Update on MRI in pediatric intracranial germ cell tumors-The clinical and radiological features

Machine learning decision support model construction for craniotomy approach of pineal region tumors based on MRI images

BACKGROUND

Pineal region tumors (PRTs) are rare but deep-seated brain tumors, and complete surgical resection is crucial for effective tumor treatment. The choice of surgical approach is often challenging due to the low incidence and deep location. This study aims to combine machine learning and deep learning algorithms with pre-operative MRI images to build a model for PRTs surgical approaches recommendation, striving to model clinical experience for practical reference and education.

METHODS

This study was a retrospective study which enrolled a total of 173 patients diagnosed with PRTs radiologically from our hospital. Three traditional surgical approaches of were recorded for prediction label. Clinical and VASARI related radiological information were selected for machine learning prediction model construction. And MRI images from axial, sagittal and coronal views of orientation were also used for deep learning craniotomy approach prediction model establishment and evaluation.

RESULTS

5 machine learning methods were applied to construct the predictive classifiers with the clinical and VASARI features and all methods could achieve area under the ROC (Receiver operating characteristic) curve (AUC) values over than 0.7. And also, 3 deep learning algorithms (ResNet-50, EfficientNetV2-m and ViT) were applied based on MRI images from different orientations. EfficientNetV2-m achieved the highest AUC value of 0.89, demonstrating a significant high performance of prediction. And class activation mapping was used to reveal that the tumor itself and its surrounding relations are crucial areas for model decision-making.

CONCLUSION

In our study, we used machine learning and deep learning to construct surgical approach recommendation models. Deep learning could achieve high performance of prediction and provide efficient and personalized decision support tools for PRTs surgical approach.

CLINICAL TRIAL NUMBER

Not applicable.

Pediatric Suprasellar Tumors: Unveiling the Mysteries of Craniopharyngioma and Germ Cell Tumors-Insights From Diagnosis to Advanced Therapeutics

BACKGROUND

Pediatric suprasellar tumors represent a unique and intricate challenge in the landscape of pediatric neuro-oncology.

METHODS

We conducted an in-depth literature review, focusing on large clinical trials and major publications in pediatric suprasellar tumors, particularly craniopharyngiomas and germ cell tumors, to provide a comprehensive perspective on the challenges in the diagnosis, treatment, and molecular aspects of these tumors.

RESULTS

Nestled within the critical confines of the suprasellar region, these tumors manifest against the backdrop of crucial growth and developmental processes. The suprasellar region, housing the pituitary gland and surrounding structures, plays a pivotal role in orchestrating hormonal regulation and growth. The emergence of tumors within this delicate terrain introduces a complex array of challenges, encompassing neurological, endocrinological, and developmental dimensions from damage to the hypothalamic-pituitary axis.

CONCLUSIONS

This article provides a thorough exploration of pediatric craniopharyngiomas and germ cell tumors, elucidating their clinical presentations, treatment modalities, and outcomes. The focused analysis aims to deepen our understanding of these tumors by offering insights for refined clinical management and improved patient outcomes.

Radiological features of basal ganglia germinoma: a case report and early-stage alerts

Basal ganglia germinomas are uncommon neoplasms. Basal ganglia germinomas exhibit high sensitivity to both radiation therapy and chemotherapy. In contrast, surgery is the standard treatment for most primary brain tumors (such as gliomas, which are the most common tumors in the pediatric basal ganglia region). A 21-year-old male patient was admitted to our hospital because of unexplained right-sided hemiparesis for two years. Biomarkers indicating germ cell tumors are typically negative. On the initial MRI, the abnormalities were nonspecific, causing no suspicion of a tumor. Therefore, the patient did not receive an earlier diagnosis or treatment. His brain MRI revealed a mass with more apparent features one year later. Based on the imaging characteristics of conventional and advanced MR images, the preoperative radiological diagnosis was highly likely to reveal germinomas. The patient then underwent a biopsy and received appropriate treatment. Despite treatment, his symptoms only partially improved. Accurate preoperative diagnosis is crucial for ensuring that patients receive appropriate treatment and to help avoid more invasive surgery. Additionally, early identification of germinomas is also important for improving long-term patient outcomes and preventing tumor spread due to delayed diagnosis. Therefore, we aim to review and report this case to assist radiologists in recognizing and becoming familiar with the early imaging signs of basal ganglia germinoma.

