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Alhaj AK, Burhamah T, Mohammad F, Almutawa M, Dashti F, Almurshed M, Behzad S, Snuderl M, Hasan A. Are the Radiological and Molecular Features of Pediatric Medulloblastomas Valuable Prognostic Indicators? A 10-Year Retrospective Review in the Middle East. World Neurosurg 2024:S1878-8750(24)00620-X. [PMID: 38636638 DOI: 10.1016/j.wneu.2024.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Medulloblastomas are the most common malignant brain tumors in the pediatric population. Based on the idea that tumors with identical radio-genomic features should behave similarly, the 4 molecular subtypes are now widely accepted as a guide for the management and prognosis. The radiological features of medulloblastomas can predict the molecular subtype; thus, anticipating the subsequent disease progression. However, this has not been evaluated comprehensively. We aim to thoroughly study the association between the molecular subtypes and radiological features of medulloblastomas. Moreover, we aim to investigate the efficacy of this correlation with the use of progression-free survival and 5-year survival rates. METHODS A retrospective analysis was conducted for all histopathological confirmed medulloblastomas in pediatric patients (<16 years old) that were operated on in Kuwait over the past ten years (n = 44). The radiological, histological, and molecular characteristics were justifiably evaluated and analyzed in our sample. RESULTS The overall progression-free survival after one year was noticed among 27 cases (≈44%) and the nonspecific 5-year survival was seen in 31 cases (≈70%) after a 5-year follow-up. Sonic Hedgehog and Wingless had the best outcomes, while group 3 showed the worst outcomes. CONCLUSIONS Our findings did not support the association between most of the typical magnetic resonance imaging characteristics and survival rate. We further established that Sonic Hedgehog and Wingless biological types have a better prognosis. There was no association observed between the radiographic features, specifically the location, and the molecular subtype.
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Affiliation(s)
- Ahmad Kh Alhaj
- Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait; Department of Neurology and Neurosurgery, McGill University, Montreal, Québec, Canada
| | - Talal Burhamah
- Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Fadil Mohammad
- Department of Dermatology, McGill University, Montreal, Québec, Canada
| | - Mariam Almutawa
- Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Fatima Dashti
- Department of Neuroradiology, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Maryam Almurshed
- Department of Pathology, Sabah Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Shakir Behzad
- Department of Molecular Pathology, Kuwait Cancer Center, Ministry of Health, Kuwait City, Kuwait
| | - Matija Snuderl
- Department of Molecular Pathology, NYU Langone Hospital, New York, New York, USA
| | - Alya Hasan
- Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait.
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2
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Tanyel T, Nadarajan C, Duc NM, Keserci B. Deciphering Machine Learning Decisions to Distinguish between Posterior Fossa Tumor Types Using MRI Features: What Do the Data Tell Us? Cancers (Basel) 2023; 15:4015. [PMID: 37627043 PMCID: PMC10452543 DOI: 10.3390/cancers15164015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/22/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
Machine learning (ML) models have become capable of making critical decisions on our behalf. Nevertheless, due to complexity of these models, interpreting their decisions can be challenging, and humans cannot always control them. This paper provides explanations of decisions made by ML models in diagnosing four types of posterior fossa tumors: medulloblastoma, ependymoma, pilocytic astrocytoma, and brainstem glioma. The proposed methodology involves data analysis using kernel density estimations with Gaussian distributions to examine individual MRI features, conducting an analysis on the relationships between these features, and performing a comprehensive analysis of ML model behavior. This approach offers a simple yet informative and reliable means of identifying and validating distinguishable MRI features for the diagnosis of pediatric brain tumors. By presenting a comprehensive analysis of the responses of the four pediatric tumor types to each other and to ML models in a single source, this study aims to bridge the knowledge gap in the existing literature concerning the relationship between ML and medical outcomes. The results highlight that employing a simplistic approach in the absence of very large datasets leads to significantly more pronounced and explainable outcomes, as expected. Additionally, the study also demonstrates that the pre-analysis results consistently align with the outputs of the ML models and the clinical findings reported in the existing literature.
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Affiliation(s)
- Toygar Tanyel
- Department of Computer Engineering, Yildiz Technical University, Istanbul 34349, Türkiye;
| | - Chandran Nadarajan
- Department of Radiology, Gleneagles Hospital Kota Kinabalu, Kota Kinabalu 88100, Sabah, Malaysia;
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 700000, Vietnam;
| | - Bilgin Keserci
- Department of Biomedical Engineering, Yildiz Technical University, Istanbul 34349, Türkiye
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3
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Perillo T, de Giorgi M, Papace UM, Serino A, Cuocolo R, Manto A. Current role of machine learning and radiogenomics in precision neuro-oncology. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2023; 4:545-555. [PMID: 37720347 PMCID: PMC10501892 DOI: 10.37349/etat.2023.00151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/20/2023] [Indexed: 09/19/2023] Open
Abstract
In the past few years, artificial intelligence (AI) has been increasingly used to create tools that can enhance workflow in medicine. In particular, neuro-oncology has benefited from the use of AI and especially machine learning (ML) and radiogenomics, which are subfields of AI. ML can be used to develop algorithms that dynamically learn from available medical data in order to automatically do specific tasks. On the other hand, radiogenomics can identify relationships between tumor genetics and imaging features, thus possibly giving new insights into the pathophysiology of tumors. Therefore, ML and radiogenomics could help treatment tailoring, which is crucial in personalized neuro-oncology. The aim of this review is to illustrate current and possible future applications of ML and radiomics in neuro-oncology.
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Affiliation(s)
- Teresa Perillo
- Department of Neuroradiology, “Umberto I” Hospital, 84014 Norcera Inferiore, Italy
| | - Marco de Giorgi
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80138 Naples, Italy
| | - Umberto Maria Papace
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80138 Naples, Italy
| | - Antonietta Serino
- Department of Neuroradiology, “Umberto I” Hospital, 84014 Norcera Inferiore, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery, and Dentistry, University of Salerno, 84084 Fisciano, Italy
| | - Andrea Manto
- Department of Neuroradiology, “Umberto I” Hospital, 84014 Norcera Inferiore, Italy
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4
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Calandrelli R, Massimi L, Pilato F, Verdolotti T, Ruggiero A, Attinà G, Gessi M, Colosimo C. Atypical Teratoid Rhabdoid Tumor: Proposal of a Diagnostic Pathway Based on Clinical Features and Neuroimaging Findings. Diagnostics (Basel) 2023; 13:diagnostics13030475. [PMID: 36766580 PMCID: PMC9914341 DOI: 10.3390/diagnostics13030475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/17/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To assess the main imaging and clinical features in adult- and pediatric-onset atypical teratoid rhabdoid tumor (ATRT) in order to build a predefined pathway useful for the diagnosis. METHODS We enrolled 11 ATRT patients (10 children, one adult) and we conducted a literature search on PubMed Central using the key terms "adult" or "pediatric" and "atypical teratoid/rhabdoid tumor". We collected clinical and neuroradiological data reported in previous studies and combined them with those from our case series. A three step process was built to reach diagnosis by identifying the main distinctive clinical and imaging features. RESULTS Clinical evaluation: neurological symptoms were nonspecific. ATRT was more frequent in children under 3 years of age (7 out of 10 children) and infratentorial localization was reported more frequently in children under the age of 24 months. Midline/off-midline localization was influenced by the age. IMAGING FINDINGS Preferential location near the ventricles and liquor spaces and the presence of eccentric cysts were hallmark for ATRT; higher frequency of peripheral cysts was detected in children and in the supratentorial compartment (five out of eight patients with solid-cystic ATRT). Leptomeningeal dissemination at diagnosis was common (5 out of 10 children), while intratumoral hemorrhage, calcifications, and high cellularity were non-specific findings. Histopathological analysis: specific immunohistochemical markers were essential to confirm the diagnosis. CONCLUSION In younger children, a bulky, heterogeneous mass with eccentric cystic components and development near ventricles or cisternal spaces may be suggestive of ATRT. ATRT diagnosis is more challenging in adults and relies exclusively on neuropathological examination.
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Affiliation(s)
- Rosalinda Calandrelli
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168 Rome, Italy
- Correspondence:
| | - Luca Massimi
- Pediatric Neurosurgery, Neurosurgery Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168 Rome, Italy
| | - Fabio Pilato
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy
| | - Tommaso Verdolotti
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168 Rome, Italy
| | - Antonio Ruggiero
- UOSD di Oncologia Pediatrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Largo F.sco Vito 1, 00168 Rome, Italy
| | - Giorgio Attinà
- UOSD di Oncologia Pediatrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Marco Gessi
- Neuropathology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cesare Colosimo
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168 Rome, Italy
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Lampros M, Alexiou GA. Brain and Spinal Cord Tumors of Embryonic Origin. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:405-420. [PMID: 37452947 DOI: 10.1007/978-3-031-23705-8_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Embryonal tumors (ETs) of the central nervous system (CNS) comprise a large heterogeneous group of highly malignant tumors that predominantly affect children and adolescents. Currently, the neoplasms classified as ET are the medulloblastoma (MB), embryonal tumors with multilayered rosettes (ETMR), medulloepithelioma (ME), CNS neuroblastoma (NB), CNS ganglioneuroblastoma (GNB), atypical teratoid/rhabdoid tumors (AT/RT), and CNS embryonal tumors with rhabdoid features. All these tumors are classified as malignant-grade IV neoplasms, and the prognosis of patients with these neoplasms is very poor. Currently, except for the histological classification of MB, the recently utilized WHO classification accepts a novel molecular classification of MBs into four distinct molecular subgroups: wingless/integrated (WNT)-activated, sonic hedgehog (Shh), and the numerical Group3 and Group 4. The combination of both histological and genetic classifications has substantial prognostic significance, and patients are categorized as low risk with over 90% survival, the standard risk with 75-90% survival, high risk with 50-75% survival, and very high risk with survival rate lower than 50%. Children under three years are predominantly affected by AT/RT and represent about 20% of all CNS tumors in this age group. AT/RT is typically located in the posterior fossa (mainly in cerebellopontine angle) in 50-60% of the cases. The pathogenesis of this neoplasm is strongly associated with loss of function of the SMARCB1 (INI1, hSNF5) gene located at the 22q11.23 chromosome, or very rarely with alterations in (SMARCA4) BRG1 gene. The cells of this neoplasm resemble those of other neuronal tumors, and hence, immunochemistry markers have been utilized, such as smooth muscle actin, epithelial membrane antigen, vimentin, and lately antibodies for INI1. ETMRs are characterized by the presence of ependymoblastic rosettes formed by undifferentiated neuroepithelial cells and neuropil. The tumorigenesis of ETMRs is strongly related to the amplification of the pluripotency factor Chr19q13.41 miRNA cluster (C19MC) present in around 90% of the cases. Additionally, the expression of LIN28A is a highly sensitive and specific marker of ETMR diagnosis, as it is overexpressed in almost all cases of ETMR and is related to poor patient outcomes. The treatment of patients with ETs includes a combination of surgical resection, radiotherapy (focal or craniospinal), and chemotherapeutic agents. Currently, there is a trend to reduce the dose of craniospinal irradiation in the treatment of low-risk MBs. Novel targeted therapies are expected in the treatment of patients with MBs due to the identification of the main driver genes. Survival rates vary between ET types and their subtypes, with ganglioneuroblastoma having over 95% 5-year survival rate, while ATRT is probably linked with the worst prognosis with a 30% 5-year survival rate.
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Affiliation(s)
- Marios Lampros
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - George A Alexiou
- Department of Neurosurgery, School of Medicine, University of Ioannina, 45500, Ioannina, Greece.
