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Rameh V, Vajapeyam S, Ziaei A, Kao P, London WB, Baker SJ, Chiang J, Lucas J, Tinkle CL, Wright KD, Poussaint TY. Correlation between Multiparametric MR Imaging and Molecular Genetics in Pontine Pediatric High-Grade Glioma. AJNR Am J Neuroradiol 2023:ajnr.A7910. [PMID: 37321859 PMCID: PMC10337620 DOI: 10.3174/ajnr.a7910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND PURPOSE Molecular profiling is a crucial feature in the "integrated diagnosis" of CNS tumors. We aimed to determine whether radiomics could distinguish molecular types of pontine pediatric high-grade gliomas that have similar/overlapping phenotypes on conventional anatomic MR images. MATERIALS AND METHODS Baseline MR images from children with pontine pediatric high-grade gliomas were analyzed. Retrospective imaging studies included standard precontrast and postcontrast sequences and DTI. Imaging analyses included median, mean, mode, skewness, and kurtosis of the ADC histogram of the tumor volume based on T2 FLAIR and enhancement at baseline. Histone H3 mutations were identified through immunohistochemistry and/or Sanger or next-generation DNA sequencing. The log-rank test identified imaging factors prognostic of survival from the time of diagnosis. Wilcoxon rank-sum and Fisher exact tests compared imaging predictors among groups. RESULTS Eighty-three patients had pretreatment MR imaging and evaluable tissue sampling. The median age was 6 years (range, 0.7-17 years); 50 tumors had a K27M mutation in H3-3A, and 11, in H3C2/3. Seven tumors had histone H3 K27 alteration, but the specific gene was unknown. Fifteen were H3 wild-type. Overall survival was significantly higher in H3C2/3- compared with H3-3A-mutant tumors (P = .003) and in wild-type tumors compared with any histone mutation (P = .001). Lower overall survival was observed in patients with enhancing tumors (P = .02) compared with those without enhancement. H3C2/3-mutant tumors showed higher mean, median, and mode ADC_total values (P < .001) and ADC_enhancement (P < .004), with lower ADC_total skewness and kurtosis (P < .003) relative to H3-3A-mutant tumors. CONCLUSIONS ADC histogram parameters are correlated with histone H3 mutation status in pontine pediatric high-grade glioma.
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Affiliation(s)
- V Rameh
- From the Department of Radiology (V.R., S.V., A.Z., T.Y.P.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - S Vajapeyam
- From the Department of Radiology (V.R., S.V., A.Z., T.Y.P.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - A Ziaei
- From the Department of Radiology (V.R., S.V., A.Z., T.Y.P.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - P Kao
- Department of Pediatric Oncology (P.K., W.B.L., K.D.W.), Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - W B London
- Department of Pediatric Oncology (P.K., W.B.L., K.D.W.), Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - S J Baker
- Departments of Developmental Neurobiology (S.J.B.)
| | | | - J Lucas
- Radiation Oncology (J.L., C.L.T.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - C L Tinkle
- Radiation Oncology (J.L., C.L.T.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - K D Wright
- Department of Pediatric Oncology (P.K., W.B.L., K.D.W.), Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - T Y Poussaint
- From the Department of Radiology (V.R., S.V., A.Z., T.Y.P.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Cogswell PM, Jack CR, Barakos JA, Barkhof F, Benzinger TS, Raji CA, Poussaint TY, Ramanan VK, Whitlow CT. Reply. AJNR Am J Neuroradiol 2023; 44:E6. [PMID: 36574316 PMCID: PMC9835908 DOI: 10.3174/ajnr.a7731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- P M Cogswell
- Department of RadiologyMayo ClinicRochester, Minnesota
| | - C R Jack
- Department of RadiologyMayo ClinicRochester, Minnesota
| | - J A Barakos
- Department of RadiologyCalifornia Pacific Medical CenterSan Francisco, California
| | - F Barkhof
- Departments of Radiology and Nuclear MedicineVU University Medical CenterAmsterdam, the NetherlandsQueen Square Institute of Neurology and Centre for Medical Image ComputingUniversity CollegeLondon, UK
| | - T S Benzinger
- Departments of Radiology and NeurosurgeryWashington University School of MedicineSt. Louis, Missouri
| | - C A Raji
- Departments of Radiology and NeurologyWashington University School of MedicineSt. Louis, Missouri
| | - T Y Poussaint
- Department of RadiologyBoston Children's HospitalBoston, Massachusetts
| | - V K Ramanan
- Department of NeurologyMayo ClinicRochester, Minnesota
| | - C T Whitlow
- Departments of Radiology and Biomedical EngineeringWake Forest School of MedicineWinston-Salem, North Carolina
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Cogswell PM, Barakos JA, Barkhof F, Benzinger TS, Jack CR, Poussaint TY, Raji CA, Ramanan VK, Whitlow CT. Amyloid-Related Imaging Abnormalities with Emerging Alzheimer Disease Therapeutics: Detection and Reporting Recommendations for Clinical Practice. AJNR Am J Neuroradiol 2022; 43:E19-E35. [PMID: 35953274 PMCID: PMC9451628 DOI: 10.3174/ajnr.a7586] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Monoclonal antibodies are emerging disease-modifying therapies for Alzheimer disease that require brain MR imaging for eligibility assessment as well as for monitoring for amyloid-related imaging abnormalities. Amyloid-related imaging abnormalities result from treatment-related loss of vascular integrity and may occur in 2 forms. Amyloid-related imaging abnormalities with edema or effusion are transient, treatment-induced edema or sulcal effusion, identified on T2-FLAIR. Amyloid-related imaging abnormalities with hemorrhage are treatment-induced microhemorrhages or superficial siderosis identified on T2* gradient recalled-echo. As monoclonal antibodies become more widely available, treatment screening and monitoring brain MR imaging examinations may greatly increase neuroradiology practice volumes. Radiologists must become familiar with the imaging appearance of amyloid-related imaging abnormalities, how to select an appropriate imaging protocol, and report findings in clinical practice. On the basis of clinical trial literature and expert experience from clinical trial imaging, we summarize imaging findings of amyloid-related imaging abnormalities, describe potential interpretation pitfalls, and provide recommendations for a standardized imaging protocol and an amyloid-related imaging abnormalities reporting template. Standardized imaging and reporting of these findings are important because an amyloid-related imaging abnormalities severity score, derived from the imaging findings, is used along with clinical status to determine patient management and eligibility for continued monoclonal antibody dosing.
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Affiliation(s)
- P M Cogswell
- From the Departments of Radiology (P.M.C., C.R.J.)
| | - J A Barakos
- Department of Radiology (J.A.B.), California Pacific Medical Center, San Francisco, California
| | - F Barkhof
- Departments of Radiology (F.B.)
- Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, UK
| | - T S Benzinger
- Departments of Radiology (T.S.B., C.A.R.)
- Neurosurgery (T.S.B.)
| | - C R Jack
- From the Departments of Radiology (P.M.C., C.R.J.)
| | - T Y Poussaint
- Department of Radiology (T.Y.P.), Boston Children's Hospital, Boston, Massachusetts
| | - C A Raji
- Departments of Radiology (T.S.B., C.A.R.)
- Neurology (C.A.R.),Washington University School of Medicine, St. Louis, Missouri
| | - V K Ramanan
- Neurology (V.K.R.), Mayo Clinic, Rochester, Minnesota
| | - C T Whitlow
- Departments of Radiology (C.T.W.)
- Biomedical Engineering (C.T.W.), Wake Forest School of Medicine, Winston-Salem, North Carolina
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Osborn AG, Louis DN, Poussaint TY, Linscott LL, Salzman KL. The 2021 World Health Organization Classification of Tumors of the Central Nervous System: What Neuroradiologists Need to Know. AJNR Am J Neuroradiol 2022; 43:928-937. [PMID: 35710121 DOI: 10.3174/ajnr.a7462] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/08/2021] [Indexed: 12/12/2022]
Abstract
Neuroradiologists play a key role in brain tumor diagnosis and management. Staying current with the latest classification systems and diagnostic markers is important to provide optimal patient care. Publication of the 2016 World Health Organization Classification of Tumors of the Central Nervous System introduced a paradigm shift in the diagnosis of CNS neoplasms. For the first time, both histologic features and genetic alterations were incorporated into the diagnostic framework, classifying and grading brain tumors. The newly published 2021 World Health Organization Classification of Tumors of the Central Nervous System, May 2021, 5th edition, has added even more molecular features and updated pathologic diagnoses. We present, summarize, and illustrate the most salient aspects of the new 5th edition. We have selected the key "must know" topics for practicing neuroradiologists.
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Affiliation(s)
- A G Osborn
- From the Department of Radiology and Imaging Sciences (A.G.O., K.L.S.), University of Utah School of Medicine, Salt Lake City, Utah
| | - D N Louis
- Department of Pathology (D.N.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - T Y Poussaint
- Department of Radiology (T.Y.P.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - L L Linscott
- Intermountain Pediatric Imaging (L.L.L.), Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - K L Salzman
- From the Department of Radiology and Imaging Sciences (A.G.O., K.L.S.), University of Utah School of Medicine, Salt Lake City, Utah
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5
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Quon JL, Bala W, Chen LC, Wright J, Kim LH, Han M, Shpanskaya K, Lee EH, Tong E, Iv M, Seekins J, Lungren MP, Braun KRM, Poussaint TY, Laughlin S, Taylor MD, Lober RM, Vogel H, Fisher PG, Grant GA, Ramaswamy V, Vitanza NA, Ho CY, Edwards MSB, Cheshier SH, Yeom KW. Deep Learning for Pediatric Posterior Fossa Tumor Detection and Classification: A Multi-Institutional Study. AJNR Am J Neuroradiol 2020; 41:1718-1725. [PMID: 32816765 PMCID: PMC7583118 DOI: 10.3174/ajnr.a6704] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/27/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Posterior fossa tumors are the most common pediatric brain tumors. MR imaging is key to tumor detection, diagnosis, and therapy guidance. We sought to develop an MR imaging-based deep learning model for posterior fossa tumor detection and tumor pathology classification. MATERIALS AND METHODS The study cohort comprised 617 children (median age, 92 months; 56% males) from 5 pediatric institutions with posterior fossa tumors: diffuse midline glioma of the pons (n = 122), medulloblastoma (n = 272), pilocytic astrocytoma (n = 135), and ependymoma (n = 88). There were 199 controls. Tumor histology served as ground truth except for diffuse midline glioma of the pons, which was primarily diagnosed by MR imaging. A modified ResNeXt-50-32x4d architecture served as the backbone for a multitask classifier model, using T2-weighted MRIs as input to detect the presence of tumor and predict tumor class. Deep learning model performance was compared against that of 4 radiologists. RESULTS Model tumor detection accuracy exceeded an AUROC of 0.99 and was similar to that of 4 radiologists. Model tumor classification accuracy was 92% with an F1 score of 0.80. The model was most accurate at predicting diffuse midline glioma of the pons, followed by pilocytic astrocytoma and medulloblastoma. Ependymoma prediction was the least accurate. Tumor type classification accuracy and F1 score were higher than those of 2 of the 4 radiologists. CONCLUSIONS We present a multi-institutional deep learning model for pediatric posterior fossa tumor detection and classification with the potential to augment and improve the accuracy of radiologic diagnosis.