Approaches to supratentorial brain tumours in children

The differential diagnosis of supratentorial brain tumours in children can be challenging, especially considering the recent changes to the WHO classification of CNS tumours published in 2021. Many new tumour types have been proposed which frequently present in children and young adults and their imaging features are currently being described by the neuroradiology community. The purpose of this article is to provide guidance to residents and fellows new to the field of paediatric neuroradiology on how to evaluate an MRI of a patient with a newly diagnosed supratentorial tumour. Six different approaches are discussed including: 1. Tumour types, briefly discussing the main changes to the recent WHO classification of CNS tumours, 2. Patient age and its influence on incidence rates of specific tumour types, 3. Growth patterns, 4. Tumour location and how defining the correct location helps in narrowing down the differential diagnoses and 5. Imaging features of the tumour on DWI, SWI, FLAIR and post contrast sequences.

Adult ovarian and sellar region mixed germ cell tumor: a case report and literature review

Mixed germ cell tumors (mGCTs) involving both the ovaries and sellar region have been rarely reported; thus, they pose significant challenges in clinical management. Our report of a case of a 26-year-old female with left ovarian mGCTs (dysgerminoma + yolk sac tumor) who presented with postoperative headaches and blurred vision contributes new information to the literature on treating mGCTs, which can lead to standardized regimens and sequencing guidelines. A physical examination revealed right temporal hemianopia, and elevated levels of alpha-fetoprotein were detected in serum and cerebrospinal fluid. Magnetic resonance imaging (MRI) of the sellar region revealed a space-occupying lesion. Pathological examination of the tumor after endoscopic transnasal resection confirmed the diagnosis of mGCTs (germinomas + yolk sac tumor). The patient received adjuvant chemotherapy and radiotherapy at reduced dosages. During follow-up, tumor markers remained within normal limits, and there was no evidence of tumor recurrence on sellar region MRI. This case highlights the rarity of the simultaneous occurrence of ovarian and sellar region mGCTs and emphasizes the importance of accurate diagnosis and multidisciplinary management.

Plasma miRNA expression profile in pediatric pineal pure germinomas

Background

Pure germinomas account for 40% of pineal tumors and are characterized by the lack of appreciable tumor markers, thus requiring a tumor biopsy for diagnosis. MicroRNAs (miRNA) have emerged as potential non-invasive biomarkers for germ cell tumors and may facilitate the non-invasive diagnosis of pure pineal germinomas.

Material and methods

A retrospective chart review was performed on all patients treated at the Children's Cancer Hospital Egypt diagnosed with a pineal region tumor between June 2013 and March 2021 for whom a research blood sample was available. Plasma samples were profiled for miRNA expression, and DESeq2 was used to compare between pure germinoma and other tumor types. Differentially expressed miRNAs were identified. The area under the curve of the receive;r operating characteristic curve was constructed to evaluate diagnostic performance.

Results

Samples from 39 pediatric patients were available consisting of 12 pure germinomas and 27 pineal region tumors of other pathologies, including pineal origin tumors [n = 17; pineoblastoma (n = 13) and pineal parenchymal tumors of intermediate differentiation (n = 4)] and others [n = 10; low-grade glioma (n = 6) and atypical teratoid rhabdoid tumor (n = 4)]. Using an adjusted p-value <0.05, three miRNAs showed differential expression (miR-143-3p, miR-320c, miR-320d; adjusted p = 0.0058, p = 0.0478, and p = 0.0366, respectively) and good discriminatory power between the two groups (AUC 90.7%, p < 0.001) with a sensitivity of 25% and a specificity of 100%.

Conclusion

Our results suggest that a three-plasma miRNA signature has the potential to non-invasively identify pineal body pure germinomas which may allow selected patients to avoid the potential surgical complications.