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6
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AlRayahi J, Alwalid O, Mubarak W, Maaz AUR, Mifsud W. Pediatric Brain Tumors in the Molecular Era: Updates for the Radiologist. Semin Roentgenol 2023; 58:47-66. [PMID: 36732011 DOI: 10.1053/j.ro.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/28/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Jehan AlRayahi
- Department of Pediatric Radiology, Sidra Medicine, Doha, Qatar.
| | - Osamah Alwalid
- Department of Pediatric Radiology, Sidra Medicine, Doha, Qatar
| | - Walid Mubarak
- Department of Pediatric Radiology, Sidra Medicine, Doha, Qatar
| | - Ata Ur Rehman Maaz
- Department of Pediatric Hematology-Oncology, Sidra Medicine, Doha, Qatar
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7
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Gonçalves FG, Zandifar A, Ub Kim JD, Tierradentro-García LO, Ghosh A, Khrichenko D, Andronikou S, Vossough A. Application of Apparent Diffusion Coefficient Histogram Metrics for Differentiation of Pediatric Posterior Fossa Tumors : A Large Retrospective Study and Brief Review of Literature. Clin Neuroradiol 2022; 32:1097-1108. [PMID: 35674799 DOI: 10.1007/s00062-022-01179-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/08/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aimed to evaluate the application of apparent diffusion coefficient (ADC) histogram analysis to differentiate posterior fossa tumors (PFTs) in children. METHODS A total of 175 pediatric patients with PFT, including 75 pilocytic astrocytomas (PA), 59 medulloblastomas, 16 ependymomas, and 13 atypical teratoid rhabdoid tumors (ATRT), were analyzed. Tumors were visually assessed using DWI trace and conventional MRI images and manually segmented and post-processed using parametric software (pMRI). Furthermore, tumor ADC values were normalized to the thalamus and cerebellar cortex. The following histogram metrics were obtained: entropy, minimum, 10th, and 90th percentiles, maximum, mean, median, skewness, and kurtosis to distinguish the different types of tumors. Kruskal Wallis and Mann-Whitney U tests were used to evaluate the differences. Finally, receiver operating characteristic (ROC) curves were utilized to determine the optimal cut-off values for differentiating the various PFTs. RESULTS Most ADC histogram metrics showed significant differences between PFTs (p < 0.001) except for entropy, skewness, and kurtosis. There were significant pairwise differences in ADC metrics for PA versus medulloblastoma, PA versus ependymoma, PA versus ATRT, medulloblastoma versus ependymoma, and ependymoma versus ATRT (all p < 0.05). Our results showed no significant differences between medulloblastoma and ATRT. Normalized ADC data showed similar results to the absolute ADC value analysis. ROC curve analysis for normalized ADCmedian values to thalamus showed 94.9% sensitivity (95% CI: 85-100%) and 93.3% specificity (95% CI: 87-100%) for differentiating medulloblastoma from ependymoma. CONCLUSION ADC histogram metrics can be applied to differentiate most types of posterior fossa tumors in children.
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Affiliation(s)
- Fabrício Guimarães Gonçalves
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alireza Zandifar
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Jorge Du Ub Kim
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Adarsh Ghosh
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dmitry Khrichenko
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Savvas Andronikou
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Arastoo Vossough
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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8
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Borni M, Abdelmouleh S, Cherif I, Daoud H, Boudawara MZ. Pediatric synchronous multifocal and disseminated cerebrospinal classic medulloblastoma revealed by bilateral decreased visual acuity: a case report. Childs Nerv Syst 2022; 38:2211-2215. [PMID: 35590112 DOI: 10.1007/s00381-022-05546-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
Medulloblastoma (MB) is a rapidly growing malignant solid tumor that arises from stem cells located in the subependymal germinal matrix or outer granular layer of the cerebellum. It represents 15 to 30% of pediatric brain tumors and less than 1% of primary brain tumors. The reason for the high incidence of MB in children compared to adults is the embryonic origin of the tumor. In typical cases, MB manifests as a solitary lesion in the fourth ventricle or in the cerebellar parenchyma; cases of synchronous multifocal and disseminated MB are quite rare in patients without familial tumor syndromes. To date, only 7 cases in adults and a single pediatric case with Gorlin syndrome have been described previously. Here, the authors report a new case of synchronous multifocal classic cerebrospinal histologically confirmed MB in a 10-year-old male patient revealed by bilateral decreased visual acuity without any other localizing neurological signs. The authors will proceed with a review of the current literature regarding this rare entity.
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Affiliation(s)
- Mehdi Borni
- Department of Neurosurgery, UHC Habib Bourguiba, Sfax, Tunisia.
| | | | - Ines Cherif
- Department of Neurosurgery, UHC Habib Bourguiba, Sfax, Tunisia
| | - Hatem Daoud
- Department of Neurosurgery, UHC Habib Bourguiba, Sfax, Tunisia
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9
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Franceschi E, Giannini C, Furtner J, Pajtler KW, Asioli S, Guzman R, Seidel C, Gatto L, Hau P. Adult Medulloblastoma: Updates on Current Management and Future Perspectives. Cancers (Basel) 2022; 14:cancers14153708. [PMID: 35954372 PMCID: PMC9367316 DOI: 10.3390/cancers14153708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Medulloblastoma (MB) is a malignant embryonal tumor of the posterior fossa belonging to the family of primitive neuro-ectodermic tumors (PNET). MB generally occurs in pediatric age, but in 14–30% of cases, it affects the adults, mostly below the age of 40, with an incidence of 0.6 per million per year, representing about 0.4–1% of tumors of the nervous system in adults. Unlike pediatric MB, robust prospective trials are scarce for the post-puberal population, due to the low incidence of MB in adolescent and young adults. Thus, current MB treatments for older patients are largely extrapolated from the pediatric experience, but the transferability and applicability of these paradigms to adults remain an open question. Adult MB is distinct from MB in children from a molecular and clinical perspective. Here, we review the management of adult MB, reporting the recent published literature focusing on the effectiveness of upfront chemotherapy, the development of targeted therapies, and the potential role of a reduced dose of radiotherapy in treating this disease.
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Affiliation(s)
- Enrico Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40139 Bologna, Italy
- Correspondence:
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 59005, USA;
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy;
| | - Julia Furtner
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria;
| | - Kristian W. Pajtler
- Hopp Children’s Cancer Center Heidelberg (KiTZ), 69120 Heidelberg, Germany;
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), 69120 Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy;
- Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139 Bologna, Italy
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland;
| | - Clemens Seidel
- Department of Radiation Oncology, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Lidia Gatto
- Department of Oncology, AUSL of Bologna, 40139 Bologna, Italy;
| | - Peter Hau
- Wilhelm Sander NeuroOncology Unit & Department of Neurology, University Hospital Regensburg, 93055 Regensburg, Germany;
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10
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Serrallach BL, Orman G, Boltshauser E, Hackenberg A, Desai NK, Kralik SF, Huisman TAGM. Neuroimaging in cerebellar ataxia in childhood: A review. J Neuroimaging 2022; 32:825-851. [PMID: 35749078 DOI: 10.1111/jon.13017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/27/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022] Open
Abstract
Ataxia is one of the most common pediatric movement disorders and can be caused by a large number of congenital and acquired diseases affecting the cerebellum or the vestibular or sensory system. It is mainly characterized by gait abnormalities, dysmetria, intention tremor, dysdiadochokinesia, dysarthria, and nystagmus. In young children, ataxia may manifest as the inability or refusal to walk. The diagnostic approach begins with a careful clinical history including the temporal evolution of ataxia and the inquiry of additional symptoms, is followed by a meticulous physical examination, and, depending on the results, is complemented by laboratory assays, electroencephalography, nerve conduction velocity, lumbar puncture, toxicology screening, genetic testing, and neuroimaging. Neuroimaging plays a pivotal role in either providing the final diagnosis, narrowing the differential diagnosis, or planning targeted further workup. In this review, we will focus on the most common form of ataxia in childhood, cerebellar ataxia (CA). We will discuss and summarize the neuroimaging findings of either the most common or the most important causes of CA in childhood or present causes of pediatric CA with pathognomonic findings on MRI. The various pediatric CAs will be categorized and presented according to (a) the cause of ataxia (acquired/disruptive vs. inherited/genetic) and (b) the temporal evolution of symptoms (acute/subacute, chronic, progressive, nonprogressive, and recurrent). In addition, several illustrative cases with their key imaging findings will be presented.
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Affiliation(s)
- Bettina L Serrallach
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Gunes Orman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Eugen Boltshauser
- Department of Pediatric Neurology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annette Hackenberg
- Department of Pediatric Neurology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nilesh K Desai
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Stephen F Kralik
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
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11
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MR Imaging of Pediatric Brain Tumors. Diagnostics (Basel) 2022; 12:diagnostics12040961. [PMID: 35454009 PMCID: PMC9029699 DOI: 10.3390/diagnostics12040961] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 02/04/2023] Open
Abstract
Primary brain tumors are the most common solid neoplasms in children and a leading cause of mortality in this population. MRI plays a central role in the diagnosis, characterization, treatment planning, and disease surveillance of intracranial tumors. The purpose of this review is to provide an overview of imaging methodology, including conventional and advanced MRI techniques, and illustrate the MRI appearances of common pediatric brain tumors.
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12
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Multidisciplinary Management of Medulloblastoma: Consensus, Challenges, and Controversies. METHODS IN MOLECULAR BIOLOGY (CLIFTON, N.J.) 2022; 2423:215-235. [PMID: 34978701 DOI: 10.1007/978-1-0716-1952-0_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Medulloblastoma is a highly aggressive "small round blue cell tumor" of the posterior fossa predominantly seen in children. Historically aggressive multimodality regimens have achieved encouraging outcomes with the caveat of severe long-term toxicities. The last decade has unleashed a revolution in terms of evolved understanding of this heterogeneous disease entity in terms of molecular biology. Medulloblastoma as of today is grouped into one of four canonical molecular subgroups (WNT, SHH, Group 3, and Group 4) each characterized by different putative cells of origin, characteristic aberrations at the molecular level, radiogenomics, and outcomes. Our understanding continues to grow in this regard. The future promises much in terms of personalized medicine in tailoring therapy to the needs of individual patients based on their clinical and molecular profile in order to maximize individual and population based outcomes at the cost of minimizing toxicity.
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Watal P, Patel RP, Chandra T. Pearls and Pitfalls of Imaging in Pediatric Brain Tumors. Semin Ultrasound CT MR 2022; 43:31-46. [PMID: 35164908 DOI: 10.1053/j.sult.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The central nervous system (CNS) tumors constitute the most common type of solid tumors in the pediatric population. The cerebral and cerebellar parenchyma are the most common site of pediatric CNS neoplasms. Imaging plays an important role in detection, characterization, staging and prognostication of brain tumors. The focus of the current article is pediatric brain tumor imaging with emphasis on pearls and pitfalls of conventional and advanced imaging in various pediatric brain tumor subtypes. The article also elucidates changes in brain tumor terms and entities as applicable to pediatric patients, updated as per World Health Organization (WHO) 2016 classification of primary CNS tumors. This classification introduced the genetic and/or molecular information of primary CNS neoplasms as part of comprehensive tumor pathology report in the routine clinical workflow. The concepts from 2016 classification have been further refined based on current research, by the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy (cIMPACT-NOW) group and published in the form of updates. The updates serve as guidelines in the time interval between WHO updates and expect to be broadly adopted in the subsequent WHO classification. The current review covers most pediatric brain tumors except pituitary tumors, meningeal origin tumors, nerve sheath tumors and CNS lymphoma/leukemia.