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Affiliation(s)
- J L Quon
- From the Departments of Neurosurgery (J.L.Q., G.A.G., M.S.B.E.)
| | - W Bala
- Department of Radiology (W.B., J.S., M.P.L., K.W.Y.)
| | | | - J Wright
- Department of Radiology (J.W.), Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - L H Kim
- Stanford University School of Medicine (L.H.K., M.H., K.S.), Stanford, California
| | - M Han
- Stanford University School of Medicine (L.H.K., M.H., K.S.), Stanford, California
| | - K Shpanskaya
- Stanford University School of Medicine (L.H.K., M.H., K.S.), Stanford, California
| | - E H Lee
- Electrical Engineering (E.H.L.)
| | | | | | - J Seekins
- Department of Radiology (W.B., J.S., M.P.L., K.W.Y.)
| | - M P Lungren
- Department of Radiology (W.B., J.S., M.P.L., K.W.Y.)
| | - K R M Braun
- Departments of Clinical Radiology & Imaging Sciences (K.R.M.B., C.Y.H.), Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - T Y Poussaint
- Departments of Radiology (T.Y.P.), Boston Children's Hospital, Boston, Massachusetts
| | - S Laughlin
- Departments of diagnostic Imaging (S.L.)
| | | | - R M Lober
- Department of Neurosurgery (R.M.L.), Dayton Children's Hospital, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - H Vogel
- and Pathology (H.V.), Stanford University, Stanford, California
| | - P G Fisher
- Division of Child Neurology (P.G.F.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - G A Grant
- From the Departments of Neurosurgery (J.L.Q., G.A.G., M.S.B.E.)
| | - V Ramaswamy
- and Haematology/Oncology (V.R.), The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - N A Vitanza
- Division of Pediatric Hematology/Oncology (N.A.V.), Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle Washington.,Fred Hutchinson Cancer Research Center (N.A.V.), Seattle, Washington
| | - C Y Ho
- Departments of Clinical Radiology & Imaging Sciences (K.R.M.B., C.Y.H.), Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - M S B Edwards
- From the Departments of Neurosurgery (J.L.Q., G.A.G., M.S.B.E.)
| | - S H Cheshier
- Departments of Neurosurgery (S.H.C.), University of Utah School of Medicine, Salt Lake City, Utah
| | - K W Yeom
- Department of Radiology (W.B., J.S., M.P.L., K.W.Y.)
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Jaimes C, Vajapeyam S, Brown D, Kao PC, Ma C, Greenspan L, Gupta N, Goumnerova L, Bandopahayay P, Dubois F, Greenwald NF, Zack T, Shapira O, Beroukhim R, Ligon KL, Chi S, Kieran MW, Wright KD, Poussaint TY. MR Imaging Correlates for Molecular and Mutational Analyses in Children with Diffuse Intrinsic Pontine Glioma. AJNR Am J Neuroradiol 2020; 41:874-881. [PMID: 32381545 DOI: 10.3174/ajnr.a6546] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 03/16/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Recent advances in molecular techniques have characterized distinct subtypes of diffuse intrinsic pontine gliomas. Our aim was the identification of MR imaging correlates of these subtypes. MATERIALS AND METHODS Initial MRIs from subjects with diffuse intrinsic pontine gliomas recruited for a prospective clinical trial before treatment were analyzed. Retrospective imaging analyses included FLAIR/T2 tumor volume, tumor volume enhancing, the presence of cyst and/or necrosis, median, mean, mode, skewness, kurtosis of ADC tumor volume based on FLAIR, and enhancement at baseline. Molecular subgroups based on EGFR and MGMT mutations were established. Histone mutations were also determined (H3F3A, HIST1H3B, HIST1H3C). Univariate Cox proportional hazards regression was used to test the association of imaging predictors with overall and progression-free survival. Wilcoxon rank sum, Kruskal-Wallis, and Fisher exact tests were used to compare imaging measures among groups. RESULTS Fifty patients had biopsy and MR imaging. The median age at trial registration was 6 years (range, 3.3-17.5 years); 52% were female. On the basis of immunohistochemical results, 48 patients were assigned to 1 of 4 subgroups: 28 in MGMT-/epidermal growth factor receptor (EGFR)-, 14 in MGMT-/EGFR+, 3 in MGMT+/EGFR-, and 3 in MGMT+/EGFR+. Twenty-three patients had histone mutations in H3F3A, 8 in HIST1H3B, and 3 in HIST1H3C. Enhancing tumor volume was near-significantly different across molecular subgroups (P = .04), after accounting for the false discovery rate. Tumor volume enhancing, median, mode, skewness, and kurtosis ADC T2-FLAIR/T2 were significantly different (P ≤ .048) between patients with H3F3A and HIST1H3B/C mutations. CONCLUSIONS MR imaging features including enhancement and ADC histogram parameters are correlated with molecular subgroups and mutations in children with diffuse intrinsic pontine gliomas.
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Affiliation(s)
- C Jaimes
- From the Departments of Radiology (C.J., S.V., T.Y.P.).,Fetal-Neonatal Neuroimaging and Developmental Science Center (C.J.), Division of Newborn Medicine; Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - S Vajapeyam
- From the Departments of Radiology (C.J., S.V., T.Y.P.).,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - D Brown
- Tumor Imaging Metrics Core (D.B.), Massachusetts General Hospital, Boston, Massachusetts
| | - P-C Kao
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts
| | - C Ma
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - L Greenspan
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts
| | - N Gupta
- Department of Pediatric Neurosurgery (N.G.), University of California San Francisco Benioff Children's Hospital, San Francisco, California.,University of California San Francisco School of Medicine (N.G., T.Z.), San Francisco, California
| | | | - P Bandopahayay
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - F Dubois
- Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - N F Greenwald
- Stanford University School of Medicine (N.F.G.), Palo Alto, California
| | - T Zack
- University of California San Francisco School of Medicine (N.G., T.Z.), San Francisco, California
| | - O Shapira
- Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Broad Institute of Massachusetts Institute of Technology and Harvard University (O.S.), Cambridge, Massachusetts
| | - R Beroukhim
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - K L Ligon
- Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Department of Pathology (K.L.L.), Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - S Chi
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - M W Kieran
- Clinical Trials Division (M.W.K.), Bristol-Myers-Squibb, New York, New York
| | - K D Wright
- Pediatrics, Division of Oncology (P.-C.K., C.M., L.G., P.B., R.B., S.C., K.D.W.).,Dana Farber Cancer Institute (P.-C.K., C.M., L.G., P.B., F.D., O.S., R.B., K.L.L., S.C., K.D.W.), Boston, Massachusetts.,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
| | - T Y Poussaint
- From the Departments of Radiology (C.J., S.V., T.Y.P.) .,Harvard Medical School (C.J., S.V., C.M., P.B., F.D., R.B., K.L.L., S.C., K.D.W., T.Y.P.), Boston, Massachusetts
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7
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Vajapeyam S, Brown D, Billups C, Patay Z, Vezina G, Shiroishi MS, Law M, Baxter P, Onar-Thomas A, Fangusaro JR, Dunkel IJ, Poussaint TY. Advanced ADC Histogram, Perfusion, and Permeability Metrics Show an Association with Survival and Pseudoprogression in Newly Diagnosed Diffuse Intrinsic Pontine Glioma: A Report from the Pediatric Brain Tumor Consortium. AJNR Am J Neuroradiol 2020; 41:718-724. [PMID: 32241771 DOI: 10.3174/ajnr.a6499] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/10/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Diffuse intrinsic pontine glioma is a lethal childhood brain cancer with dismal prognosis and MR imaging is the primary methodology used for diagnosis and monitoring. Our aim was to determine whether advanced diffusion, perfusion, and permeability MR imaging metrics predict survival and pseudoprogression in children with newly diagnosed diffuse intrinsic pontine glioma. MATERIALS AND METHODS A clinical trial using the poly (adenosine diphosphate ribose) polymerase (PARP) inhibitor veliparib concurrently with radiation therapy, followed by maintenance therapy with veliparib + temozolomide, in children with diffuse intrinsic pontine glioma was conducted by the Pediatric Brain Tumor Consortium. Standard MR imaging, DWI, dynamic contrast-enhanced perfusion, and DSC perfusion were performed at baseline and approximately every 2 months throughout treatment. ADC histogram metrics of T2-weighted FLAIR and enhancing tumor volume, dynamic contrast-enhanced permeability metrics for enhancing tumors, and tumor relative CBV from DSC perfusion MR imaging were calculated. Baseline values, post-radiation therapy changes, and longitudinal trends for all metrics were evaluated for associations with survival and pseudoprogression. RESULTS Fifty children were evaluable for survival analyses. Higher baseline relative CBV was associated with shorter progression-free survival (P = .02, Q = 0.089) and overall survival (P = .006, Q = 0.055). Associations of higher baseline mean transfer constant from the blood plasma into the extravascular extracellular space with shorter progression-free survival (P = .03, Q = 0.105) and overall survival (P = .03, Q = 0.102) trended toward significance. An increase in relative CBV with time was associated with shorter progression-free survival (P < .001, Q < 0.001) and overall survival (P = .004, Q = 0.043). Associations of longitudinal mean extravascular extracellular volume fraction with progression-free survival (P = .03, Q = 0.104) and overall survival (P = .03, Q = 0.105) and maximum transfer constant from the blood plasma into the extravascular extracellular space with progression-free survival (P = .03, Q = 0.102) trended toward significance. Greater increases with time were associated with worse outcomes. True radiologic progression showed greater post-radiation therapy decreases in mode_ADC_FLAIR compared with pseudoprogression (means, -268.15 versus -26.11, P = .01.) CONCLUSIONS: ADC histogram, perfusion, and permeability MR imaging metrics in diffuse intrinsic pontine glioma are useful in predicting survival and pseudoprogression.
