Oncotarget

Research Papers:

Added value of diffusion weighted imaging in pediatric central nervous system embryonal tumors surveillance

Giovanni Morana _, Cesar Augusto Alves, Domenico Tortora, Mariasavina Severino, Paolo Nozza, Armando Cama, Marcello Ravegnani, Gabriella D’Apolito, Alessandro Raso, Claudia Milanaccio, Claudia da Costa Leite, Maria Luisa Garrè and Andrea Rossi

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Oncotarget. 2017; 8:60401-60413. https://doi.org/10.18632/oncotarget.19553

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Abstract

Giovanni Morana1,*, Cesar Augusto Alves1,2,*, Domenico Tortora1, Mariasavina Severino1, Paolo Nozza3, Armando Cama4, Marcello Ravegnani4, Gabriella D’Apolito5, Alessandro Raso4, Claudia Milanaccio6, Claudia da Costa Leite2, Maria Luisa Garrè6 and Andrea Rossi1

1Neuroradiology Unit, Istituto Giannina Gaslini, Genova, Italy

2Radiology Institute, Hospital das Clinicas, Sao Paulo, Brazil

3Pathology Unit, Istituto Giannina Gaslini, Genova, Italy

4Neurosurgery Unit, Istituto Giannina Gaslini, Genova, Italy

5Neuroradiology Unit, Ospedale M. Bufalini, Cesena, Italy

6Neuro-Oncology Unit, Istituto Giannina Gaslini, Genova, Italy

*co-first authorship

Correspondence to:

Giovanni Morana, email: [email protected]

Keywords: DWI, CNS embryonal tumors, medulloblastoma, ATRT, relapse

Received: February 17, 2017    Accepted: June 16, 2017    Published: July 25, 2017

ABSTRACT

Diffusion weighted imaging (DWI) has an established role in primary CNS embryonal tumor (ET) characterization; however, its diagnostic utility in detecting relapse has never been determined. We aimed to compare DWI and conventional MRI sensitivity in CNS ET recurrence detection, and to evaluate the DWI properties of contrast-enhancing radiation induced lesions (RIL).

Fifty-six patients with CNS ET (25 with disease relapse, 6 with RIL and 25 with neither disease relapse nor RIL) were retrospectively evaluated with DWI, conventional MRI (including both T2/FLAIR and post-contrast images), or contrast-enhanced MR imaging (CE-MRI) alone. MRI studies were independently reviewed by two neuroradiologists for detection and localization of potential brain relapses. Sensitivity for focal relapse detection was calculated for each image set on a lesion-by-lesion basis. A descriptive per subject analysis was also performed. Evaluation of follow-up MRI studies served as standard of reference.

Focal recurrence detection sensitivity of DWI (96%) was significantly higher than conventional MRI (77%) and CE-MRI alone (51%) (p=0.0003 and p<0.0001). On per subject analysis there were not missed diagnoses for DWI. At the time of DWI relapse detection, conventional MRI missed 2 diagnoses, and CE-MRI 8. Analysis of medulloblastoma relapses revealed that DWI identified a higher number of focal lesions than CE-MRI in subjects with classic variant. All but one RIL did not show restricted diffusion.

In conclusion, DWI is a valuable complementary technique allowing for improved detection of focal relapse in CNS ET patients, particularly in children with classic medulloblastoma, and may assist in differentiating recurrence from RIL.


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