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Affiliation(s)
- Pankaj Watal
- University of Central Florida College of Medicine and Nemours Children's Hospital, Orlando, FL.
| | - Rajan P Patel
- Section of Neuroradiology, Department of Diagnostic and Interventional Imaging The University of Texas Health Sciences Center at Houston, TX
| | - Tushar Chandra
- University of Central Florida College of Medicine and Nemours Children's Hospital, Orlando, FL
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14
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The impact of magnetic resonance imaging spectroscopy parameters on differentiating between paediatric medulloblastoma and ependymoma. Contemp Oncol (Pozn) 2021; 25:95-99. [PMID: 34667435 PMCID: PMC8506430 DOI: 10.5114/wo.2021.105939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/26/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction The distinction of medulloblastomas and ependymomas plays an important role in the care plans and prognosis of children. We aimed to investigate the role of magnetic resonance spectroscopy (MRS) in the differentiation between medulloblastomas and ependymomas in children. Materials and methods The institutional review board approved this prospective study. The brain magnetic resonance imaging protocol including axial multivoxel spectroscopy with a TE of 144 ms was assessed in 49 patients, who were divided into 2 groups: 40 patients with medulloblastomas and 9 patients with ependymomas. Receiver operating characteristic (ROC) curve analysis and the Youden index were utilized to determine the best cut-off, sensitivity, specificity, and area under the curve (AUC) values of the independent spectroscopy parameters. Results The choline level (Cho) and the choline/creatine (Cho/Cr) and choline/N-acetyl aspartate (Cho/NAA) ratios of medulloblastomas were significantly higher than those of ependymomas (p < 0.05). A Cho/NAA cut-off value of 1.24 to predict the diagnosis of medulloblastoma yielded the highest AUC and sensitivity of 80.3% and 97.5%, respectively, while a Cho cut-off value of 4.64 produced the highest specificity value of 88.9%. Conclusions Our findings suggest that Cho and Cho/NAA derived from MRS could serve as differential factors between paediatric medulloblastomas and ependymomas. Among those, a Cho/NAA cut-off value of 1.24 to predict the diagnosis of medulloblastoma generated the highest accuracy.
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15
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Das Majumdar S, Dhar SS, Lalsangzuala C, Sahu R, Purkait S, Parida D. Combined treatment modality in pediatric infratentorial midline high‐grade glioma can lead to long‐term survival: A case study and review of literature. PRECISION RADIATION ONCOLOGY 2021. [DOI: 10.1002/pro6.1127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Saroj Das Majumdar
- Department of Radiotherapy, Department of Neurosurgery, Department of Pathology All India Institute of Medical Sciences Bhubaneswar Odisha 751019 India
| | - Sovan Sarang Dhar
- Department of Radiotherapy, Department of Neurosurgery, Department of Pathology All India Institute of Medical Sciences Bhubaneswar Odisha 751019 India
| | - Chinzah Lalsangzuala
- Department of Radiotherapy, Department of Neurosurgery, Department of Pathology All India Institute of Medical Sciences Bhubaneswar Odisha 751019 India
| | - Rabi Sahu
- Department of Radiotherapy, Department of Neurosurgery, Department of Pathology All India Institute of Medical Sciences Bhubaneswar Odisha 751019 India
| | - Suvendu Purkait
- Department of Radiotherapy, Department of Neurosurgery, Department of Pathology All India Institute of Medical Sciences Bhubaneswar Odisha 751019 India
| | - Dillip Parida
- Department of Radiotherapy, Department of Neurosurgery, Department of Pathology All India Institute of Medical Sciences Bhubaneswar Odisha 751019 India
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16
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Zhang M, Wong SW, Lummus S, Han M, Radmanesh A, Ahmadian SS, Prolo LM, Lai H, Eghbal A, Oztekin O, Cheshier SH, Fisher PG, Ho CY, Vogel H, Vitanza NA, Lober RM, Grant GA, Jaju A, Yeom KW. Radiomic Phenotypes Distinguish Atypical Teratoid/Rhabdoid Tumors from Medulloblastoma. AJNR Am J Neuroradiol 2021; 42:1702-1708. [PMID: 34266866 DOI: 10.3174/ajnr.a7200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/05/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Atypical teratoid/rhabdoid tumors and medulloblastomas have similar imaging and histologic features but distinctly different outcomes. We hypothesized that they could be distinguished by MR imaging-based radiomic phenotypes. MATERIALS AND METHODS We retrospectively assembled T2-weighted and gadolinium-enhanced T1-weighted images of 48 posterior fossa atypical teratoid/rhabdoid tumors and 96 match-paired medulloblastomas from 7 institutions. Using a holdout test set, we measured the performance of 6 candidate classifier models using 6 imaging features derived by sparse regression of 900 T2WI and 900 T1WI Imaging Biomarker Standardization Initiative-based radiomics features. RESULTS From the originally extracted 1800 total Imaging Biomarker Standardization Initiative-based features, sparse regression consistently reduced the feature set to 1 from T1WI and 5 from T2WI. Among classifier models, logistic regression performed with the highest AUC of 0.86, with sensitivity, specificity, accuracy, and F1 scores of 0.80, 0.82, 0.81, and 0.85, respectively. The top 3 important Imaging Biomarker Standardization Initiative features, by decreasing order of relative contribution, included voxel intensity at the 90th percentile, inverse difference moment normalized, and kurtosis-all from T2WI. CONCLUSIONS Six quantitative signatures of image intensity, texture, and morphology distinguish atypical teratoid/rhabdoid tumors from medulloblastomas with high prediction performance across different machine learning strategies. Use of this technique for preoperative diagnosis of atypical teratoid/rhabdoid tumors could significantly inform therapeutic strategies and patient care discussions.
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Affiliation(s)
- M Zhang
- From the Departments of Neurosurgery (M.Z.)
| | - S W Wong
- Department of Statistics (S.W.W.), Stanford University, Stanford, California
| | - S Lummus
- Department of Physiology and Nutrition (S.L.), University of Colorado, Colorado Springs, Colorado
| | - M Han
- Department of Pediatrics (M.H.), Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - A Radmanesh
- Department of Radiology (A.R.), New York University Grossman School of Medicine, New York, New York
| | - S S Ahmadian
- Pathology (S.S.A., H.V.), Stanford Medical Center, Stanford University, Stanford, California
| | - L M Prolo
- Departments of Neurosurgery (L.M.P., G.A.G.)
| | - H Lai
- Department of Radiology (H.L., A.E.), Children's Hospital of Orange County, Orange, California and University of California, Irvine, Irvine, California
| | - A Eghbal
- Department of Radiology (H.L., A.E.), Children's Hospital of Orange County, Orange, California and University of California, Irvine, Irvine, California
| | - O Oztekin
- Department of Neuroradiology (O.O.), Cigli Education and Research Hospital, Bakircay University, Izmir, Turkey.,Department of Neuroradiology (O.O.), Tepecik Education and Research Hospital, Health Science University, Izmir, Turkey
| | - S H Cheshier
- Division of Pediatric Neurosurgery (S.H.C.), Department of Neurosurgery, Huntsman Cancer Institute, Intermountain Healthcare Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - C Y Ho
- Departments of Clinical Radiology & Imaging Sciences (C.Y.H.), Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - H Vogel
- Pathology (S.S.A., H.V.), Stanford Medical Center, Stanford University, Stanford, California
| | - N A Vitanza
- Division of Pediatric Hematology/Oncology (N.A.V.), Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - R M Lober
- Division of Neurosurgery (R.M.L.), Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, Ohio
| | - G A Grant
- Departments of Neurosurgery (L.M.P., G.A.G.)
| | - A Jaju
- Department of Medical Imaging (A.J.), Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - K W Yeom
- Radiology (K.W.Y.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
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17
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Abstract
Magnetic resonance spectroscopy (MRS), being able to identify and measure some brain components (metabolites) in pathologic lesions and in normal-appearing tissue, offers a valuable additional diagnostic tool to assess several pediatric neurological diseases. In this review we will illustrate the basic principles and clinical applications of brain proton (H1; hydrogen) MRS (H1MRS), by now the only MRS method widely available in clinical practice. Performing H1MRS in the brain is inherently less complicated than in other tissues (e.g., liver, muscle), in which spectra are heavily affected by magnetic field inhomogeneities, respiration artifacts, and dominating signals from the surrounding adipose tissues. H1MRS in pediatric neuroradiology has some advantages over acquisitions in adults (lack of motion due to children sedation and lack of brain iron deposition allow optimal results), but it requires a deep knowledge of pediatric pathologies and familiarity with the developmental changes in spectral patterns, particularly occurring in the first two years of life. Examples from our database, obtained mainly from a 1.5 Tesla clinical scanner in a time span of 15 years, will demonstrate the efficacy of H1MRS in the diagnosis of a wide range of selected pediatric pathologies, like brain tumors, infections, neonatal hypoxic-ischemic encephalopathy, metabolic and white matter disorders.
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Affiliation(s)
- Roberto Liserre
- Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Lorenzo Pinelli
- Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Roberto Gasparotti
- Neuroradiology Unit, Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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18
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Clinical Neuropathological Conference: There’s a Child in All of Us. Can J Neurol Sci 2021. [DOI: 10.1017/cjn.2021.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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19
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Eibl T, Hammer A, Yakubov E, Blechschmidt C, Kalisch A, Steiner HH. Medulloblastoma in adults - reviewing the literature from a surgeon's point of view. Aging (Albany NY) 2021; 13:3146-3160. [PMID: 33497354 PMCID: PMC7880386 DOI: 10.18632/aging.202568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
Medulloblastoma is a common primary brain tumor in children but it is a rare cancer in adult patients. We reviewed the literature, searching PubMed for articles on this rare tumor entity, with a focus on tumor biology, advanced neurosurgical opportunities for safe tumor resection, and multimodal treatment options. Adult medulloblastoma occurs at a rate of 0.6 per one million people per year. There is a slight disparity between male and female patients, and patients with a fair skin tone are more likely to have a medulloblastoma. Patients present with cerebellar signs and signs of elevated intracranial pressure. Diagnostic efforts should consist of cerebral MRI and MRI of the spinal axis. Cerebrospinal fluid should be investigated to look for tumor dissemination. Medulloblastoma tumors can be classified as classic, desmoplastic, anaplastic, and large cell, according to the WHO tumor classification. Molecular subgroups include WNT, SHH, group 3, and group 4 tumors. Further molecular analyses suggest that there are several subgroups within the four existing subgroups, with significant differences in patient age, frequency of metastatic spread, and patient survival. As molecular markers have started to play an increasing role in determining treatment strategies and prognosis, their importance has increased rapidly. Treatment options include microsurgical tumor resection and radiotherapy and, in addition, chemotherapy that respects the tumor biology of individual patients offers targeted therapeutic approaches. For neurosurgeons, intraoperative imaging and tumor fluorescence may improve resection rates. Disseminated disease, residual tumor after surgery, lower radiation dose, and low Karnofsky performance status are all suggestive of a poor outcome. Extraneural spread occurs only in very few cases. The reported 5-year-survival rates range between 60% and 80% for all adult medulloblastoma patients.