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Affiliation(s)
- S Vajapeyam
- From the Radiology (S.V., T.Y.P.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - D Brown
- DF/HCC Tumor Imaging Metrics Core (D.B.), Massachusetts General Hospital, Boston, Massachusetts
| | | | - Z Patay
- Diagnostic Imaging (Z.P.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - G Vezina
- Radiology (G.V.), Children's National Medical Center, Washington, DC
| | - M S Shiroishi
- Radiology (M.S.S.), Keck Medical Center of USC, Los Angeles, California
| | - M Law
- Neuroscience (M.L.), Monash University, Melbourne, Australia
| | - P Baxter
- Cancer and Hematology Center (P.B.), Texas Children's Hospital, Houston, Texas
| | | | - J R Fangusaro
- Aflac Cancer and Blood Disorders Center (J.R.F.), Children's Healthcare of Atlanta, Atlanta, Georgia
| | - I J Dunkel
- Pediatrics (I.J.D.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - T Y Poussaint
- From the Radiology (S.V., T.Y.P.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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8
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Iv M, Zhou M, Shpanskaya K, Perreault S, Wang Z, Tranvinh E, Lanzman B, Vajapeyam S, Vitanza NA, Fisher PG, Cho YJ, Laughlin S, Ramaswamy V, Taylor MD, Cheshier SH, Grant GA, Young Poussaint T, Gevaert O, Yeom KW. MR Imaging-Based Radiomic Signatures of Distinct Molecular Subgroups of Medulloblastoma. AJNR Am J Neuroradiol 2018; 40:154-161. [PMID: 30523141 DOI: 10.3174/ajnr.a5899] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/06/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Distinct molecular subgroups of pediatric medulloblastoma confer important differences in prognosis and therapy. Currently, tissue sampling is the only method to obtain information for classification. Our goal was to develop and validate radiomic and machine learning approaches for predicting molecular subgroups of pediatric medulloblastoma. MATERIALS AND METHODS In this multi-institutional retrospective study, we evaluated MR imaging datasets of 109 pediatric patients with medulloblastoma from 3 children's hospitals from January 2001 to January 2014. A computational framework was developed to extract MR imaging-based radiomic features from tumor segmentations, and we tested 2 predictive models: a double 10-fold cross-validation using a combined dataset consisting of all 3 patient cohorts and a 3-dataset cross-validation, in which training was performed on 2 cohorts and testing was performed on the third independent cohort. We used the Wilcoxon rank sum test for feature selection with assessment of area under the receiver operating characteristic curve to evaluate model performance. RESULTS Of 590 MR imaging-derived radiomic features, including intensity-based histograms, tumor edge-sharpness, Gabor features, and local area integral invariant features, extracted from imaging-derived tumor segmentations, tumor edge-sharpness was most useful for predicting sonic hedgehog and group 4 tumors. Receiver operating characteristic analysis revealed superior performance of the double 10-fold cross-validation model for predicting sonic hedgehog, group 3, and group 4 tumors when using combined T1- and T2-weighted images (area under the curve = 0.79, 0.70, and 0.83, respectively). With the independent 3-dataset cross-validation strategy, select radiomic features were predictive of sonic hedgehog (area under the curve = 0.70-0.73) and group 4 (area under the curve = 0.76-0.80) medulloblastoma. CONCLUSIONS This study provides proof-of-concept results for the application of radiomic and machine learning approaches to a multi-institutional dataset for the prediction of medulloblastoma subgroups.
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Affiliation(s)
- M Iv
- From the Department of Radiology (M.I., M.Z., K.S., E.T., B.L., K.W.Y.)
| | - M Zhou
- From the Department of Radiology (M.I., M.Z., K.S., E.T., B.L., K.W.Y.).,Stanford Center for Biomedical Informatics (M.Z., O.G., Z.W.)
| | - K Shpanskaya
- From the Department of Radiology (M.I., M.Z., K.S., E.T., B.L., K.W.Y.)
| | - S Perreault
- Department of Pediatrics (S.P.), Pediatric Neurology, Centre Hospitalier Universitaire Sainte Justine, University of Montréal, Montreal, Quebec, Canada
| | - Z Wang
- Stanford Center for Biomedical Informatics (M.Z., O.G., Z.W.)
| | - E Tranvinh
- From the Department of Radiology (M.I., M.Z., K.S., E.T., B.L., K.W.Y.)
| | - B Lanzman
- From the Department of Radiology (M.I., M.Z., K.S., E.T., B.L., K.W.Y.)
| | - S Vajapeyam
- Department of Radiology (S.V., T.Y.P.), Boston Children's Hospital, Harvard University, Boston, Massachusetts
| | - N A Vitanza
- Department Pediatrics Hematology-Oncology (N.A.V.), Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - P G Fisher
- Department of Pediatrics (P.G.F.), Pediatric Neurology
| | - Y J Cho
- Department of Pediatrics (Y.J.C.), Pediatric Neurology, Oregon Health & Science University, Portland, Oregon
| | - S Laughlin
- Departments of Radiology, Neuro-Oncology, and Neurosurgery (S.L., V.R., M.D.T.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - V Ramaswamy
- Departments of Radiology, Neuro-Oncology, and Neurosurgery (S.L., V.R., M.D.T.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - M D Taylor
- Departments of Radiology, Neuro-Oncology, and Neurosurgery (S.L., V.R., M.D.T.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - S H Cheshier
- Department of Neurosurgery (S.H.C.), Pediatric Neurosurgery, University of Utah, Salt Lake City, Utah
| | - G A Grant
- Department of Neurosurgery (G.A.G.), Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - T Young Poussaint
- Department of Radiology (S.V., T.Y.P.), Boston Children's Hospital, Harvard University, Boston, Massachusetts
| | - O Gevaert
- Stanford Center for Biomedical Informatics (M.Z., O.G., Z.W.)
| | - K W Yeom
- From the Department of Radiology (M.I., M.Z., K.S., E.T., B.L., K.W.Y.) .,Department of Radiology (K.W.Y.), Artificial Intelligence in Medicine and Imaging, Stanford University, Stanford, California
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9
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Vajapeyam S, Brown D, Johnston PR, Ricci KI, Kieran MW, Lidov HGW, Poussaint TY. Multiparametric Analysis of Permeability and ADC Histogram Metrics for Classification of Pediatric Brain Tumors by Tumor Grade. AJNR Am J Neuroradiol 2018; 39:552-557. [PMID: 29301780 DOI: 10.3174/ajnr.a5502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/30/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Accurate tumor grading is essential for treatment planning of pediatric brain tumors. We hypothesized that multiparametric analyses of a combination of permeability metrics and ADC histogram metrics would differentiate high- and low-grade tumors with high accuracy. MATERIALS AND METHODS DTI and dynamic contrast-enhanced MR imaging using T1-mapping with flip angles of 2°, 5°, 10°, and 15°, followed by a 0.1-mmol/kg body weight gadolinium-based bolus was performed on all patients in addition to standard MR imaging. Permeability data were processed and transfer constant from the blood plasma into the extracellular extravascular space, rate constant from the extracellular extravascular space back into blood plasma, extravascular extracellular volume fraction, and fractional blood plasma volume were calculated from 3D tumor volumes. Apparent diffusion coefficient histogram metrics were calculated for 3 separate tumor volumes derived from T2-FLAIR sequences, T1 contrast-enhanced sequences, and permeability maps, respectively. RESULTS Results from 41 patients (0.3-16.76 years of age; mean, 6.22 years) with newly diagnosed contrast-enhancing brain tumors (16 low-grade; 25 high-grade) were included in the institutional review board-approved retrospective analysis. Wilcoxon tests showed a higher transfer constant from blood plasma into extracellular extravascular space and rate constant from extracellular extravascular space back into blood plasma, and lower extracellular extravascular volume fraction (P < .001) in high-grade tumors. The mean ADCs of FLAIR and enhancing tumor volumes were significantly lower in high-grade tumors (P < .001). ROC analysis showed that a combination of extravascular volume fraction and mean ADC of FLAIR volume differentiated high- and low-grade tumors with high accuracy (area under receiver operating characteristic curve = 0.918). CONCLUSIONS ADC histogram metrics combined with permeability metrics differentiate low- and high-grade pediatric brain tumors with high accuracy.
