Use of T2 signal intensity of cerebellar neoplasms in pediatric patients to guide preoperative staging of the neuraxis

Forbes, Jonathan A.; Chambless, Lola B.; Smith, Jason G.; Wushensky, Curtis A.; Lebow, Richard L.; Alvarez, JoAnn; Pearson, Matthew M.

doi:10.3171/2010.11.peds10312

Cited by 14 publications

(16 citation statements)

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“…Cerebellar ependymomas involve the fourth ventricle and usually extend to some extent through the outlet foramina of Magendie and Luschka [18]. In light of an elevated risk of leptomeningeal dissemination [12], preoperative imaging of the neuraxis in patients suspected to harbor ependymoma is recommended. As chemotherapy has not been shown to significantly improve outcome in patients with ependymoma, surgical resection and postoperative irradiation of the primary site (dose has traditionally ranged from 4,500 to 5,600 cGy) have remained the mainstays of therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Although tumor exit through the outlet foramina of the fourth ventricle does sometimes occur, medulloblastomas are much less likely than ependymomas to exhibit this phenomenon [8]. Patients with medulloblastoma have elevated associated risks of leptomeningeal dissemination at time of presentation [12]. Preoperative knowledge of whether or not leptomeningeal spread is present in patients suspected to harbor medulloblastoma is useful to the pediatric neurosurgeon, as this can influence whether or not the patient is deemed ‘high risk’ and concomitantly alter the risk/benefit analysis of aggressive surgical resection in eloquent locations.…”

Section: Discussionmentioning

confidence: 99%

“…We have previously described our method for evaluating the rT2SI of cerebellar neoplasms in a publication describing its utility in identifying tumors at an elevated risk for leptomeningeal dissemination [12]. Briefly, the measurement is as follows: the solid component of the tumor in question is again identified.…”

Section: Clinical Materials and Methodsmentioning

confidence: 99%

“…Previous studies have demonstrated hyperintensity on DWI to be strongly predictive of medulloblastoma [9,10]. Recently, measurement of T 2 -weighted signal intensity (T2SI) was shown to be useful in identification of low-grade cerebellar neoplasms [12]. Because the preponderance of tumors in the cerebellar/fourth ventricular location fall into one of the aforementioned three histopathologic categories, the authors sought to assess whether objective findings on these MRI sequences could be used to accurately predict underlying histopathology.…”

Section: Introductionmentioning

confidence: 99%

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Findings on Preoperative Brain MRI Predict Histopathology in Children with Cerebellar Neoplasms

Forbes¹,

Reig²,

Smith

et al. 2011

Pediatr Neurosurg

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Background/Aims: The majority of pediatric patients with cerebellar neoplasms harbor pilocytic astrocytomas (PAs), medulloblastomas, or ependymomas. Knowledge of a preoperative likelihood of histopathology in this group of patients has the potential to influence many aspects of care. Previous studies have demonstrated hyperintensity on diffusion-weighted imaging to correlate with medulloblastomas. Recently, measurement of T₂-weighted signal intensity (T2SI) was shown to be useful in identification of low-grade cerebellar neoplasms. The goal of this study was to assess whether objective findings on these MRI sequences reliably correlated with the underlying histopathology. Methods: We reviewed the radiologic findings of 50 pediatric patients who underwent resection of a cerebellar neoplasm since 2003 at our institution. Region of interest placement was used to calculate the relative diffusion-weighted signal intensity (rDWSI) and relative T2SI (rT2SI) of each neoplasm. Results: Tukey’s multiple comparison test demonstrated medulloblastomas to have significantly higher rDWSIs than PAs/ependymomas, and PAs to have significantly higher rT2SIs than medulloblastomas/ependymomas. A simple method consisting of sequential measurement of rDWSI and rT2SI to predict histopathology was then constructed. Using this method, 39 of 50 (78%) tumors were accurately predicted. Conclusion: Measurement of rDWSI and rT2SI using standard MRI of the brain can be used to predict histopathology with favorable accuracy in pediatric patients with cerebellar tumors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Clinical Materials and Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Findings on Preoperative Brain MRI Predict Histopathology in Children with Cerebellar Neoplasms

Forbes¹,

Reig²,

Smith

et al. 2011

Pediatr Neurosurg

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“…14,15 In this case report, the diagnosis of PMA was made predominantly on the basis of histological features after first surgery. Histopathological distinction between PA and PMA is useful because PMAs have been associated with increased rates of local recurrence and leptomeningeal dissemination, as well as decreased overall survival relative to PAs .9 Although it is not uncommon for conventional PAs to spread locally to involve the leptomeninges, the incidence of leptomeningeal dissemination in cerebellar PAs is extremely rare, 17 and many neurosurgeons do not routinely obtain MR imaging of the neuraxis to rule out leptomeningeal dissemination before or after resection. 8 Thus, pathological designation in these patients may influence the frequency and scope of surveillance imaging.…”

Section: Discussionmentioning

confidence: 99%

Cerebellar Pilomyxoid Astrocytoma

Biluts¹,

Zewdie²,

Gemechu³

2017

East. Cent. Afr. J. Surg.