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Affiliation(s)
- Thomas Eibl
- Department of Neurosurgery, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Alexander Hammer
- Department of Neurosurgery, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Eduard Yakubov
- Department of Neurosurgery, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Cristiane Blechschmidt
- Department of Neuropathology, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Alexander Kalisch
- Department of Oncology, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Hans-Herbert Steiner
- Department of Neurosurgery, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
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20
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Minh Thong P, Minh Duc N. The Role of Apparent Diffusion Coefficient in the Differentiation between Cerebellar Medulloblastoma and Brainstem Glioma. Neurol Int 2020; 12:34-40. [PMID: 33137983 PMCID: PMC7768368 DOI: 10.3390/neurolint12030009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Pham Minh Thong
- Department of Radiology, Hanoi Medical University, Ha Noi 100000, Vietnam; or
| | - Nguyen Minh Duc
- Department of Radiology, Hanoi Medical University, Ha Noi 100000, Vietnam; or
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 700000, Vietnam
- Department of Radiology, Children’s Hospital 02, Ho Chi Minh City 700000, Vietnam
- Correspondence:
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21
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Carta R, Del Baldo G, Miele E, Po A, Besharat ZM, Nazio F, Colafati GS, Piccirilli E, Agolini E, Rinelli M, Lodi M, Cacchione A, Carai A, Boccuto L, Ferretti E, Locatelli F, Mastronuzzi A. Cancer Predisposition Syndromes and Medulloblastoma in the Molecular Era. Front Oncol 2020; 10:566822. [PMID: 33194646 PMCID: PMC7658916 DOI: 10.3389/fonc.2020.566822] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022] Open
Abstract
Medulloblastoma is the most common malignant brain tumor in children. In addition to sporadic cases, medulloblastoma may occur in association with cancer predisposition syndromes. This review aims to provide a complete description of inherited cancer syndromes associated with medulloblastoma. We examine their epidemiological, clinical, genetic, and diagnostic features and therapeutic approaches, including their correlation with medulloblastoma. Furthermore, according to the most recent molecular advances, we describe the association between the various molecular subgroups of medulloblastoma and each cancer predisposition syndrome. Knowledge of the aforementioned conditions can guide pediatric oncologists in performing adequate cancer surveillance. This will allow clinicians to promptly diagnose and treat medulloblastoma in syndromic children, forming a team with all specialists necessary for the correct management of the other various manifestations/symptoms related to the inherited cancer syndromes.
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Affiliation(s)
- Roberto Carta
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giada Del Baldo
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Evelina Miele
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Agnese Po
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Francesca Nazio
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giovanna Stefania Colafati
- Oncological Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Eleonora Piccirilli
- Department of Neuroscience, Imaging and Clinical Science, University "G.d'Annunzio" of Chieti, Chieti, Italy
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Martina Rinelli
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mariachiara Lodi
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonella Cacchione
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Carai
- Neurosurgery Unit, Department of Neurological and Psychiatric Sciences, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Luigi Boccuto
- JC Self Research Institute, Greenwood Genetic Center, Greenwood, SC, United States.,School of Nursing, College of Behavioral, Social and Health Science, Clemson University, Clemson, SC, United States
| | - Elisabetta Ferretti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Franco Locatelli
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Maternal, Infantile, and Urological Sciences, University of Rome La Sapienza, Rome, Italy
| | - Angela Mastronuzzi
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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22
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Intracranial calcifications in childhood: Part 2. Pediatr Radiol 2020; 50:1448-1475. [PMID: 32642802 DOI: 10.1007/s00247-020-04716-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/03/2020] [Accepted: 05/12/2020] [Indexed: 02/08/2023]
Abstract
This article is the second of a two-part series on intracranial calcification in childhood. In Part 1, the authors discussed the main differences between physiological and pathological intracranial calcification. They also outlined histological intracranial calcification characteristics and how these can be detected across different neuroimaging modalities. Part 1 emphasized the importance of age at presentation and intracranial calcification location and proposed a comprehensive neuroimaging approach toward the differential diagnosis of the causes of intracranial calcification. Pathological intracranial calcification can be divided into infectious, congenital, endocrine/metabolic, vascular, and neoplastic. In Part 2, the chief focus is on discussing endocrine/metabolic, vascular, and neoplastic intracranial calcification etiologies of intracranial calcification. Endocrine/metabolic diseases causing intracranial calcification are mainly from parathyroid and thyroid dysfunction and inborn errors of metabolism, such as mitochondrial disorders (MELAS, or mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes; Kearns-Sayre; and Cockayne syndromes), interferonopathies (Aicardi-Goutières syndrome), and lysosomal disorders (Krabbe disease). Specific noninfectious causes of intracranial calcification that mimic TORCH (toxoplasmosis, other [syphilis, varicella-zoster, parvovirus B19], rubella, cytomegalovirus, and herpes) infections are known as pseudo-TORCH. Cavernous malformations, arteriovenous malformations, arteriovenous fistulas, and chronic venous hypertension are also known causes of intracranial calcification. Other vascular-related causes of intracranial calcification include early atherosclerosis presentation (children with risk factors such as hyperhomocysteinemia, familial hypercholesterolemia, and others), healed hematoma, radiotherapy treatment, old infarct, and disorders of the microvasculature such as COL4A1- and COL4A2-related diseases. Intracranial calcification is also seen in several pediatric brain tumors. Clinical and familial information such as age at presentation, maternal exposure to teratogens including viruses, and association with chromosomal abnormalities, pathogenic genes, and postnatal infections facilitates narrowing the differential diagnosis of the multiple causes of intracranial calcification.
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23
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Franceschi E, Hofer S, Brandes AA, Frappaz D, Kortmann RD, Bromberg J, Dangouloff-Ros V, Boddaert N, Hattingen E, Wiestler B, Clifford SC, Figarella-Branger D, Giangaspero F, Haberler C, Pietsch T, Pajtler KW, Pfister SM, Guzman R, Stummer W, Combs SE, Seidel C, Beier D, McCabe MG, Grotzer M, Laigle-Donadey F, Stücklin ASG, Idbaih A, Preusser M, van den Bent M, Weller M, Hau P. EANO-EURACAN clinical practice guideline for diagnosis, treatment, and follow-up of post-pubertal and adult patients with medulloblastoma. Lancet Oncol 2020; 20:e715-e728. [PMID: 31797797 DOI: 10.1016/s1470-2045(19)30669-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/13/2019] [Accepted: 09/02/2019] [Indexed: 12/20/2022]
Abstract
The European Association of Neuro-Oncology (EANO) and EUropean RAre CANcer (EURACAN) guideline provides recommendations for the diagnosis, treatment, and follow-up of post-pubertal and adult patients with medulloblastoma. The guideline is based on the 2016 WHO classification of tumours of the CNS and on scientific developments published since 1980. It aims to provide direction for diagnostic and management decisions, and for limiting unnecessary treatments and cost. In view of the scarcity of data in adults with medulloblastoma, we base our recommendations on adult data when possible, but also include recommendations derived from paediatric data if justified. Our recommendations are a resource for professionals involved in the management of post-pubertal and adult patients with medulloblastoma, for patients and caregivers, and for health-care providers in Europe. The implementation of this guideline requires multidisciplinary structures of care, and defined processes of diagnosis and treatment.
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Affiliation(s)
- Enrico Franceschi
- Department of Medical Oncology, Azienda USL, Bologna, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Silvia Hofer
- Division of Medical Oncology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Alba A Brandes
- Department of Medical Oncology, Azienda USL, Bologna, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Didier Frappaz
- Department of Neuro-Oncology and Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | | | - Jacoline Bromberg
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - Volodia Dangouloff-Ros
- Paediatric Radiology Department, Hôpital Necker Enfants Malades, Paris, France; UMR 1163, Imagine Institute, Paris, France
| | - Nathalie Boddaert
- Paediatric Radiology Department, Hôpital Necker Enfants Malades, Paris, France; UMR 1163, Imagine Institute, Paris, France
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, Technical University of Munich Hospital, Munich, Germany
| | - Steven C Clifford
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Dominique Figarella-Branger
- Aix-Marseille Univ, APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - Felice Giangaspero
- Department of Radiological, Oncological and Anatomopathological Sciences, Policlinico Umberto I, Sapienza University, Rome, Italy; IRCCS Neuromed, Mediterranean Neurological Institute, Pozzilli, Italy
| | - Christine Haberler
- Institute of Neurology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Torsten Pietsch
- Department of Neuropathology, DGNN Brain Tumour Reference Center, University of Bonn Medical Center, Bonn, Germany
| | - Kristian W Pajtler
- KiTZ Hopp Children's Cancer Center Heidelberg, Division of Pediatric Neurooncology, DKFZ German Cancer Research Center, DKTK German Cancer Consortium, and Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan M Pfister
- KiTZ Hopp Children's Cancer Center Heidelberg, Division of Pediatric Neurooncology, DKFZ German Cancer Research Center, DKTK German Cancer Consortium, and Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Raphael Guzman
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Hospital and University Children's Hospital, Basel, Switzerland
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute of Radiation Medicine, Department of Radiation Sciences, Helmholtz Zentrum München, Munich, Germany
| | - Clemens Seidel
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Dagmar Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Martin G McCabe
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Michael Grotzer
- Department of Oncology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Florence Laigle-Donadey
- Service de Neurologie 2-Mazarin, Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Ana S Guerreiro Stücklin
- Department of Oncology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ahmed Idbaih
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Matthias Preusser
- Division of Oncology, Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Peter Hau
- Wilhelm Sander-NeuroOncology Unit and Department of Neurology, University Hospital Regensburg, Regensburg, Germany.
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Duc NM. The effect of semi-quantitative T1-perfusion parameters for the differentiation between pediatric medulloblastoma and ependymoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00226-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Abstract
Background
The differentiation between medulloblastomas and ependymomas plays an important role in treatment planning and prognosis for children. This study aims to investigate the role of T1-perfusion parameters during the differentiation between medulloblastomas and ependymomas in children. The institutional review board approved this prospective study. The brain magnetic resonance imaging (MRI) protocol, including axial T1-perfusion, was assessed in 26 patients, divided into a medulloblastoma group (group 1, n = 22) and an ependymoma group (group 2, n = 4). The quantified region of interest (ROI) values for 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 the independent T1-perfusion parameters.
Results
The relative enhancement, maximum enhancement, maximum relative enhancement, time to peak, and AUC values for medulloblastomas were significantly higher than those for ependymomas (p < 0.05). Furthermore, the maximum enhancement and maximum relative enhancement for medulloblastoma to parenchyma ratios were also significantly higher than those for ependymomas. A cut-off maximum enhancement value of 100.25 was identified as sufficient to discriminate between medulloblastoma and ependymoma and resulted in a sensitivity of 90.9%, a specificity of 100%, and an AUC of 94.3%.
Conclusion
A cut-off maximum enhancement value of 100.25 derived from T1-perfusion was able to discriminate between medulloblastoma and ependymoma, with high sensitivity, specificity, and accuracy values.
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Dasgupta A, Gupta T, Pungavkar S, Shirsat N, Epari S, Chinnaswamy G, Mahajan A, Janu A, Moiyadi A, Kannan S, Krishnatry R, Sastri GJ, Jalali R. Nomograms based on preoperative multiparametric magnetic resonance imaging for prediction of molecular subgrouping in medulloblastoma: results from a radiogenomics study of 111 patients. Neuro Oncol 2020; 21:115-124. [PMID: 29846693 DOI: 10.1093/neuonc/noy093] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Novel biological insights have led to consensus classification of medulloblastoma into 4 distinct molecular subgroups-wingless (WNT), sonic hedgehog (SHH), Group 3, and Group 4. We aimed to predict molecular subgrouping in medulloblastoma based on preoperative multiparametric magnetic resonance imaging (MRI) characteristics. Methods A set of 19 MRI features were evaluated in 111 patients with histologic diagnosis of medulloblastoma for prediction of molecular subgrouping. MRI characteristics were correlated with molecular subgroups derived from tissue samples in 111 patients (WNT = 17, SHH = 44, Group 3 = 27, and Group 4 = 23). Multinomial logistic regression of imaging parameters was performed on a training cohort (TC) of 76 patients, representing two-thirds of randomly selected patients from each of 4 molecular subgroups, to generate binary nomograms. Validation of these nomograms was performed on the remaining 35 patients as the validation cohort (VC). Results Medulloblastoma subgroups could be accurately predicted by preoperative MRI features in 74% of cases. Predictive accuracy was excellent for SHH (95%), acceptably high for Group 4 (78%), modest for Group 3 (56%) and worst for WNT (41%) subgroup medulloblastoma. SHH-specific nomogram was associated with excellent correlation between TC and VC, with area under the curve (AUC) of 0.939 and 0.991, respectively. AUC for Group 4 was acceptable at 0.851 and 0.788 in TC and VC, respectively; however, these values were consistently suboptimal in WNT and Group 3 medulloblastoma. Conclusion The predictive accuracy of MRI-based nomograms was excellent for SHH and encouraging for Group 4 medulloblastoma. Further work is needed for Group 3 and WNT-pathway medulloblastoma.