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Affiliation(s)
- S Vajapeyam
- From the Departments of Radiology (S.V., D.B., P.R.J., T.Y.P.) .,Harvard Medical School (S.V., M.W.K., H.G.W.L., T.Y.P.), Boston, Massachusetts
| | - D Brown
- From the Departments of Radiology (S.V., D.B., P.R.J., T.Y.P.)
| | - P R Johnston
- From the Departments of Radiology (S.V., D.B., P.R.J., T.Y.P.)
| | - K I Ricci
- Cancer Center (K.I.R.), Massachusetts General Hospital, Boston, Massachusetts
| | - M W Kieran
- Division of Pediatric Oncology (M.W.K.), Dana-Farber Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School (S.V., M.W.K., H.G.W.L., T.Y.P.), Boston, Massachusetts
| | - H G W Lidov
- Pathology (H.G.W.L.), Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School (S.V., M.W.K., H.G.W.L., T.Y.P.), Boston, Massachusetts
| | - T Y Poussaint
- From the Departments of Radiology (S.V., D.B., P.R.J., T.Y.P.).,Harvard Medical School (S.V., M.W.K., H.G.W.L., T.Y.P.), Boston, Massachusetts
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10
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Vajapeyam S, Stamoulis C, Ricci K, Kieran M, Poussaint TY. Automated Processing of Dynamic Contrast-Enhanced MRI: Correlation of Advanced Pharmacokinetic Metrics with Tumor Grade in Pediatric Brain Tumors. AJNR Am J Neuroradiol 2016; 38:170-175. [PMID: 27633807 DOI: 10.3174/ajnr.a4949] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/01/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Pharmacokinetic parameters from dynamic contrast-enhanced MR imaging have proved useful for differentiating brain tumor grades in adults. In this study, we retrospectively reviewed dynamic contrast-enhanced perfusion data from children with newly diagnosed brain tumors and analyzed the pharmacokinetic parameters correlating with tumor grade. MATERIALS AND METHODS Dynamic contrast-enhanced MR imaging data from 38 patients were analyzed by using commercially available software. Subjects were categorized into 2 groups based on pathologic analyses consisting of low-grade (World Health Organization I and II) and high-grade (World Health Organization III and IV) tumors. Pharmacokinetic parameters were compared between the 2 groups by using linear regression models. For parameters that were statistically distinct between the 2 groups, sensitivity and specificity were also estimated. RESULTS Eighteen tumors were classified as low-grade, and 20, as high-grade. Transfer constant from the blood plasma into the extracellular extravascular space (Ktrans), rate constant from extracellular extravascular space back into blood plasma (Kep), and extracellular extravascular volume fraction (Ve) were all significantly correlated with tumor grade; high-grade tumors showed higher Ktrans, higher Kep, and lower Ve. Although all 3 parameters had high specificity (range, 82%-100%), Kep had the highest specificity for both grades. Optimal sensitivity was achieved for Ve, with a combined sensitivity of 76% (compared with 71% for Ktrans and Kep). CONCLUSIONS Pharmacokinetic parameters derived from dynamic contrast-enhanced MR imaging can effectively discriminate low- and high-grade pediatric brain tumors.
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Affiliation(s)
- S Vajapeyam
- From the Departments of Radiology (S.V., C.S., T.Y.P.) .,Harvard Medical School (S.V., C.S., M.K., T.Y.P.), Boston, Massachusetts
| | - C Stamoulis
- From the Departments of Radiology (S.V., C.S., T.Y.P.).,Neurology (C.S.), Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School (S.V., C.S., M.K., T.Y.P.), Boston, Massachusetts
| | - K Ricci
- Cancer Center (K.R.), Massachusetts General Hospital, Boston, Massachusetts
| | - M Kieran
- Department of Pediatric Oncology (M.K.), Dana-Farber Cancer Center, Boston, Massachusetts.,Harvard Medical School (S.V., C.S., M.K., T.Y.P.), Boston, Massachusetts
| | - T Young Poussaint
- From the Departments of Radiology (S.V., C.S., T.Y.P.).,Harvard Medical School (S.V., C.S., M.K., T.Y.P.), Boston, Massachusetts
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11
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Li Y, Estroff JA, Khwaja O, Mehta TS, Poussaint TY, Robson CD, Feldman HA, Ware J, Levine D. Callosal dysgenesis in fetuses with ventriculomegaly: levels of agreement between imaging modalities and postnatal outcome. Ultrasound Obstet Gynecol 2012; 40:522-529. [PMID: 22262510 PMCID: PMC3733468 DOI: 10.1002/uog.11098] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess neurodevelopmental outcome of fetuses diagnosed with callosal abnormalities after referral for ventriculomegaly. METHODS This sub-analysis of a prospective study of 430 fetuses, which were referred for ventriculomegaly and underwent sonography and magnetic resonance imaging (MRI), included those fetuses with a diagnosis of corpus callosal abnormalities after recruitment into the main study. Between three and six radiologists independently reviewed ultrasound and MR images and recorded central nervous system (CNS) abnormalities, with final diagnoses being decided by consensus. Postnatal outcomes of fetuses with callosal abnormalities were compared between those with and those without other abnormalities. RESULTS Callosal abnormalities were detected in 13% (58/430) of the fetuses referred with ventriculomegaly. Callosal dysgenesis was isolated in 24% (14/58) of these cases, with the remainder complicated by CNS, karyotypic or other major abnormalities. Five fetuses diagnosed prenatally as having isolated callosal abnormalities had additional CNS findings on postnatal assessment. Preconference kappa for callosal abnormalities was 0.76 for ultrasound and 0.78 for MRI, indicating that these investigations had a similar level of operator dependence. Neurodevelopmental outcome was normal or showed only mild delay that resolved in 67% (8/12) children with isolated callosal abnormalities compared to 7% (2/27) in those with non-isolated callosal abnormalities (P = 0.003). CONCLUSION Callosal abnormalities are present in a significant proportion of fetuses with a diagnosis of ventriculomegaly. Isolated callosal abnormalities are associated with normal neurodevelopmental outcome in approximately two-thirds of fetuses.
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Affiliation(s)
- Y Li
- Harvard Medical School, Boston, MA, USA
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12
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Senapati GM, Levine D, Smith C, Estroff JA, Barnewolt CE, Robertson RL, Poussaint TY, Mehta TS, Werdich XQ, Pier D, Feldman HA, Robson CD. Frequency and cause of disagreements in imaging diagnosis in children with ventriculomegaly diagnosed prenatally. Ultrasound Obstet Gynecol 2010; 36:582-595. [PMID: 20499405 PMCID: PMC2965802 DOI: 10.1002/uog.7680] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To assess the frequency and cause of variability in diagnosis on cranial sonography and magnetic resonance imaging (MRI) in children referred following prenatal diagnosis of ventriculomegaly. METHODS Between 19 September 2003 and 16 March 2007, 119 infants with ultrasound and/or MRI studies performed within 13 months (median, 6 days) after birth, following prenatal referral for ventriculomegaly, were studied prospectively. There were 97 infants with ultrasound results and 53 with MRI, including 31 with both. Three sonologists and three pediatric neuroradiologists interpreted the postnatal ultrasound and MRI findings, blinded to prenatal diagnosis, and a final consensus diagnosis or group of diagnoses was obtained. Ventricular sizes as well as types of and reasons for any disagreement in diagnosis were recorded. Disagreements on a per patient basis were categorized as being major when they crossed diagnostic categories and had the potential to change patient counseling. Postnatal and prenatal diagnoses were compared. RESULTS There was prospective agreement on 42/97 (43%) ultrasound and on 9/53 (17%) MRI readings. Prospective consensus was more likely when the number of central nervous system (CNS) anomalies was lower (P < 0.001 and P = 0.002 for ultrasound and MRI, respectively). In 24/55 (44%) ultrasound and 11/44 (25%) MRI examinations with disagreement in diagnosis, there was disagreement concerning the presence of ventriculomegaly. In 22/97 (23%) ultrasound studies and 22/53 (42%) MRI studies the disagreements were potentially important. Reasons for discrepancies in the reporting of major findings included errors of observation as well as modality differences in depiction of abnormalities. In comparing prenatal with postnatal diagnoses, there were 11/97 (11%) ultrasound and 27/53 (51%) MRI examinations with newly detected major findings, the most common being migrational abnormalities, callosal dysgenesis/destruction and interval development of hemorrhage. CONCLUSION Variability in postnatal CNS diagnosis is common after a prenatal diagnosis of ventriculomegaly. This is due in part to a lack of standardization in the definition of postnatal ventriculomegaly.
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Affiliation(s)
- G M Senapati
- Tufts University School of Medicine, Boston, MA, USA
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13
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Abstract
While back pain presents less frequently in children than in adults, it still poses a significant clinical challenge with respect to making a firm diagnosis and developing an effective treatment plan. When children have back pain and medical attention is sought, an underlying pathology is usually suspected. Pediatric patients are evaluated, first, with a complete clinical history and examination and, second, by an imaging work-up that is based on initial findings, including the child's age and size, signs and symptoms, and suspected etiology. This article describes 1) the epidemiology of back pain in children, 2) the imaging work-up used, and 3) the correlation of imaging findings with disease entities that may cause back pain in the pediatric patient. The list of diseases giving rise to back pain is not meant to be exhaustive but rather reflective of the most commonly identified pathologies and disorders among young children and adolescents, from athletic injuries to lethal cancers.
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Affiliation(s)
- D P Rodriguez
- Harvard Medical School and Division of Neuroradiology, Department of Radiology, Children's Hospital, Boston, Massachusetts 02115, USA
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14
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Poussaint TY, Phillips PC, Vajapeyam S, Fahey FH, Robertson RL, Osganian S, Ramamurthy U, Mulkern RV, Treves ST, Boyett JM, Kun LE. The Neuroimaging Center of the Pediatric Brain Tumor Consortium-collaborative neuroimaging in pediatric brain tumor research: a work in progress. AJNR Am J Neuroradiol 2007; 28:603-7. [PMID: 17416804 PMCID: PMC7977358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
As an essential part of the National Cancer Institute (NCI)-funded Pediatric Brain Tumor Consortium (PBTC), the Neuroimaging Center (NIC) is dedicated to infusing the study of pediatric brain tumors with imaging "best practice" by producing a correlative research plan that 1) resonates with novel therapeutic interventions being developed by the wider PBTC, 2) ensures that every PBTC protocol incorporates an imaging "end point" among its objectives, 3) promotes the widespread implementation of standardized technical protocols for neuroimaging, and 4) facilitates a quality assurance program that complies with the highest standards for image data transfer, diagnostic image quality, and data integrity. To accomplish these specific objectives, the NIC works with the various PBTC sites (10 in all, plus NCI/ National Institute of Neurological Diseases and Stroke representation) to ensure that the overarching mission of the consortium--to better understand tumor biology and develop new therapies for central nervous system tumors in children--is furthered by creating a uniform body of imaging techniques, technical protocols, and standards. Since the inception of the NIC in 2003, this broader mandate has been largely accomplished through a series of site visits and meetings aimed at assessing prevailing neuroimaging practices against NIC-recommended protocols, techniques, and strategies for achieving superior image quality and executing the secure transfer of data to the central PBTC. These ongoing evaluations periodically examine investigations into targeted drug therapies. In the future, the NIC will concentrate its efforts on improving image analysis for MR imaging and positron-emission tomography (PET) and on developing new ligands for PET; imaging markers for radiation therapy; and novel systemic, intrathecal, and intralesional therapeutic interventions.