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Pilomyxoid astrocytomas (PMA) are new class of Pilocytic Astrocytoma (PA.), which typically have their origin in hypothalamus and Chiasmatic region. There are very few case reports of PMAs arising from cerebellum. Their imaging features are similar to PA but they behave more aggressively than PA. To increase awareness of PMA within the neurosurgical community, the authors reviewed a case of 11-year-old male child who presented with truncal and cerebellar ataxia and vomiting and right cerebellar tumor diagnosed as PA radiologically but PMA on histopathology examination. These findings indicate that PMA may be a unique entity that is distinct from PA, or it may be an unusual variant.Key words: -Pilocytic astrocytoma • pilomyxoid astrocytoma • diagnosis • cerebellar DOI: http://dx.doi.org/10.4314/ecajs.v21i3.22 IntroductionPilocytic astrocytomas are generally benign, typically showing 20-year survival rates of 70 to 80%, even when only a subtotal resection is achieved. 1 These highly treatable and potentially curable pediatric tumors are considered Grade I neoplasms according to the World Health Organization tumor classification system. 2, 3 Prior to its recognition, PMA was grouped with PA, because the two display similar histological features.In 1999, Tihan and colleagues provided the sentinel description of PMAs. 1 Because of their similar histological and radiological features, 2 PMAs were classified as PAs prior to acceptance of this publication. . Earlier reports pointed out unusual features of some pediatric astrocytomas, particularly those within the hypothalamic/chiasmatic region, but did not specifically use a term to distinguish them. 4,5,9 In contrast to PAs, PMAs demonstrate a more aggressive clinical course 8-9 and appear to be associated with a higher incidence of leptomeningeal spread. 9 Pilomyxoid astrocytomas are considered to be WHO Grade II neoplasms, and most often arise from the hypothalamic/chiasmatic region. However, PMAs sometimes originate from the posterior fossa. 4 whereas hypothalamic PMAs have been well described in the literature, there is a relative paucity of information about PMAs that arise from the cerebellum. Although limited clinical experience makes it difficult to generate conclusive prognostic data regarding this recently described pediatric tumor, PMA has been shown to behave more aggressively than PA . 11 Here we report a case of cerebellar PMA in a 11 year old male child and discuss literature review Case reportThis was an 11 year old male patient who was relatively in a good state of health prior to his presentation to neurosurgical referral clinics at which time he presented with global headache,projectile vomiting of ingested matter of one moth duration, these symptoms were associated with difficulty of maintaining balance, and blurring of vision.Physical examination revealed papilledema with positive Romberg's test.Abnormal rapid alternating movements, and tandemwalk were indicative of cerebellar ataxia and truncal ataxia. Brain CT scan with contrast was done, With di...

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Cerebral tumors: Specific features in children

Koob

Girard

2014

Diagnostic and Interventional Imaging

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Brain tumors are the second leading cause of cancer in children. Primary tumors predominate and are of very varied histological types. Their prognosis and treatment depend on the histological type and grade. The diagnostic approach to these includes analysis of the site of the lesion and appearances on computed tomography and MR, and taking account of the age and clinical features of the child. CT is used to diagnose the tumor in an emergency situation. Conventional MR provides a morphological approach and allows a staging assessment to be carried out before surgery. Advanced MR techniques (diffusion-weighted and perfusion imaging, MR spectroscopy) provide further information for the differential diagnosis, presumptive diagnosis of type and grade and to guide biopsy towards the most malignant areas in the lesion.

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Use of T2 signal intensity of cerebellar neoplasms in pediatric patients to guide preoperative staging of the neuraxis

Cited by 14 publications

References 42 publications

Findings on Preoperative Brain MRI Predict Histopathology in Children with Cerebellar Neoplasms

Findings on Preoperative Brain MRI Predict Histopathology in Children with Cerebellar Neoplasms

Cerebellar Pilomyxoid Astrocytoma

Cerebral tumors: Specific features in children

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