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Affiliation(s)
- Archya Dasgupta
- Department of Radiation Oncology, Tata Memorial Hospital/Advanced Centre for Treatment, Research, & Education in Cancer, Tata Memorial Centre, Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Hospital/Advanced Centre for Treatment, Research, & Education in Cancer, Tata Memorial Centre, Mumbai, India
| | - Sona Pungavkar
- Department of Radiodiagnosis & Imaging, Global Hospitals, Mumbai, India
| | - Neelam Shirsat
- Neuro-Oncology Lab, Tata Memorial Hospital/Advanced Centre for Treatment, Research, & Education in Cancer, Tata Memorial Centre, Mumbai, India
| | - Sridhar Epari
- Department of Pathology, Tata Memorial Hospital/Advanced Centre for Treatment, Research, & Education in Cancer, Tata Memorial Centre, Mumbai, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Hospital/Advanced Centre for Treatment, Research, & Education in Cancer, Tata Memorial Centre, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital/Advanced Centre for Treatment, Research, & Education in Cancer, Tata Memorial Centre, Mumbai, India
| | - Amit Janu
- Department of Radiodiagnosis, Tata Memorial Hospital/Advanced Centre for Treatment, Research, & Education in Cancer, Tata Memorial Centre, Mumbai, India
| | - Aliasgar Moiyadi
- Department of Neurosurgical Oncology, Tata Memorial Hospital/Advanced Centre for Treatment, Research, & Education in Cancer, Tata Memorial Centre, Mumbai, India
| | - Sadhana Kannan
- Department of Clinical Trials Unit-Clinical Research Secretariat, Tata Memorial Hospital/Advanced Centre for Treatment, Research, & Education in Cancer, Tata Memorial Centre, Mumbai, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, Tata Memorial Hospital/Advanced Centre for Treatment, Research, & Education in Cancer, Tata Memorial Centre, Mumbai, India
| | - Goda Jayant Sastri
- Department of Radiation Oncology, Tata Memorial Hospital/Advanced Centre for Treatment, Research, & Education in Cancer, Tata Memorial Centre, Mumbai, India
| | - Rakesh Jalali
- Department of Radiation Oncology, Tata Memorial Hospital/Advanced Centre for Treatment, Research, & Education in Cancer, Tata Memorial Centre, Mumbai, India
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26
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Duc NM. Three-Dimensional Pseudo-Continuous Arterial Spin Labeling Parameters Distinguish Pediatric Medulloblastoma and Pilocytic Astrocytoma. Front Pediatr 2020; 8:598190. [PMID: 33763392 PMCID: PMC7982871 DOI: 10.3389/fped.2020.598190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/03/2020] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Nguyen Minh Duc
- Doctoral Program, Department of Radiology, Hanoi Medical University, Ha Noi, Vietnam.,Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Department of Radiology, Children's Hospital 02, Ho Chi Minh City, Vietnam
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AlRayahi J, Zapotocky M, Ramaswamy V, Hanagandi P, Branson H, Mubarak W, Raybaud C, Laughlin S. Pediatric Brain Tumor Genetics: What Radiologists Need to Know. Radiographics 2019; 38:2102-2122. [PMID: 30422762 DOI: 10.1148/rg.2018180109] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Brain tumors are the most common solid tumors in the pediatric population. Pediatric neuro-oncology has changed tremendously during the past decade owing to ongoing genomic advances. The diagnosis, prognosis, and treatment of pediatric brain tumors are now highly reliant on the genetic profile and histopathologic features of the tumor rather than the histopathologic features alone, which previously were the reference standard. The clinical information expected to be gleaned from radiologic interpretations also has evolved. Imaging is now expected to not only lead to a relevant short differential diagnosis but in certain instances also aid in predicting the specific tumor and subtype and possibly the prognosis. These processes fall under the umbrella of radiogenomics. Therefore, to continue to actively participate in patient care and/or radiogenomic research, it is important that radiologists have a basic understanding of the molecular mechanisms of common pediatric central nervous system tumors. The genetic features of pediatric low-grade gliomas, high-grade gliomas, medulloblastomas, and ependymomas are reviewed; differences between pediatric and adult gliomas are highlighted; and the critical oncogenic pathways of each tumor group are described. The role of the mitogen-activated protein kinase pathway in pediatric low-grade gliomas and of histone mutations as epigenetic regulators in pediatric high-grade gliomas is emphasized. In addition, the oncogenic drivers responsible for medulloblastoma, the classification of ependymomas, and the associated imaging correlations and clinical implications are discussed. ©RSNA, 2018.
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Affiliation(s)
- Jehan AlRayahi
- From the Departments of Diagnostic Imaging (J.A., W.M.), Neurooncology (M.Z., V.R.), and Pediatric Neuroradiology (H.B., C.R., S.L.), The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Diagnostic Imaging (J.A., P.H.) and Pediatric Interventional Radiology (W.M.), Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar
| | - Michal Zapotocky
- From the Departments of Diagnostic Imaging (J.A., W.M.), Neurooncology (M.Z., V.R.), and Pediatric Neuroradiology (H.B., C.R., S.L.), The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Diagnostic Imaging (J.A., P.H.) and Pediatric Interventional Radiology (W.M.), Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar
| | - Vijay Ramaswamy
- From the Departments of Diagnostic Imaging (J.A., W.M.), Neurooncology (M.Z., V.R.), and Pediatric Neuroradiology (H.B., C.R., S.L.), The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Diagnostic Imaging (J.A., P.H.) and Pediatric Interventional Radiology (W.M.), Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar
| | - Prasad Hanagandi
- From the Departments of Diagnostic Imaging (J.A., W.M.), Neurooncology (M.Z., V.R.), and Pediatric Neuroradiology (H.B., C.R., S.L.), The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Diagnostic Imaging (J.A., P.H.) and Pediatric Interventional Radiology (W.M.), Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar
| | - Helen Branson
- From the Departments of Diagnostic Imaging (J.A., W.M.), Neurooncology (M.Z., V.R.), and Pediatric Neuroradiology (H.B., C.R., S.L.), The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Diagnostic Imaging (J.A., P.H.) and Pediatric Interventional Radiology (W.M.), Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar
| | - Walid Mubarak
- From the Departments of Diagnostic Imaging (J.A., W.M.), Neurooncology (M.Z., V.R.), and Pediatric Neuroradiology (H.B., C.R., S.L.), The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Diagnostic Imaging (J.A., P.H.) and Pediatric Interventional Radiology (W.M.), Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar
| | - Charles Raybaud
- From the Departments of Diagnostic Imaging (J.A., W.M.), Neurooncology (M.Z., V.R.), and Pediatric Neuroradiology (H.B., C.R., S.L.), The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Diagnostic Imaging (J.A., P.H.) and Pediatric Interventional Radiology (W.M.), Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar
| | - Suzanne Laughlin
- From the Departments of Diagnostic Imaging (J.A., W.M.), Neurooncology (M.Z., V.R.), and Pediatric Neuroradiology (H.B., C.R., S.L.), The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Diagnostic Imaging (J.A., P.H.) and Pediatric Interventional Radiology (W.M.), Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar
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Duc NM, Huy HQ. Magnetic Resonance Imaging Features of Common Posterior Fossa Brain Tumors in Children: A Preliminary Vietnamese Study. Open Access Maced J Med Sci 2019; 7:2413-2418. [PMID: 31666838 PMCID: PMC6814486 DOI: 10.3889/oamjms.2019.635] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND: Magnetic Resonance Imaging (MRI) nowadays plays an important role in the evaluation of posterior fossa brain tumours in children for appropriate diagnosis, treatment planning, and follow-up. AIM: To assess the MRI features of common posterior fossa brain tumours including medulloblastomas, ependymomas, and pilocytic astrocytomas along with the postoperative parameters to contribute the local knowledge to the neuroradiology and neurosurgery fields. METHODS: The study was performed at Children’s Hospital 02 from January 2016 to June 2019. In this study, all pediatric patients adopted MRI to evaluate the posterior fossa brain tumours’ characteristics and then underwent surgery to eradicate the posterior fossa tumours. We retrospectively compared the baseline parameters, MRI parameters, and postoperative parameters among medulloblastomas, ependymomas, and pilocytic astrocytomas. RESULTS: There were 62 patients (27 medulloblastomas, 20 ependymomas, and 15 pilocytic astrocytomas) in this research. The main structure of medulloblastomas and ependymomas was predominantly solid, whereas the main structure of pilocytic astrocytomas was superiorly cystic (p < 0.05). Ependymoma tended to extend tumour through foramina of Luschka and Magendie (p < 0.05). Medulloblastomas chiefly showed iso intensity on T2W and FLAIR images meanwhile ependymomas and pilocytic astrocytomas predominantly appeared hyperintensity on T2W and FLAIR images. Medulloblastomas and ependymomas were mostly high intensity on DWI, and low intensity on ADC whereas pilocytic astrocytomas were usually low intensity on DWI and high intensity on ADC. After injecting CE, pilocytic astrocytomas showed a mixed intensity whereas the signal intensity of medulloblastoma and ependymoma on T1CE was generally strong. There were positive correlations between FH diameter and estimated blood loss (r = 0.289, p < 0.05); and surgical time (r = 0.312, p < 0.05). CONCLUSION: MRI plays a crucial role in demonstrating the features of posterior fossa brain tumours for appropriate diagnosis of medulloblastomas, ependymomas, and pilocytic astrocytomas. Medulloblastomas are problematic tumours and the clinicians should also take into consideration in cases of larger feet-to-head diameter of tumours to ensure the efficacy and safety surgery for patients.
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Affiliation(s)
- Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Vietnam.,Department of Radiology, Children's Hospital 02, Vietnam
| | - Huynh Quang Huy
- Department of Radiology, Pham Ngoc Thach University of Medicine, Vietnam
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Abstract
Medulloblastoma is the most common malignant solid tumor in childhood and the most common embryonal neuroepithelial tumor of the central nervous system. Several morphological variants are recognized: classic medulloblastoma, large cell/anaplastic medulloblastoma, desmoplastic/nodular medulloblastoma, and medulloblastoma with extensive nodularity. Recent advances in transcriptome and methylome profiling of these tumors led to a molecular classification that includes 4 major genetically defined groups. Accordingly, the 2016 revision of the World Health Organization's Classification of Tumors of the Central Nervous System recognizes the following medulloblastoma entities: Wingless (WNT)-activated, Sonic hedgehog (SHH)-activated, Group 3, and Group 4. This transcriptionally driven classification constitutes the basis of new risk stratification schemes applied to current therapeutic clinical trials. Because additional layers of molecular tumor heterogeneities are being progressively unveiled, several clinically relevant subgroups within the 4 major groups have already been identified. The purpose of this article is to review the recent basic science and clinical advances in the understanding of "medulloblastomas," and their diagnostic imaging correlates and the implications of those on current neuroimaging practice.