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15
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Anselm IA, Anselm IM, Alkuraya FS, Salomons GS, Jakobs C, Fulton AB, Mazumdar M, Rivkin M, Frye R, Poussaint TY, Marsden D. X-linked creatine transporter defect: a report on two unrelated boys with a severe clinical phenotype. J Inherit Metab Dis 2006; 29:214-9. [PMID: 16601897 PMCID: PMC2393549 DOI: 10.1007/s10545-006-0123-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report two unrelated boys with the X-linked creatine transporter defect (CRTR) and clinical features more severe than those previously described with this disorder. These two boys presented at ages 12 and 30 months with severe mental retardation, absent speech development, hypotonia, myopathy and extra-pyramidal movement disorder. One boy has seizures and some dysmorphic features; he also has evidence of an oxidative phosphorylation defect. They both had classical absence of creatine peak on brain magnetic resonance spectroscopy (MRS). In one, however, this critical finding was overlooked in the initial interpretation and was discovered upon subsequent review of the MRS. Molecular studies showed large genomic deletions of a large part of the 3' end of the complete open reading frame of the SLC6A8 gene. This report emphasizes the importance of MRS in evaluating neurological symptoms, broadens the phenotypic spectrum of CRTR and adds knowledge about the pathogenesis of creatine depletion in the brain and retina.
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Affiliation(s)
- I A Anselm
- Department of Neurology, Children's Hospital Boston, Harvard Medical School, Massachusetts 02115, USA
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16
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Baser ME, Poussaint TY. Age associated increase in the prevalence of chromosome 22q loss of heterozygosity in histological subsets of benign meningioma. J Med Genet 2005; 43:285-7. [PMID: 15980114 PMCID: PMC2563234 DOI: 10.1136/jmg.2005.035162] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Chromosome 22q loss of heterozygosity (LOH) is the most common allelic loss in benign meningioma and is thought to be the earliest initiating event in meningioma formation. We used published data and logistic regression to evaluate the association of 22q LOH with age at diagnosis in 318 transitional, fibroblastic, and meningothelial meningiomas. After adjustment for anatomical location, the odds ratio of 22q LOH per year of age was >1 in each histological type of meningioma, and was significantly >1 in transitional and fibroblastic meningioma. This finding is compatible with involvement of the neurofibromatosis 2 tumour suppressor gene, NF2, on chromosome 22q in the high incidence of benign meningioma in the elderly.
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17
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Caruso PA, Poussaint TY, Tzika AA, Zurakowski D, Astrakas LG, Elias ER, Bay C, Irons MB. MRI and 1H MRS findings in Smith-Lemli-Opitz syndrome. Neuroradiology 2003; 46:3-14. [PMID: 14605787 DOI: 10.1007/s00234-003-1110-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2003] [Accepted: 07/29/2003] [Indexed: 04/13/2023]
Abstract
Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive disorder characterized by a defect in cholesterol biosynthesis, associated with mental retardation and multisystem structural abnormalities. This study investigated the prevalence of congenital CNS abnormalities by MRI in a large series of patients with SLOS and the correlation of the clinical and biochemical findings with the results of MRI and 1H MRS. Eighteen patients were studied; all underwent MRI of the brain, and 16 had 1H MRS of the cerebral white matter. The ratios choline:NAA, lipid:NAA, and lipid:choline metabolite were found to be correlated with the clinical degree of disease severity, serum total sterol ratios (cholesterol/cholesterol + 7-dehydrocholesterol + 8-dehydrocholesterol) and in two cases with the effect of cholesterol therapy. Abnormal CNS findings were noted in five patients, including callosal abnormalities (n = 4), Dandy-Walker variant (n = 1), and arachnoid cyst (n = 1). Holoprosencephaly was noted in one patient with a prevalence of 6%. Choline:NAA was elevated in seven patients. There was a statistically significant positive correlation between the lipid:choline ratio and the serum cholesterol precursor, 8-dehydrocholesterol. In two patients 1H MRS demonstrated abnormally elevated lipids prior to cholesterol therapy, which improved on therapy. The use of MRI and 1H MRS is an effective way to demonstrate brain structural abnormalities in patients with SLOS and may prove to be an effective method for the assessment of the effects of cholesterol replacement therapy in the brain.
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Affiliation(s)
- P A Caruso
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, USA
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Abstract
Over the past 25 years, magnetic resonance imaging (MRI) has developed into the primary imaging tool for evaluation of the central nervous system. MRI is the essential imaging study in the twenty-first century for the evaluation of the child with a brain tumor for initial preoperative diagnosis, treatment planning and image-guided therapies. This article provides an overview of the locations and MRI features of common pediatric tumors of childhood.
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Affiliation(s)
- T Y Poussaint
- Department of Radiology, Harvard Medical School, and Children's Hospital, Boston, Massachusetts 02115, USA.
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19
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Poussaint TY. Magnetic resonance imaging (MRI) is one of the most important imaging modalities in pediatric neuroradiology. Top Magn Reson Imaging 2001; 12:359. [PMID: 11744874 DOI: 10.1097/00002142-200112000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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O'Tuama LA, Young Poussaint T. Thallum-201 single-proton emission CT versus CT for the detection of recurrent squamous cell carcinoma of the head and neck. AJNR Am J Neuroradiol 2001; 22:1983-4. [PMID: 11733339 PMCID: PMC7973847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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21
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Abstract
Two twins with late infantile globoid cell leukodystrophy of Krabbe's disease were studied with conventional magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy. Brain MRI demonstrated brain atrophy with extensive bilateral symmetric abnormal T2 signal in the posterior periventricular white matter, parietal lobes, corona radiata, centrum semiovale, and splenium of the corpus callosum. Magnetic resonance imaging-guided proton magnetic resonance spectroscopy revealed prominent peaks from choline-containing compounds, total creatine, and inositols. The N-acetylaspartate peak was markedly reduced, and the choline-to-N-acetylaspartate ratio was abnormally high; in one of the twins, lactic acid was also detected. The constellation of magnetic resonance spectroscopy findings is indicative of extensive demyelination, gliosis, and loss of axons in the involved white matter; the latter two events occur in the later stages of globoid cell leukodystrophy. In conjunction with brain MRI, these magnetic resonance spectroscopy findings may alert clinicians to the possibility of leukodystrophy in children with progressive encephalopathy.
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Affiliation(s)
- M K Zarifi
- Department of Radiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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22
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Tzika AA, Zurakowski D, Poussaint TY, Goumnerova L, Astrakas LG, Barnes PD, Anthony DC, Billett AL, Tarbell NJ, Scott RM, Black PM. Proton magnetic spectroscopic imaging of the child's brain: the response of tumors to treatment. Neuroradiology 2001; 43:169-77. [PMID: 11326567 DOI: 10.1007/s002340000454] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Our aim was to determine and/or predict response to treatment of brain tumors in children using proton magnetic resonance spectro-scopic imaging (MRSI). We studied 24 patients aged 10 months to 24 years, using MRI and point-resolved spectroscopy (PRESS; TR 2000 TE 65 ms) with volume preselection and phase-encoding in two dimensions on a 1.5 T imager. Multiple logistic regression was used to establish independent predictors of active tumor growth. Biologically vital cell metabolites, such as N-acetyl aspartate and choline-containing compounds (Cho), were significantly different between tumor and control tissues (P < 0.001). The eight brain tumors which responded to radiation or chemotherapy, exhibited lower Cho (P = 0.05), higher total creatine (tCr) (P = 0.02) and lower lactate and lipid (L) (P = 0.04) than 16 tumors which were not treated (except by surgery) or did not respond to treatment. The only significant independent predictor of active tumor growth was tCr (P < 0.01). We suggest that tCr is useful in assessing response of brain tumors to treatment.
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Affiliation(s)
- A A Tzika
- Department of Radiology, Children's Hospital and Harvard Medical School, Boston, MA, USA.
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Young Poussaint T, Barnes PD. Imaging of the developmentally delayed child. Magn Reson Imaging Clin N Am 2001; 9:99-119, viii. [PMID: 11278185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Neuroimaging can aid in determining the causes of developmental delay in a child. Information from neuroimaging examinations may help guide further testing and treatment in these children. This article emphasizes the neuroimaging approaches, modalities, and features in the child with developmental delay. The common causative categories of developmental delay are reviewed.
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Affiliation(s)
- T Young Poussaint
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
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Poussaint TY, Fox JW, Dobyns WB, Radtke R, Scheffer IE, Berkovic SF, Barnes PD, Huttenlocher PR, Walsh CA. Periventricular nodular heterotopia in patients with filamin-1 gene mutations: neuroimaging findings. Pediatr Radiol 2000; 30:748-55. [PMID: 11100490 DOI: 10.1007/s002470000312] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The filamin-1 (FLN-1) gene is responsible for periventricular nodular heterotopia (PNH), which is an X-linked dominant neuronal migration disorder. OBJECTIVE To review the clinical and imaging findings in a series of patients with documented filamin-1 mutations. MATERIALS AND METHODS A retrospective review of the medical records and MR studies of a series of patients with PNH and confirmed FLN-1 mutations was done. There were 16 female patients (age range: .67-71 years; mean = 28.6) with filamin-1 gene mutations. RESULTS In six of the patients the same mutation was inherited in four generations in one pedigree. In a second pedigree, a distinct mutation was found in two patients in two generations. In a third pedigree, a third mutation was found in four patients in two generations. The remaining four patients had sporadic de novo mutations that were not present in the parents. Ten patients had seizures, and all patients had normal intelligence. In all 16 patients MR demonstrated bilateral near-continuous PNH. There were no consistent radiographic or clinical differences between patients carrying different mutations. CONCLUSION Patients with confirmed FLN-1 gene mutations are usually female and have a distinctive MR pattern of PNH. Other female patients with this same MR pattern probably harbor FLN-1 mutations and risk transmission to their progeny. This information is important for genetic counseling.
