity of 75%, and an AUC of 83.5%.Conclusion: The rCBF measurement, obtained during MRI with 3D pseudo-continuous ASL, plays a supplemental role in the differentiation of medulloblastoma from pilocytic astrocytoma.

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Pseudo-Continuous Arterial Spin Labeling Parameters Distinguish Pediatric Medulloblastoma and Pilocytic Astrocytoma

2021

Front. Pediatr.

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“…Any increases in the cellular density, odd substances, or heavy particles within those spaces will result in a reduction of the diffusion coefficient [ 8 , 9 , 10 , 11 , 12 , 16 , 19 , 20 ]. Medulloblastoma is a malignant brain tumor, characterized by high cell numbers and density [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 20 , 21 , 22 , 23 ]. The reduction in free water movement caused by narrow inter- and intracellular spaces will result in reduced signal production.…”

Section: Discussionmentioning

confidence: 99%

The Role of Apparent Diffusion Coefficient in the Differentiation between Cerebellar Medulloblastoma and Brainstem Glioma

Thong

Neurology International

2020

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For certain clinical circumstances, the differentiation between cerebellar medulloblastoma and brainstem glioma is essential. We aimed to evaluate the role played by the apparent diffusion coefficient (ADC) values in the differentiation between cerebellar medulloblastomas and brainstem gliomas in children. The institutional review board approved this prospective study. Brain magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) and ADC, was assessed in 32 patients (median age: 7.0 years), divided into two groups, a medulloblastoma group (group 1, n = 22) and a brainstem glioma group (group 2, n = 10). The Mann–Whitney U test was utilized to compare tumor ADCmax, ADCmin, ADCmean, and ADCsd values, and their ratios with the parenchyma values between the two groups. Receiver operating characteristic (ROC) curve analysis and the Youden index were used to calculate the cut-off value, along with the area under the curve (AUC), sensitivity, and specificity. The median ADCmax, ADCmin, and ADCmean values were significantly higher in group 2 than in group 1 (p < 0.05). The median ratios of ADCmin and ADCmean to the parenchyma were significantly higher in group 2 than in group 1 (p < 0.05). The ROC analysis showed that the AUC for the ADCmean ratio was the highest among these parameters, at 98.2%. The ADCmean tumor to parenchyma ratio was a significant and effective parameter for the differentiation between pediatric medulloblastomas and brainstem gliomas.

“…Therefore, the speed of apparent diffusion in a solid, dense tumor like ependymomas, would be small. 9,10,12,19,21 Inversely, gliomas in the brain stem are less condensed. The intercellular space is usually larger, such that the protons of hydrogen are not greatly restrained.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Applying Apparent Diffusion Coefficient Parameters on the Differentiation between Fourth Ventricular Ependymoma and Diffuse Intrinsic Pontine Glioma

Journal of Child Science

2020

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Distinguishing the fourth ventricular ependymoma from diffuse intrinsic pontine glioma (DIPG) is essential to improve the treatment strategy between these two tumor types. We attempted to evaluate the effects of applying apparent diffusion coefficient (ADC) values to the distinction between pediatric fourth ventricular ependymomas and DIPGs. Brain magnetic resonance imaging, including diffusion-weighted imaging and ADC, was assessed in 26 patients, who were divided into two groups: group 1 included 8 patients with fourth ventricular ependymoma and group 2 included 18 patients with DIPG. The Mann–Whitney U test was utilized to compare tumoral maximum (ADCmax), minimum ADC (ADCmin), mean ADC (ADCmean), and standard deviation (ADCsd) values, and the ratios between the tumor and parenchyma values for each of these parameters (rADCmax, rADCmin, rADCmean, and rADCsd, respectively) between the two groups. Cutoff values were calculated based on receiver operating characteristic curve analysis and the Youden index, and the area under the curve (AUC), sensitivity, and specificity were determined. The median ADCmax, ADCmin, ADCmean, rADCmax, rADCmin, and rADCmean values were significantly lower in group 1 than in group 2 (p < 0.05). For the differential diagnosis of ependymomas and DIPGs, a cutoff ADCmean value of 1.02 × 10−3 mm2/s was determined, which produced a sensitivity of 100%, a specificity of 88.9%, and an AUC of 95.8%. ADC parameters should be considered when performing a differential diagnosis between fourth ventricular ependymomas and DIPGs. Based on our findings, a cutoff ADCmean value of 1.02 × 10−3 mm2/s was the most significant and effective parameter for this purpose.