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30
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Beera KG, Li YQ, Dazai J, Stewart J, Egan S, Ahmed M, Wong CS, Jaffray DA, Nieman BJ. Altered brain morphology after focal radiation reveals impact of off-target effects: implications for white matter development and neurogenesis. Neuro Oncol 2019; 20:788-798. [PMID: 29228390 PMCID: PMC5961122 DOI: 10.1093/neuonc/nox211] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Children with brain tumors treated with cranial radiation therapy (RT) often exhibit cognitive late effects, commonly associated with reduced white matter (WM) volume and decreased neurogenesis. The impact of radiation damage in particular regions or tissues on brain development as a whole has not been elucidated. Methods We delivered whole-brain or focal radiation (8 Gy single dose) to infant mice. Focal treatments targeted white matter (anterior commissure), neuronal (olfactory bulbs), or neurogenic (subventricular zone) regions. High-resolution ex vivo MRI was used to assess radiation-induced volume differences. Immunohistochemistry for myelin basic protein and doublecortin was performed to assess associated cellular changes within white matter and related to neurogenesis, respectively. Results Both whole-brain and focal RT in infancy resulted in volume deficits in young adulthood, with whole-brain RT resulting in the largest deficits. RT of the anterior commissure, surprisingly, showed no impact on its volume or on brain development as a whole. In contrast, RT of the olfactory bulbs resulted in off-target volume reduction in the anterior commissure and decreased subventricular zone neurogenesis. RT of the subventricular zone likewise produced volume deficits in both the olfactory bulbs and the anterior commissure. Similar off-target effects were found in the corpus callosum and parietal cortex. Conclusions Our results demonstrate that radiation damage locally can have important off-target consequences for brain development. These data suggest that WM may be less radiosensitive than volume change alone would indicate and have implications for region-sparing radiation treatments aimed at reducing cognitive late effects.
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Affiliation(s)
- Kiran G Beera
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Yu-Qing Li
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jun Dazai
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James Stewart
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Shannon Egan
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Physics, University of McGill, Montreal, Quebec, Canada
| | - Mashal Ahmed
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Biology, University of Waterloo, Waterloo, Ontario, Canada
| | - C Shun Wong
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - David A Jaffray
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, Radiation Medicine Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Brian J Nieman
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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31
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Gembruch O, Junker A, Mönninghoff C, Ahmadipour Y, Darkwah Oppong M, Sure U, El Hindy N, Lemonas E. Liponeurocytoma: Systematic Review of a Rare Entity. World Neurosurg 2018; 120:214-233. [DOI: 10.1016/j.wneu.2018.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/30/2018] [Accepted: 09/02/2018] [Indexed: 11/25/2022]
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32
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Clinical Applications of Quantitative 3-Dimensional MRI Analysis for Pediatric Embryonal Brain Tumors. Int J Radiat Oncol Biol Phys 2018; 102:744-756. [DOI: 10.1016/j.ijrobp.2018.05.077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 12/23/2022]
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33
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Muly S, Liu S, Lee R, Nicolaou S, Rojas R, Khosa F. MRI of intracranial intraventricular lesions. Clin Imaging 2018; 52:226-239. [DOI: 10.1016/j.clinimag.2018.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 05/26/2018] [Accepted: 07/23/2018] [Indexed: 01/25/2023]
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34
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Shih RY, Koeller KK. Embryonal Tumors of the Central Nervous System: From the Radiologic Pathology Archives. Radiographics 2018. [PMID: 29528832 DOI: 10.1148/rg.2018170182] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Embryonal tumors of the central nervous system (CNS) are highly malignant undifferentiated or poorly differentiated tumors of neuroepithelial origin and have been defined as a category in the World Health Organization (WHO) classification since the first edition of the "Blue Book" in 1979. This category has evolved over time to reflect our ever-improving understanding of tumor biology and behavior. With the most recent update in 2016, many previous histologic diagnoses incorporate molecular parameters for the first time (genetically defined entities). While medulloblastoma and atypical teratoid/rhabdoid tumor are familiar carryovers from the 2007 CNS WHO classification, there are major changes to the embryonal tumor category: for example, elimination of the term CNS primitive neuroectodermal tumor and addition of a new genetically defined entity, embryonal tumor with multilayered rosettes, C19MC-altered. The purpose of this article is to discuss both the radiologic-pathologic features of CNS embryonal tumors and the new molecularly defined types/subtypes that will become the standard classification/terminology for future diagnoses and tumor research.
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Affiliation(s)
- Robert Y Shih
- From the Department of Neuroradiology, American Institute for Radiologic Pathology, Silver Spring, Md (R.Y.S., K.K.K.); Uniformed Services University of the Health Sciences, Bethesda, Md (R.Y.S.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (R.Y.S.); and Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (K.K.K.)
| | - Kelly K Koeller
- From the Department of Neuroradiology, American Institute for Radiologic Pathology, Silver Spring, Md (R.Y.S., K.K.K.); Uniformed Services University of the Health Sciences, Bethesda, Md (R.Y.S.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (R.Y.S.); and Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (K.K.K.)
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Dangouloff-Ros V, Varlet P, Levy R, Beccaria K, Puget S, Dufour C, Boddaert N. Imaging features of medulloblastoma: Conventional imaging, diffusion-weighted imaging, perfusion-weighted imaging, and spectroscopy: From general features to subtypes and characteristics. Neurochirurgie 2018; 67:6-13. [PMID: 30170827 DOI: 10.1016/j.neuchi.2017.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/13/2017] [Accepted: 10/29/2017] [Indexed: 12/13/2022]
Abstract
Medulloblastoma is a frequent high-grade neoplasm among pediatric brain tumours. Its classical imaging features are a midline tumour growing into the fourth ventricle, hyperdense on CT-scan, displaying a hypersignal when using diffusion-weighted imaging, with a variable contrast enhancement. Nevertheless, atypical imaging features have been widely reported, varying according to the age of the patient, and histopathological subtype. In this study, we review the classical and atypical imaging features of medulloblastomas, with emphasis on advanced MRI techniques, histopathological and molecular subtypes and characteristics, and follow-up modalities.
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Affiliation(s)
- V Dangouloff-Ros
- Department of pediatric radiology, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75105 Paris, France; Inserm U1000, 149, rue de Sèvres, 75015 Paris, France; University René-Descartes, PRES-Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, Paris, France.
| | - P Varlet
- University René-Descartes, PRES-Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, Paris, France; Department of neuropathology, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - R Levy
- Department of pediatric radiology, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75105 Paris, France; Inserm U1000, 149, rue de Sèvres, 75015 Paris, France; University René-Descartes, PRES-Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, Paris, France
| | - K Beccaria
- University René-Descartes, PRES-Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, Paris, France; Department of pediatric neurosurgery, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75105 Paris, France
| | - S Puget
- University René-Descartes, PRES-Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, Paris, France; Department of pediatric neurosurgery, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75105 Paris, France
| | - C Dufour
- Department of pediatric and adolescent oncology, Gustave-Roussy Institute, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - N Boddaert
- Department of pediatric radiology, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75105 Paris, France; Inserm U1000, 149, rue de Sèvres, 75015 Paris, France; University René-Descartes, PRES-Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, Paris, France; UMR 1163, institut Imagine, 24, boulevard du Montparnasse, 75015 Paris, France
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Johnson SB, Hung J, Kapadia N, Oh KS, Kim M, Hamstra DA. Spinal Growth Patterns After Craniospinal Irradiation in Children With Medulloblastoma. Pract Radiat Oncol 2018; 9:e22-e28. [PMID: 30036592 DOI: 10.1016/j.prro.2018.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/13/2018] [Accepted: 07/05/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to evaluate the impact on spine growth in children with medulloblastoma using either photon or electron craniospinal irradiation (CSI). METHODS AND MATERIALS This was a single institution retrospective review of children who were treated with CSI for medulloblastoma. Spine growth was measured on magnetic resonance imaging scans at defined locations on the basis of a published predictive model of spine growth after CSI. Differences between spine growth in the anterior, middle, and posterior aspect of the designated vertebral segments were also assessed. Differences between the groups treated with photons or electrons were assessed with student's t test. RESULTS A total of 19 patients (10 patients treated with electrons and 9 with photons) with a median follow-up time of 45.5 months (confidence interval, 34.9-55.1 months) were evaluated. Patients treated with electrons were younger than those who received photons (5.1 years [range, 3.8-9.0 years] vs 9.6 years [range, 3.5-12.9 years]); however, there were no differences in other clinical characteristics, treatment, or follow-up between the groups. Spine growth rate for patients treated with electrons fit the predictive model (104% ± 5.2%), but patients treated with photons had growth that was faster than predicted by the model (150% ± 47%) and different from that observed with electrons. The differences between treatment the modalities were statistically significant (P = .03). For patients treated with photons, there were no statistical differences between the growth rate of the anterior vertebral body compared with the posterior aspect, but for patients treated with electrons, a faster spine growth in the anterior L1-L5 lumbar spine was observed compared with the posterior lumbar spine (3.90 vs 2.52 mm/year; P = .006) without differences in the cervical or thoracic spine. CONCLUSIONS The use of electrons to treat the craniospinal axis in children with medulloblastoma resulted in no significant difference in spine growth compared with the predicted spine growth on the basis of previously published models using photons, but with a clinically insignificant faster spine growth rate in the anterior lumbar spine.
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Affiliation(s)
- Skyler B Johnson
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Jonathon Hung
- Department of Emergency Medicine, Northwestern University, Chicago, Illinois
| | - Nirav Kapadia
- Radiation Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Kevin S Oh
- Massachusetts General Hospital, Boston, Massachusetts
| | - Michelle Kim
- The University of Michigan, Department of Radiation Oncology, Ann Arbor, Michigan
| | - Daniel A Hamstra
- Department of Radiation Oncology, Beaumont Health, Dearborn, Michigan.
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Li Q, Dai Z, Cao Y, Wang L. Comparing children and adults with medulloblastoma: a SEER based analysis. Oncotarget 2018; 9:30189-30198. [PMID: 30046397 PMCID: PMC6059016 DOI: 10.18632/oncotarget.23773] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 12/26/2017] [Indexed: 11/25/2022] Open
Abstract
Medulloblastoma (MB) is a brain malignancy, which commonly occurs in children, but is rare in adults. The Surveillance, Epidemiology, and End Results (SEER) database was used to compare survival, clinical features, and prognostic factors of children and adults with MB from 1992 to 2013. Overall survival estimates were compared using the Kaplan-Meier method, and Cox Proportion Hazard Regression modeling was used to evaluate prognostic variables. We identified 616 children (63.8%) and 349 adults (36.2%) with diagnosis of MB. The estimated survival rates for children diagnosed with MB for 2, 5, and 10 years were 85.6%, 75.5%, and 67.9%, respectively; the corresponding estimates for adults were 84.9%, 74.2%, and 67.3%. Radiotherapy was the only identical prognostic factor observed in the two groups. Children MB patients were more likely to experience distal metastases that was associated with increased hazard of mortality, and be diagnosed after 2003. Among adult MB patients, gross total resection (GTR) was a favorable prognostic factor, while large cell/anaplastic (LC/A) histology was correlated with decreased survival. Our analysis highlighted that both groups had similar overall survival time, but the prognostic factors were not comparable, except radiotherapy which was associated with better survival.