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Affiliation(s)
- T Y Poussaint
- Department of Radiology, Children's Hospital, Boston, Massachusetts 02115, USA.
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25
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Drubach LA, Connolly LP, Poussaint TY, Faul PN, Treves ST. Role of intraoperative skeletal scintigraphy in the localization of osteoblastomas. Clin Nucl Med 2000; 25:819-20. [PMID: 11043725 DOI: 10.1097/00003072-200010000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L A Drubach
- Department of Radiology, Children's Hospital, Boston, Massachusetts 02115, USA
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26
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Siffert J, Poussaint TY, Goumnerova LC, Scott RM, LaValley B, Tarbell NJ, Pomeroy SL. Neurological dysfunction associated with postoperative cerebellar mutism. J Neurooncol 2000; 48:75-81. [PMID: 11026700 DOI: 10.1023/a:1006483531811] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES The postoperative cerebellar mutism syndrome (CMS) is an unique acute postoperative complication characterized by transient decrease in speech output (often mutism), apathy, irritability as well as global cerebellar dysfunction. As much as 25% of patients undergoing a resection of a cerebellar or IV ventricular tumor may develop such a syndrome. In this retrospective study we characterize the clinical features of the CMS and explore potential etiologic mechanisms. METHODS We conducted a retrospective analysis of medical records and imaging tests of 8 consecutive patients with the CMS identified through the database of the Children's Hospital and Dana-Farber Cancer Institute, Boston, and compared with a control group of 8 unaffected children undergoing a comparable tumor resection. RESULTS In contrast to the control group, children in the affected group had marked decrease in speech output and comprehension, apathy and lack of initiative, inattention, persistent eye closure, flaccid hemiparesis and a severe global cerebellar dysfunction. Swallowing difficulties and bowel and bladder dysfunction were also observed. The median duration of the syndrome as judged by the persistence of the communication abnormalities was 4 weeks. The recovery was near complete with exception for a persistent global cerebellar dysfunction. A comparison of CT and MRI scans of children in both groups failed to identify distinguishing features. CONCLUSION A surgical lesion of the midline cerebellum can cause a complex neurological dysfunction such as the CMS. Thus, we postulate that the cerebellum and its connections function as a 'modulatory system' in control of both motor and non-motor functions, including attention and language.
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Affiliation(s)
- J Siffert
- The Hyman-Newman Institute for Neurology and Neurosurgery, Beth Israel Medical Center, New York, NY 10128, USA.
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27
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Young Poussaint T, Yousuf N, Barnes PD, Anthony DC, Zurakowski D, Scott RM, Tarbell NJ. Cervicomedullary astrocytomas of childhood: clinical and imaging follow-up. Pediatr Radiol 1999; 29:662-8. [PMID: 10460326 DOI: 10.1007/s002470050671] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED BACKGROUND. Cervicomedullary astrocytomas are a unique subset of brainstem tumors in children because they have a good prognosis when compared to the pontine subset of brainstem gliomas. Objective. To review the clinical and imaging findings in a series of children with cervicomedullary astrocytomas as to diagnosis and management. MATERIALS AND METHODS A retrospective review of eleven children (six females, five males, age range: 10 days-18 years; mean = 7 years) with cervicomedullary tumors was done including the clinical presentation, imaging studies (MR: eleven, CT and MR: four), surgical findings, pathological results, and follow-up clinical and imaging findings (range: 0.2-11 years; mean = 5.2 years). RESULTS Symptoms and signs were delayed and protracted, often occurring over months to years (mean = 2.3 years, range 0.5-7 years). The tumors expanded the dorsal medulla and involved the upper cervical spinal cord (mean maximum tumor diameter = 4.4 cm). Only three patients had hydrocephalus. In three of four cases the tumor was not seen on CT. On MR, the majority of the tumors were T1 hypointense and T2 hyperintense. Treatment consisted of surgery only in six patients, surgery and radiation therapy in four, and surgery, chemotherapy, and radiation in one. There was recurrent local disease in four patients and on follow-up metastatic disease in the brain in one. On follow-up the majority of the patients are alive and stable (mean = 5.2 years, range 0.2-11 years). There has been one death. The majority of tumors were pilocytic astrocytomas. CONCLUSION Cervicomedullary tumors are a unique subset of brainstem gliomas in childhood that present with a long duration of symptoms and a greater long-term survival than pontine gliomas.
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Affiliation(s)
- T Young Poussaint
- Division of Neuroradiology, Department of Radiology, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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28
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Santiago Medina L, al-Orfali M, Zurakowski D, Poussaint TY, DiCanzio J, Barnes PD. Occult lumbosacral dysraphism in children and young adults: diagnostic performance of fast screening and conventional MR imaging. Radiology 1999; 211:767-71. [PMID: 10352604 DOI: 10.1148/radiology.211.3.r99jn09767] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare fast screening and conventional magnetic resonance (MR) imaging for the detection of occult dysraphic myelodysplasias in children and young adults. MATERIALS AND METHODS A retrospective case-control study included 101 patients (mean age, 4.9 years; range, 1 day to 26 years) suspected of having occult lumbosacral dysraphism. Sixty case patients had myelodysplastic lesions (19 filar lipoma, 14 syringomyelia, 10 intradural lipoma, eight dermal sinus, five diastematomyelia, five lipomyelomeningocele, two caudal regression syndrome); 41 control patients had no dysraphic lesions; 17 patients had associated renal anomalies. Two neuroradiologists reviewed MR images from conventional and fast screening protocols. Diagnostic performance parameters included sensitivity, specificity, and area under the receiver operating characteristic curve (Az value). RESULTS The sensitivity of conventional and fast screening MR studies was 97.1% and 98.5%, respectively, the specificity was 90.9% and 84.8%, respectively. The Az value was 0.973 for the fast screening and 0.976 for the conventional MR studies (P = .83). Interobserver agreement was very good for fast screening images (kappa = 0.68) and excellent for conventional images (kappa = 0.75). For renal anomalies, the Az value was 0.786 and 0.853 for fast screening and conventional MR imaging, respectively (P = .28). CONCLUSION Conventional three-plane lumbosacral MR imaging in children and young adults suspected of having occult dysraphism provides better diagnostic information than does fast screening two-plane MR imaging because of its higher specificity and interobserver agreement.
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Affiliation(s)
- L Santiago Medina
- Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45236, USA
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29
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Korf BR, Schneider G, Poussaint TY. Structural anomalies revealed by neuroimaging studies in the brains of patients with neurofibromatosis type 1 and large deletions. Genet Med 1999; 1:136-40. [PMID: 11258348 DOI: 10.1097/00125817-199905000-00004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The basis for cognitive problems in patients with neurofibromatosis type 1 (NF1) is unknown. A subset of NF1 patients with deletion of the entire NF1 gene has severe learning problems or mental retardation. We have reviewed neuroimaging studies (CT and MRI) in five such patients to determine whether structural anomalies in the brain are present and might explain the impaired cognitive function. METHODS Five patients with NF1 and deletion of the entire gene were identified by FISH studies. A retrospective review was conducted of CT and MRI images, as well as of data from developmental assessments. RESULTS All five patients had severe developmental impairment. None had been exposed to chemotherapy or radiation therapy. All had multiple regions of bright T2 signal intensity. Structural anomalies were seen in three of the five patients and included callosal dysgenesis in one, septum cavum vergae and pellucidum in two, mega cisterna magna in one, and Chiari I malformation with severe hydrocephalus in one patient. CONCLUSION Individuals with NF1 and large gene deletions have an increased frequency of structural anomalies of the brain not usually seen in NF1 patients. This suggests that the mental retardation in these individuals is due, at least in part, to abnormal brain development rather than a defect in brain function due to haplosufficiency of the NF1 gene product.
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Affiliation(s)
- B R Korf
- Division of Genetics, Children's Hospital, Boston, MA 02115, USA.
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30
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Poussaint TY, Gudas T, Barnes PD. Imaging of neuroendocrine disorders of childhood. Neuroimaging Clin N Am 1999; 9:157-75. [PMID: 9974504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
This article focuses on the neuroendocrine disorders of childhood. The commonly associated neuroradiologic abnormalities of the hypothalamic-pituitary axis are covered in detail.
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Affiliation(s)
- T Y Poussaint
- Department of Radiology, Harvard Medical School, Children's Hospital, Boston, Massachusetts 02115, USA
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Kim FM, Poussaint TY, Barnes PD. Neuroimaging of scoliosis in childhood. Neuroimaging Clin N Am 1999; 9:195-221. [PMID: 9974506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
A curvature abnormality may be the initial or major presenting feature in a child with disease of the spinal column or spinal neuraxis. A simplified classification of common spinal curvature abnormalities of childhood include idiopathic, congenital/dysraphic, skeletal dysplasia, neurofibromatosis, and painful. The great majority of childhood scoliosis falls into the idiopathic category. Atypical clinical or radiographic features in a presumed idiopathic scoliosis may indicate an otherwise occult tumor or hydrosyringomyelia, or may be a consequence of increasing curvature with disk protrusion, nerve impingement, or cord attenuation. Neuroimaging beyond plain films is commonly necessary for atypical idiopathic scoliosis and for the other categories of scoliosis listed.
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Affiliation(s)
- F M Kim
- Division of Neuroradiology, Department of Radiology, Children's Hospital, Boston, Massachusetts 02115, USA.
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32
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Abstract
Plain film imaging remains important for the diagnosis and surveillance of scoliosis, as well as for the detection of complications after surgery. New means of treating scoliosis have become established and should be understood by the radiologist. To the well-known postoperative complications, including pneumothorax, pneumonia, and gastrointestinal obstruction, are added new specific potential problems with the new surgical methodology.
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Affiliation(s)
- A E Oestreich
- Radiology Department, Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
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33
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Abstract
Plain film imaging remains important for the diagnosis and surveillance of scoliosis, as well as for the detection of complications after surgery. Advances in CT and MR imaging have greatly improved the ability to detect or confirming non-idiopathic causes of scoliosis, including abnormalities within the spinal canal. Three-dimensional thinking has become more important in evaluating and understanding scoliosis.
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Affiliation(s)
- A E Oestreich
- Radiology Department, Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
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Abstract
The authors explored the hypothesis that functional behavior of childhood brain tumors can be estimated by serial analysis of imaging (thallium-201 [201Tl] single-photon emission computed tomography and magnetic resonance imaging [MRI]) examinations. Seventy-five patients diagnosed on clinical or histologic grounds were monitored for a period of 1 day to 3.9 years (mean +/- S.D. = 1.39 +/- 1.10 years). Abnormal 201Tl uptake appeared to denote a subgroup of lesions with distinctly greater mortality and morbidity. Of 201Tl-positive patients, 17% died within the course of this study; no deaths occurred among the 201Tl-negative group. Other parameters of disease outcome also clearly separated the 201Tl-positive and 201Tl-negative groups, with the former demonstrating a 50% shorter period of recurrence-free survival from the time of diagnosis (two-tailed t test, P < 0.01). Significant enhancement with paramagnetic contrast agents paralleled 201Tl positivity in correlating with greater mortality but failed to predict duration of recurrence-free survival. The authors conclude that 201Tl activity provides significant predictive information of the expected biologic behavior of childhood brain tumors, both for duration of recurrence-free survival and for estimated life expectancy. This information complements and extends data provided by MRI enhancement patterns.
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Affiliation(s)
- L A O'Tuama
- Department of Radiology, Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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35
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Madsen JR, Vallat AV, Poussaint TY, Scott RM, De Girolami U, Anthony DC. Focal cortical dysplasia with glioproliferative changes causing seizures: report of 3 cases. Pediatr Neurosurg 1998; 28:261-6. [PMID: 9732260 DOI: 10.1159/000028662] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In contrast to neoplasia, lesions of focal cerebral dysplasia are thought to be completed developmental processes of abnormal neuronal migration. We present three children with seizures resulting from brain lesions which pathologically demonstrate regions of both clearcut focal cortical dysplasia and also hypercellularity and monomorphism typical of proliferative lesions such as low grade glial tumor. These cases suggest the existence of a distinct subgroup of patients with prominent glioproliferative changes in association with focal cortical dysplasia, challenging the conventional dichotomy between dysplastic and proliferative categories of brain lesions. Recognition of patients with dual pathology may be of practical as well as theoretical importance.
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Affiliation(s)
- J R Madsen
- Department of Neurosurgery, Children's Hospital, Boston, Mass., USA.
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36
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Poussaint TY, Kowal JR, Barnes PD, Zurakowski D, Anthony DC, Goumnerova L, Tarbell NJ. Tectal tumors of childhood: clinical and imaging follow-up. AJNR Am J Neuroradiol 1998; 19:977-83. [PMID: 9613524 PMCID: PMC8337580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE This study was done to determine which clinical and imaging findings best correlate with outcome in children with tectal tumors. METHODS A retrospective review was done of the medical records and imaging studies of 32 children (16 boys and 16 girls; mean age, 8 years) with tectal tumors. Eight children had CT, 11 had MR imaging, and 13 had both CT and MR studies. Findings from surgical and pathologic reports as well as from follow-up examinations (mean follow-up period, 5 years; range, 3.6 months to 17 years) were included in the review. RESULTS All patients had hydrocephalus and all but one required CSF diversion. The tectum was the center of the tumor in all cases and the majority of the tumors appeared isodense on CT scans, isointense on T1-weighted MR images, and hyperintense on T2-weighted images. Twenty patients required no further treatment. In this group, the mean maximum tumor diameter was 1.8 cm and enhancement occurred in two cases. At follow-up, 18 patients had stable tumor size, one had an increase in tumor size with cyst formation but no worsening of symptoms, and one had a decrease in tumor size. Twelve patients required further treatment (excision and/or radiotherapy) because of progression as indicated by either increased tumor size or worsening of symptoms. In this group, the mean maximum tumor diameter was 2.5 cm and contrast enhancement occurred in nine cases. Further follow-up in this group showed decreased tumor size in eight and stable residual tumor in three. CONCLUSION Tectal tumors in childhood have variable behavior. MR imaging assists in the clinical determination of which children need treatment beyond CSF diversion. Larger tumor size and enhancement are radiologic predictors of the need for further treatment.
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Affiliation(s)
- T Y Poussaint
- Department of Radiology, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
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37
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Medina LS, Zurakowski D, Strife KR, Robertson RL, Poussaint TY, Barnes PD. Efficacy of fast screening MR in children and adolescents with suspected intracranial tumors. AJNR Am J Neuroradiol 1998; 19:529-34. [PMID: 9541313 PMCID: PMC8338265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Our purpose was to determine the sensitivity, specificity, and receiver operator characteristic (ROC) curve of a fast screening MR protocol in children and adolescents with suspected intracranial tumors. METHODS One hundred forty-one patients (mean age, 9.7 years; range, 2 months to 23.5 years) with suspected brain tumor were entered in a case-control study. Eighty-seven patients had intracranial tumors (31 suprasellar/hypothalamic, 27 supratentorial, 26 infratentorial, and three pineal) and 54 patients in the control group had other disorders. Two neuroradiologists reviewed blindly a detailed three-sequence conventional protocol (acquisition time, 8 minutes 27 seconds) and a two-sequence fast screening MR protocol (acquisition time, 4 minutes 44 seconds). RESULTS Sensitivity and specificity of the fast screening protocol for intracranial tumors was 100% and 92.6%, respectively. The areas under the ROC curves were 0.966 for the fast screening and 0.980 for the conventional MR protocol. No diagnostic performance difference was found between the ROC curves using the Az index. A kappa statistic of .93 for both examinations indicated excellent interobserver agreement. Additional MR sequences and other neuroimaging studies were not deemed necessary to exclude the presence of an intracranial tumor. CONCLUSION A fast dual-plane brain MR protocol may be adequate to screen children and adolescents thought to have an intracranial tumor. The less than 5 minute acquisition time allows a complete examination (including preparation) to be performed in 10 to 15 minutes. Future studies are recommended before this time-efficient neuroimaging examination is incorporated into clinical practice.
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Affiliation(s)
- L S Medina
- Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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Poussaint TY, Barnes PD, Nichols K, Anthony DC, Cohen L, Tarbell NJ, Goumnerova L. Diencephalic syndrome: clinical features and imaging findings. AJNR Am J Neuroradiol 1997; 18:1499-505. [PMID: 9296191 PMCID: PMC8338138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To emphasize the importance of imaging in children with diencephalic syndrome due to hypothalamic/chiasmatic astrocytomas. METHODS Findings in nine patients (mean age, 26 months) with diencephalic syndrome and hypothalamic/chiasmatic astrocytomas were analyzed retrospectively, including reviewing clinical records, imaging examinations, and follow-up studies. RESULTS Symptoms and signs included failure to thrive (n = 9), nystagmus (n = 3), visual field defects (n = 1), optic pallor (n = 1), emesis (n = 2), and headache (n = 1). All patients had hypothalamic/chiasmatic masses. Five patients underwent biopsy, and, in all cases, specimens showed low-grade astrocytoma. Imaging studies were available in eight patients. All tumors were large (median maximum diameter, 3.5 cm), involved the chiasm and hypothalamus, and showed homogeneous enhancement. Three patients had hydrocephalus and two had metastases. At follow-up, five patients had recurrent disease and two had died. CONCLUSION Diencephalic syndrome is a rare cause of failure to thrive in childhood, and diagnosis of a hypothalamic/ chiasmatic astrocytoma might therefore be delayed. The astrocytomas associated with this syndrome are larger, occur at a younger age, and are often more aggressive than other astrocytomas arising in this region.
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Affiliation(s)
- T Y Poussaint
- Department of Radiology, Children's Hospital, Boston, MA 02115, USA
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Robertson RL, Burrows PE, Barnes PD, Robson CD, Poussaint TY, Scott RM. Angiographic changes after pial synangiosis in childhood moyamoya disease. AJNR Am J Neuroradiol 1997; 18:837-45. [PMID: 9159360 PMCID: PMC8338121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To describe the angiographic changes accompanying the surgical treatment of moyamoya disease by pial synangiosis and to compare these changes with patient outcome. METHODS The preoperative and postoperative cerebral angiograms, MR images, and clinical records of 13 children treated with pial synangiosis for moyamoya disease were reviewed. RESULTS After synangiosis, 10 patients had significant neurologic improvement and three had minimal or no improvement. Postoperative MR images showed no new infarctions. Well-developed (grade A or B) transpial or transdural collaterals to the brain were present at the site of synangiosis in 84% of the surgically treated hemispheres. Cerebrovascular occlusive changes increased postoperatively in 76% of hemispheres. After synangiosis, moyamoya collaterals were increased in 48%, unchanged in 16%, and decreased in 36% of surgically treated hemispheres. All 10 patients with grade A or B collaterals bilaterally after synangiosis were asymptomatic or improved on follow-up. CONCLUSION Pial synangiosis typically results in an increase in collaterals from the superficial temporal artery or middle meningeal artery to the brain. Synangiosis appears to result in stabilization or improvement in neurologic symptoms but does not prevent the angiographic progression of disease or the development of moyamoya collaterals. The angiographic demonstration of well-formed collaterals after synangiosis is associated with a favorable clinical outcome.