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Affiliation(s)
- Qian Li
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin 150081, Heilongjiang, China
| | - Zhenguo Dai
- Department of Cardiology, The Second Affiliated Hospital, Harbin Medical University, Harbin 150081, Heilongjiang, China
| | - Yuze Cao
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin 150081, Heilongjiang, China
| | - Lihua Wang
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin 150081, Heilongjiang, China
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Colafati GS, Voicu IP, Carducci C, Miele E, Carai A, Di Loreto S, Marrazzo A, Cacchione A, Cecinati V, Tornesello A, Mastronuzzi A. MRI features as a helpful tool to predict the molecular subgroups of medulloblastoma: state of the art. Ther Adv Neurol Disord 2018; 11:1756286418775375. [PMID: 29977341 PMCID: PMC6024494 DOI: 10.1177/1756286418775375] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/28/2018] [Indexed: 12/20/2022] Open
Abstract
Medulloblastoma is the most common malignant pediatric brain tumor. Medulloblastoma should not be viewed as a single disease, but as a heterogeneous mixture of various subgroups with distinct characteristics. Based on genomic profiles, four distinct molecular subgroups are identified: Wingless (WNT), Sonic Hedgehog (SHH), Group 3 and Group 4. Each of these subgroups are associated with specific genetic aberrations, typical age of onset as well as survival prognosis. Magnetic resonance imaging (MRI) is performed for all patients with brain tumors, and has a key role in the diagnosis, surgical guidance and follow up of patients with medulloblastoma. Several studies indicate MRI as a promising tool for early detection of medulloblastoma subgroups. The early identification of the subgroup can influence the extent of surgical resection, radiotherapy and chemotherapy targeted treatments. In this article, we review the state of the art in MRI-facilitated medulloblastoma subgrouping, with a summary of the main MRI features in medulloblastoma and a brief discussion on molecular characterization of medulloblastoma subgroups. The main focus of the article is MRI features that correlate with medulloblastoma subtypes, as well as features suggestive of molecular subgroups. Finally, we briefly discuss the latest trends in MRI studies and latest developments in molecular characterization.
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Affiliation(s)
| | - Ioan Paul Voicu
- Department of Imaging, Neuroradiology Unit and Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Chiara Carducci
- Department of Imaging, Neuroradiology Unit, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Evelina Miele
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Carai
- Department of Neuroscience and Neurorehabilitation, Neurosurgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Simona Di Loreto
- Dipartimento di Pediatria, Università degli studi di Chieti, Chieti, Italy
| | - Antonio Marrazzo
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonella Cacchione
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Valerio Cecinati
- Pediatric Hematology and Oncology Unit, Department of Hematology, Transfusion Medicine and Biotechnology, Pescara, Italy
| | | | - Angela Mastronuzzi
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, Rome, Italy
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Gembruch O, Junker A, Ahmadipour Y, Sure U, Lemonas E. Cerebellar liponeurocytoma - a rare entity: a case report. J Med Case Rep 2018; 12:170. [PMID: 29908563 PMCID: PMC6004288 DOI: 10.1186/s13256-018-1706-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/01/2018] [Indexed: 01/28/2023] Open
Abstract
Background Cerebellar liponeurocytoma is a rare tumor of the central nervous system occurring mainly in the posterior fossa, which shows neuronal and variable astrocytic differentiation with foci of lipomatous differentiation. Liponeurocytoma develops in adult patients and is defined in the World Health Organization classification of 2016 as a rare benign grade II tumor. Case presentation A 39-year-old Italian man presented to our department suffering from headache and nausea. Magnetic resonance imaging revealed a right-sided cerebellar lesion showing poor contrast enhancement without an obstructive hydrocephalus. Surgery was indicated and total tumor resection was achieved. He was discharged without any neurological deficits. Histopathological examinations revealed a cerebellar liponeurocytoma. A neurological follow-up examination revealed no neurological deficit directly after surgery and 1 year later. Radiotherapy was recommended at the neurooncological board despite the total removal of the tumor, but our patient refused adjuvant radiotherapy. Magnetic resonance imaging of his neurocranium with and without contrast enhancement 48 hours after surgery and 15 months after surgery showed no residual tumor. Conclusions Liponeurocytomas are rare benign tumors occurring in the majority of cases in the cerebellum. The therapy of choice is surgery. Postoperative radiotherapy has to be discussed individually, but seems to be sufficient if complete tumor resection is not achieved or in cases of a tumor recurrence.
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Affiliation(s)
- Oliver Gembruch
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany.
| | - Andreas Junker
- Department of Neuropathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Yahya Ahmadipour
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Elias Lemonas
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany
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Murase M, Saito K, Abiko T, Yoshida K, Tomita H. Medulloblastoma in Older Adults: A Case Report and Literature Review. World Neurosurg 2018; 117:25-31. [PMID: 29883827 DOI: 10.1016/j.wneu.2018.05.216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Medulloblastoma is a malignant tumor of the posterior fossa and is predominantly seen in children younger than 15 years of age. This tumor is uncommon in adults, especially those older than 40 years of age, and reports of cases in patients older than 60 years of age are particularly rare. Although surgery and radiotherapy play important roles in treatment of medulloblastoma in adults, addition of chemotherapy is controversial, especially prior to radiotherapy. CASE DESCRIPTION We present a case of a 63-year-old woman with an atypical medulloblastoma in the cerebellum and a lesion in the suprasellar area that did not appear to be a metastasis of the medulloblastoma. The patient underwent a subtotal resection of the cerebellar medulloblastoma, which was classified histologically as classic subtype and molecularly as non-Wingless/non-Sonic hedgehog subtype in World Health Organization 2016 classification. Then she underwent postoperative chemotherapy followed by radiotherapy. We administered chemotherapy to facilitate therapeutic diagnosis of the suprasellar lesion. The combination treatment resulted in the disappearance of the cerebellar medulloblastoma with treatment toxicity well tolerated. Additionally, the suprasellar lesion remains under control. CONCLUSIONS Even in adults over 60 years of age, medulloblastoma should be included in the differential diagnosis of a cerebellar mass. Chemotherapy for adult medulloblastoma has the potential to be efficacious and tolerable.
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Affiliation(s)
- Makoto Murase
- Department of Neurosurgery, Ashikaga Red Cross Hospital, Ashikaga-shi, Tochigi, Japan.
| | - Katsuya Saito
- Department of Neurosurgery, Ashikaga Red Cross Hospital, Ashikaga-shi, Tochigi, Japan
| | - Tomohiro Abiko
- Department of Neurosurgery, Ashikaga Red Cross Hospital, Ashikaga-shi, Tochigi, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hideyuki Tomita
- Department of Neurosurgery, Ashikaga Red Cross Hospital, Ashikaga-shi, Tochigi, Japan
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The Child With Macrocephaly: Differential Diagnosis and Neuroimaging Findings. AJR Am J Roentgenol 2018; 210:848-859. [DOI: 10.2214/ajr.17.18693] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Aboian MS, Kline CN, Li Y, Solomon DA, Felton E, Banerjee A, Braunstein SE, Mueller S, Dillon WP, Cha S. Early detection of recurrent medulloblastoma: the critical role of diffusion-weighted imaging. Neurooncol Pract 2018; 5:234-240. [PMID: 30402262 DOI: 10.1093/nop/npx036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Imaging diagnosis of medulloblastoma recurrence relies heavily on identifying new contrast-enhancing lesions on surveillance imaging, with diffusion-weighted imaging (DWI) being used primarily for detection of complications. We propose that DWI is more sensitive in detecting distal and leptomeningeal recurrent medulloblastoma than T1-weighted postgadolinium imaging. Methods We identified 53 pediatric patients with medulloblastoma, 21 of whom developed definitive disease recurrence within the brain. MRI at diagnosis of recurrence and 6 months prior was evaluated for new lesions with reduced diffusion on DWI, contrast enhancement, size, and recurrence location. Results All recurrent medulloblastoma lesions demonstrated reduced diffusion. Apparent diffusion coefficient (ADC) measurements were statistically significantly lower (P = .00001) in recurrent lesions (mean=0.658, SD=0.072) as compared to contralateral normal region of interest (mean=0.923, SD=0.146). Sixteen patients (76.2%) with disease recurrence demonstrated contrast enhancement within the recurrent lesions. All 5 patients with nonenhancing recurrence demonstrated reduced diffusion, with a mean ADC of 0.695 ± 0.101 (normal=0.893 ± 0.100, P = .0027). While group 3 and group 4 molecular subtypes demonstrated distal recurrence more frequently, nonenhancing metastatic disease was found in all molecular subtypes. Conclusion Recurrent medulloblastoma lesions do not uniformly demonstrate contrast enhancement on MRI, but all demonstrate reduced diffusion. Our findings support that DWI is more sensitive than contrast enhancement for detection of medulloblastoma recurrence, particularly in cases of leptomeningeal nonenhancing disease and distal nonenhancing focal disease. As such, recurrent medulloblastoma can present as a reduced diffusion lesion in a patient with normal postgadolinium contrast MRI.
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Affiliation(s)
- Mariam S Aboian
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Cassie N Kline
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California San Francisco, San Francisco CA
| | - Yi Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - David A Solomon
- Department of Pathology, University of California San Francisco, San Francisco CA
| | - Erin Felton
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California San Francisco, San Francisco CA
| | - Anu Banerjee
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA.,Department of Neurological Surgery, University of California San Francisco, San Francisco CA
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California San Francisco, San Francisco CA
| | - Sabine Mueller
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California San Francisco, San Francisco CA.,Department of Neurological Surgery, University of California San Francisco, San Francisco CA
| | - William P Dillon
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
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Presutto E, Chappell M, Fullmer J, Ezhapilli S. Posterior fossa medulloblastoma in an atypical extra-axial location: A case report. Radiol Case Rep 2018; 13:365-370. [PMID: 29904474 PMCID: PMC5999935 DOI: 10.1016/j.radcr.2018.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/04/2018] [Indexed: 12/12/2022] Open
Abstract
Medulloblastoma is the most common posterior fossa tumor of childhood typically within the fourth ventricle. However, extra-axial medulloblastoma in posterior fossa is an uncommon diagnosis. We report a case in a 33-month-old male who presented with repeated complaints of abdominal pain, intermittent emesis, and diarrhea, and diagnosed with right cerebellar extra-axial medulloblastoma, which was surgically resected. Majority of the reported extra-axial medulloblastoma in posterior fossa in the United States are located in the cerebellopontine angle. However, to the best of our knowledge, our case is the first to document medulloblastoma occurring exclusively in the cerebellar hemispheric extra-axial space rather than the cerebellopontine angle. Although the diagnosis can present as a radiological dilemma, a systematic multimodality imaging approach can aid in narrowing the differential diagnosis and timely management. In this case report, we will discuss the imaging characteristics, differential diagnosis, and management strategies, alongside a brief review of the world literature of extra-axial medulloblastoma.