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Affiliation(s)
- R L Robertson
- Department of Radiology, Children's Hospital Medical Center and Harvard Medical School, Boston, Mass. 02115, USA
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Abstract
Phenylketonuria (PKU) produces white matter changes identifiable by magnetic resonance imaging. These changes occur postnatally. Offspring of untreated mothers with PKU also have a brain effect, expressed as microcephaly and mental retardation. This effect occurs prenatally. To determine whether the white matter changes seen in PKU are also present in maternal PKU offspring, despite the different developmental stages of exposure to PKU, we performed brain magnetic resonance imaging studies in seven maternal PKU offspring, five from essentially untreated pregnancies and two from treated pregnancies. None had white matter changes, although the one offspring with PKU had delayed myelination. However, hypoplasia of the corpus callosum was present in three of the four offspring from untreated pregnancies and in the offspring from a maternal PKU pregnancy not treated until the third trimester. Unlike PKU, white matter changes are not a feature of the brain effect in maternal PKU. However, hypoplasia of the corpus callosum is a feature of maternal PKU and is probably a result of inhibition of corpus callosum development at 8 to 20 weeks of gestation. The hypoplastic corpus callosum could be a marker for brain effect in maternal PKU and may have implications for the cognitive deficits in these offspring.
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Affiliation(s)
- H L Levy
- Genetic and Radiology Services, Children's Hospital, Boston, Massachusetts 02115, USA
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Steingard RJ, Renshaw PF, Yurgelun-Todd D, Appelmans KE, Lyoo IK, Shorrock KL, Bucci JP, Cesena M, Abebe D, Zurakowski D, Poussaint TY, Barnes P. Structural abnormalities in brain magnetic resonance images of depressed children. J Am Acad Child Adolesc Psychiatry 1996; 35:307-11. [PMID: 8714318 DOI: 10.1097/00004583-199603000-00011] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Brain magnetic resonance images (MRIs) of 65 children and adolescents who were hospitalized with depressive disorders (DD) were compared with the brain MRIs of 18 hospitalized psychiatric controls (PC) without a depressive disorder. METHOD Volumetric analyses were used to measure frontal lobe volumes (FLV), lateral ventricular volumes (VV), and total cerebral volumes (CV) for all subjects. To correct for differences in absolute cerebral volume associated with different body and head size, the ratios of FLV/CV and VV/CV were used to compare differences between the two groups. A multivariate analysis was used to control for the effects of several independent variables (age, sex, diagnosis). RESULTS Significant differences were seen in the FLV/CV ratio and the VV/CV ratio when the results were compared between the two groups (DD versus PC). The DD group had a significantly smaller FLV/CV ratio (t = 2.148, df = 79, p = .035) and a significantly larger VV/CV ratio (t = -2.093, df = 79, p = .040). CONCLUSION The findings are consistent with previous reports in depressed adults and may implicate the frontal lobes in the pathogenesis of early-onset depressive disorders.
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Affiliation(s)
- R J Steingard
- Psychopharmacology Clinic, Children's Hospital, Boston, MA, USA
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Barnes PD, Robson CD, Robertson RL, Poussaint TY. Pediatric orbital and visual pathway lesions. Neuroimaging Clin N Am 1996; 6:179-98. [PMID: 8919140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This article presents the clinical and imaging aspects of some common and important orbital and optic pathway lesions occurring in childhood. Lesions that arise outside of and encroach on the orbit and visual pathways are included. Abnormalities intrinsic to the globe are covered elsewhere in this issue.
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Affiliation(s)
- P D Barnes
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
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Poussaint TY, Barnes PD, Anthony DC, Spack N, Scott RM, Tarbell NJ. Hemorrhagic pituitary adenomas of adolescence. AJNR Am J Neuroradiol 1996; 17:1907-12. [PMID: 8933876 PMCID: PMC8337538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To review the clinical and MR imaging findings in adolescents with hemorrhagic pituitary adenomas and to compare those findings with pathologic results and outcome. METHODS We reviewed the clinical records, imaging examinations, surgical and pathologic findings, and follow-up studies in 11 girls and six boys (12 to 20 years old; mean age, 16 years) with pituitary adenomas who were treated at our institution between August 1986 and June 1995. RESULTS Of the 17 adenomas, eight were macroadenomas (> 1 cm) in patients 14 to 18 years old (three girls, five boys). Six of the macroadenomas were grossly hemorrhagic, and appeared as high-intensity intrasellar/suprasellar masses on all MR sequences obtained before definitive diagnosis and treatment. Clinical presentation in the patients with the hemorrhagic macroadenomas included headache (five), visual field deficits (three), and neuroendocrine symptoms (three). One patient was asymptomatic. The preliminary clinical and imaging diagnoses were craniopharyngioma or Rathke's cyst in five of the six cases. Pathologic diagnoses were prolactinoma in four patients, plurihormonal (prolactin/follicle-stimulating hormone) tumor in one patient, and nonfunctioning adenoma in one patient. Surgical resection was performed in all six hemorrhagic tumors and radiation therapy was required in three cases. CONCLUSION Pituitary adenomas uncommonly occur in childhood and are usually seen in adolescence. The majority of the macroadenomas are hemorrhagic and often occur in male subjects. The clinical and MR imaging features may mimic craniopharyngioma or Rathke's cyst. These tumors often require surgery and/or radiation therapy.
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Affiliation(s)
- T Y Poussaint
- Department of Radiology, Children's Hospital, Boston, MA 02115, USA
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Poussaint TY, Siffert J, Barnes PD, Pomeroy SL, Goumnerova LC, Anthony DC, Sallan SE, Tarbell NJ. Hemorrhagic vasculopathy after treatment of central nervous system neoplasia in childhood: diagnosis and follow-up. AJNR Am J Neuroradiol 1995; 16:693-9. [PMID: 7611024 PMCID: PMC8332247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To review the clinical data, imaging findings, and intermediate outcomes of a series of children with hemorrhagic vasculopathy after treatment for intracranial neoplasia. METHODS We retrospectively analyzed the medical records and imaging examinations of 20 pediatric patients (ages 1 to 15 years) with intracranial neoplasia in whom delayed intracranial hemorrhage developed after cranial irradiation or radiation combined with systemic or intrathecal chemotherapy. Patients with intracranial hemorrhage from other identifiable causes were excluded. Histopathologic analysis was available in four patients. RESULTS Twenty patients with delayed intracranial hemorrhage received cranial irradiation alone (n = 9) or combined radiation and chemotherapy (n = 11) for primary brain tumors (n = 13), leukemia (n = 6), or lymphoma (n = 1). Imaging findings were consistent with hemorrhages of varying ages. The hemorrhages were not associated with tumor recurrence nor second tumors. Except for location of the hemorrhage, no significant relationship was established between outcome and original diagnosis, radiation dose (range, 1800 to 6000 centigray), chemotherapeutic agent or dosage, age at treatment, or interval between therapy and hemorrhage (mean, 8.1 years). Only brain stem hemorrhage was associated with a poor outcome. CONCLUSION In children with central nervous system neoplasia who have undergone cranial irradiation, or radiation combined with chemotherapy, delayed intracranial hemorrhage may develop.
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Affiliation(s)
- T Y Poussaint
- Department of Radiology, Children's Hospital, Boston, MA 02115, USA
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Affiliation(s)
- V Chiang
- Department of Medicine, Children's Hospital, Boston, MA 02115, USA
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Appignani BA, Jaramillo D, Barnes PD, Poussaint TY. Dysraphic myelodysplasias associated with urogenital and anorectal anomalies: prevalence and types seen with MR imaging. AJR Am J Roentgenol 1994; 163:1199-203. [PMID: 7976901 DOI: 10.2214/ajr.163.5.7976901] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The purpose of this study was to determine by MR imaging the prevalence and types of dysraphic abnormalities of the spinal cord (i.e., myelodysplasias) associated with urogenital and anorectal malformations of childhood. MATERIALS AND METHODS Since 1987, 92 patients with imperforate anus complex, cloacal malformation, and cloacal exstrophy have had MR imaging as a screening examination for occult dysraphic myelodysplasia. The prevalence and types of myelodysplasia were determined for each group. RESULTS The prevalence of dysraphic myelodysplasia in each group of children was 17% (1/6) for low imperforate anus (ectopic anus), 34% (11/32) for high imperforate anus (with fistulization), 46% (19/41) for cloacal malformation, and 100% (13/13) for cloacal exstrophy. The most common abnormalities in each group were tethered cord with intradural or filar lipoma in imperforate anus; low-placed or dysplastic conus medullaris and tethered cord with lipoma or myelolipoma in cloacal malformation; and lipomyelocele, lipomyelomeningocele, or lipomyelocystocele in cloacal exstrophy. CONCLUSION Our results show that the prevalence of myelodysplasia as seen on MR imaging is high in patients with urogenital and anorectal anomalies.
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Affiliation(s)
- B A Appignani
- Department of Radiology, Children's Hospital, Boston, MA 02115
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Barnes PD, Poussaint TY, Burrows PE. Imaging of pediatric central nervous system infections. Neuroimaging Clin N Am 1994; 4:367-91. [PMID: 7915944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- P D Barnes
- Department of Radiology, Children's Hospital, Boston, Massachusetts
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Strand RD, Barnes PD, Poussaint TY, Estroff JA, Burrows PE. Cystic retrocerebellar malformations: unification of the Dandy-Walker complex and the Blake's pouch cyst. Pediatr Radiol 1993; 23:258-60. [PMID: 8414749 DOI: 10.1007/bf02010910] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Twenty-six cases of developmental retrocerebellar cyst (RCC) formation are studied with respect to determining the usefulness and anatomic relevance of separate terms currently in use, including Dandy-Walker complex, Dandy-Walker malformation, Dandy-Walker variant, mega-cisterna magna (MCM), and Blake's pouch cyst. An anatomic and embryological continuum between Dandy-Walker complex and Blake's pouch cyst is proposed. A method for the useful assessment of RCC is outlined. The patency or closure of the aqueduct is crucial to the evaluation and management of hydrocephalus associated with RCC formation.
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Affiliation(s)
- R D Strand
- Department of Radiology, Children's Hospital, Boston, MA 02115
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