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Affiliation(s)
- Elizabeth Presutto
- SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Matthew Chappell
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Joseph Fullmer
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Sajeev Ezhapilli
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
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Mata-Mbemba D, Donnellan J, Krishnan P, Shroff M, Muthusami P. Imaging Features of Common Pediatric Intracranial Tumours: A Primer for the Radiology Trainee. Can Assoc Radiol J 2018; 69:105-117. [DOI: 10.1016/j.carj.2017.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Daddy Mata-Mbemba
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John Donnellan
- Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pradeep Krishnan
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Manohar Shroff
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Prakash Muthusami
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
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Keil VC, Warmuth-Metz M, Reh C, Enkirch SJ, Reinert C, Beier D, Jones DTW, Pietsch T, Schild HH, Hattingen E, Hau P. Imaging Biomarkers for Adult Medulloblastomas: Genetic Entities May Be Identified by Their MR Imaging Radiophenotype. AJNR Am J Neuroradiol 2017; 38:1892-1898. [PMID: 28798218 DOI: 10.3174/ajnr.a5313] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/24/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE The occurrence of medulloblastomas in adults is rare; nevertheless, these tumors can be subdivided into genetic and histologic entities each having distinct prognoses. This study aimed to identify MR imaging biomarkers to classify these entities and to uncover differences in MR imaging biomarkers identified in pediatric medulloblastomas. MATERIALS AND METHODS Eligible preoperative MRIs from 28 patients (11 women; 22-53 years of age) of the Multicenter Pilot-study for the Therapy of Medulloblastoma of Adults (NOA-7) cohort were assessed by 3 experienced neuroradiologists. Lesions and perifocal edema were volumetrized and multiparametrically evaluated for classic morphologic characteristics, location, hydrocephalus, and Chang criteria. To identify MR imaging biomarkers, we correlated genetic entities sonic hedgehog (SHH) TP53 wild type, wingless (WNT), and non-WNT/non-SHH medulloblastomas (in adults, Group 4), and histologic entities were correlated with the imaging criteria. These MR imaging biomarkers were compared with corresponding data from a pediatric study. RESULTS There were 19 SHH TP53 wild type (69%), 4 WNT-activated (14%), and 5 Group 4 (17%) medulloblastomas. Six potential MR imaging biomarkers were identified, 3 of which, hydrocephalus (P = .03), intraventricular macrometastases (P = .02), and hemorrhage (P = .04), when combined, could identify WNT medulloblastoma with 100% sensitivity and 88.3% specificity (95% CI, 39.8%-100.0% and 62.6%-95.3%). WNT-activated nuclear β-catenin accumulating medulloblastomas were smaller than the other entities (95% CI, 5.2-22.3 cm3 versus 35.1-47.6 cm3; P = .03). Hemorrhage was exclusively present in non-WNT/non-SHH medulloblastomas (P = .04; n = 2/5). MR imaging biomarkers were all discordant from those identified in the pediatric cohort. Desmoplastic/nodular medulloblastomas were more rarely in contact with the fourth ventricle (4/15 versus 7/13; P = .04). CONCLUSIONS MR imaging biomarkers can help distinguish histologic and genetic medulloblastoma entities in adults and appear to be different from those identified in children.
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Affiliation(s)
- V C Keil
- From the Department of Radiology and Neuroradiology (V.C.K., C.R., S.J.E., H.H.S., E.H.), University Hospital Bonn, Bonn, Germany
| | - M Warmuth-Metz
- Institute for Diagnostic and Interventional Neuroradiology (M.W.-M.), University Hospital Würzburg, Würzburg, Germany
| | - C Reh
- From the Department of Radiology and Neuroradiology (V.C.K., C.R., S.J.E., H.H.S., E.H.), University Hospital Bonn, Bonn, Germany
- Wilhelm Sander-Therapieeinheit NeuroOnkologie (C.R., P.H.)
- Department of Neurology (C.R., P.H.), University Hospital Regensburg, Regensburg, Germany
| | - S J Enkirch
- From the Department of Radiology and Neuroradiology (V.C.K., C.R., S.J.E., H.H.S., E.H.), University Hospital Bonn, Bonn, Germany
| | - C Reinert
- From the Department of Radiology and Neuroradiology (V.C.K., C.R., S.J.E., H.H.S., E.H.), University Hospital Bonn, Bonn, Germany
| | - D Beier
- Department of Neurology (D.B.), University Hospital Odense and Clinical Institute, University of Southern Denmark, Odense, Denmark
- Department of Neurology (D.B.), University of Regensburg, Regensburg, Germany
| | - D T W Jones
- Deutsches Krebsforschungszentrum (D.T.W.J.), Division of Pediatric Neurooncology, Heidelberg, Germany
| | - T Pietsch
- Department of Neuropathology (T.P.), Brain Tumor Reference Center of the German Society for Neuropathology and Neuroanatomy, Bonn, Germany
| | - H H Schild
- From the Department of Radiology and Neuroradiology (V.C.K., C.R., S.J.E., H.H.S., E.H.), University Hospital Bonn, Bonn, Germany
| | - E Hattingen
- From the Department of Radiology and Neuroradiology (V.C.K., C.R., S.J.E., H.H.S., E.H.), University Hospital Bonn, Bonn, Germany
| | - P Hau
- Wilhelm Sander-Therapieeinheit NeuroOnkologie (C.R., P.H.)
- Department of Neurology (C.R., P.H.), University Hospital Regensburg, Regensburg, Germany
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Paunović A, Milisavljević F, Bošković J. Evaluation of clinical characteristics as indicators for shunt procedure in patients with medulloblastoma: PS210. Porto Biomed J 2017; 2:240-241. [PMID: 32258762 DOI: 10.1016/j.pbj.2017.07.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- A Paunović
- School of Medicine, University of Belgrade, Serbia
| | | | - J Bošković
- School of Medicine, University of Belgrade, Serbia
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47
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Incidence and survival trends for medulloblastomas in the United States from 2001 to 2013. J Neurooncol 2017; 135:433-441. [DOI: 10.1007/s11060-017-2594-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/13/2017] [Indexed: 10/19/2022]
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48
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Kline CN, Packer RJ, Hwang EI, Raleigh DR, Braunstein S, Raffel C, Bandopadhayay P, Solomon DA, Aboian M, Cha S, Mueller S. Case-based review: pediatric medulloblastoma. Neurooncol Pract 2017; 4:138-150. [PMID: 29692919 DOI: 10.1093/nop/npx011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Medulloblastoma is the most common malignant brain tumor affecting children. These tumors are high grade with propensity to metastasize within the central nervous system and, less frequently, outside the neuraxis. Recent advancements in molecular subgrouping of medulloblastoma refine diagnosis and improve counseling in regards to overall prognosis. Both are predicated on the molecular drivers of each subgroup-WNT-activated, SHH-activated, group 3, and group 4. The traditional therapeutic mainstay for medulloblastoma includes a multimodal approach with surgery, radiation, and multiagent chemotherapy. As we discover more about the molecular basis of medulloblastoma, efforts to adjust treatment approaches based on molecular risk stratification are under active investigation. Certainly, the known neurological, developmental, endocrine, and psychosocial injury related to medulloblastoma and its associated therapies motivate ongoing research towards improving treatment for this life-threatening tumor while at the same time minimizing long-term side effects.
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Affiliation(s)
- Cassie N Kline
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - Roger J Packer
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - Eugene I Hwang
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - David R Raleigh
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - Steve Braunstein
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - Corey Raffel
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - Pratiti Bandopadhayay
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - David A Solomon
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - Mariam Aboian
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - Soonmee Cha
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
| | - Sabine Mueller
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158 (C.K., S.M.); Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P.); Brain Tumor Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Division of Hematology/Oncology, Center for Cancer and Blood Disorders, Children's National Health Systems, 111 Michigan Avenue NW, Washington, DC 20010 (R.P., E.H.); Department of Radiation Oncology, University of California, 1825 4th Street, San Francisco, San Francisco, CA 94158 (D.R., S.B.); Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143 (C.R., S.M.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02215 (P.B.); Department of Pediatrics, Harvard Medical School, Boston, MA 02215 (P.B.); Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142 (P.B.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, M551, Box 0102 San Francisco, CA 94143 (D.S.); Department of Radiology, University of California, San Francisco, 550 Parnassus Avenue, M327, San Francisco, CA 94143 (M.A., S.C.); Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA 94158 (S.M.)
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Morana G, Alves CA, Tortora D, Severino M, Nozza P, Cama A, Ravegnani M, D'Apolito G, Raso A, Milanaccio C, da Costa Leite C, Garrè ML, Rossi A. Added value of diffusion weighted imaging in pediatric central nervous system embryonal tumors surveillance. Oncotarget 2017; 8:60401-60413. [PMID: 28947980 PMCID: PMC5601148 DOI: 10.18632/oncotarget.19553] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/16/2017] [Indexed: 12/29/2022] Open
Abstract
Diffusion weighted imaging (DWI) has an established role in primary CNS embryonal tumor (ET) characterization; however, its diagnostic utility in detecting relapse has never been determined. We aimed to compare DWI and conventional MRI sensitivity in CNS ET recurrence detection, and to evaluate the DWI properties of contrast-enhancing radiation induced lesions (RIL). Fifty-six patients with CNS ET (25 with disease relapse, 6 with RIL and 25 with neither disease relapse nor RIL) were retrospectively evaluated with DWI, conventional MRI (including both T2/FLAIR and post-contrast images), or contrast-enhanced MR imaging (CE-MRI) alone. MRI studies were independently reviewed by two neuroradiologists for detection and localization of potential brain relapses. Sensitivity for focal relapse detection was calculated for each image set on a lesion-by-lesion basis. A descriptive per subject analysis was also performed. Evaluation of follow-up MRI studies served as standard of reference. Focal recurrence detection sensitivity of DWI (96%) was significantly higher than conventional MRI (77%) and CE-MRI alone (51%) (p=0.0003 and p<0.0001). On per subject analysis there were not missed diagnoses for DWI. At the time of DWI relapse detection, conventional MRI missed 2 diagnoses, and CE-MRI 8. Analysis of medulloblastoma relapses revealed that DWI identified a higher number of focal lesions than CE-MRI in subjects with classic variant. All but one RIL did not show restricted diffusion. In conclusion, DWI is a valuable complementary technique allowing for improved detection of focal relapse in CNS ET patients, particularly in children with classic medulloblastoma, and may assist in differentiating recurrence from RIL.
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Affiliation(s)
- Giovanni Morana
- Neuroradiology Unit, Istituto Giannina Gaslini, Genova, Italy
| | - Cesar Augusto Alves
- Neuroradiology Unit, Istituto Giannina Gaslini, Genova, Italy.,Radiology Institute, Hospital das Clinicas, Sao Paulo, Brazil
| | | | | | - Paolo Nozza
- Pathology Unit, Istituto Giannina Gaslini, Genova, Italy
| | - Armando Cama
- Neurosurgery Unit, Istituto Giannina Gaslini, Genova, Italy
| | | | | | | | | | | | | | - Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Genova, Italy
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50
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Song SS, Wang JH, Fu WW, Li Y, Sui QL, Liu XJ. Medulloblastoma with Atypical Dynamic Imaging Changes: Case Report with Literature Review. World Neurosurg 2017. [PMID: 28625899 DOI: 10.1016/j.wneu.2017.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We analyzed a case of medulloblastoma with atypical dynamic imaging changes retrospectively to summarize the atypical magnetic resonance imaging (MRI) features of medulloblastoma by reviewing the literature. METHODS An atypical case of medulloblastoma in the cerebellar hemisphere confirmed by pathology was analyzed retrospectively, and the literature about it was reviewed. RESULTS The radiologic findings of the patient were based on 3 examinations. The first examination showed that the cortex of the bilateral cerebellar hemisphere had diffuse nodular thickening, with a high signal on diffusion-weighted imaging and significant enhancement. Contrast enhancement MRI 1 year later showed the signal of cerebellar hemisphere returned to normal but revealed an enhanced nodule. A reexamination 6 months later showed an irregular mass with a high-density shadow in the cerebellar vermis on CT scan. The T2-weighted image revealed multiple degenerative cysts, and the mass had significant enhancement. CONCLUSION The radiologic characteristics of atypical medulloblastomas vary in adults and children. Understanding the radiologic characteristics of medulloblastomas, such as MRI features, age of onset, and location of atypical medulloblastomas, can help improve the diagnosis of medulloblastomas.
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Affiliation(s)
- Shuang-Shuang Song
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jian-Hong Wang
- Organ Transplantation Center, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei-Wei Fu
- Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ying Li
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qing-Lan Sui
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xue-Jun Liu
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, China.
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