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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 23:322-333, February 2002
© 2002 American Society of Neuroradiology

PEDIATRICS

Neuroimaging in Pediatric Brain Tumors: Gd-DTPA–enhanced, Hemodynamic, and Diffusion MR Imaging Compared with MR Spectroscopic Imaging

A. Aria Tzika^a, Maria K. Zarifi^a, Liliana Goumnerova^b, Loukas G. Astrakas^a, David Zurakowski^d, Tina Young-Poussaint^a, Douglas C. Anthony^c, R. Michael Scott^b and Peter McL. Black^b

^a Department of Radiology, Children’s Hospital, Harvard Medical School, Boston, MA
^b Department of Neurosurgery, Children’s Hospital, Harvard Medical School, Boston, MA
^c Department of Pathology, Children’s Hospital, Harvard Medical School, Boston, MA
^d Department of Biostatistics, Children’s Hospital, Harvard Medical School, Boston, MA

Address reprint requests to A. Aria Tzika, PhD, Director of the NMR Surgical Laboratory, Massachusetts General Hospital, Harvard Medical School and Shriners Burns Institute, 51 Blossom Street, Room 261, Boston, MA 02114

BACKGROUND AND PURPOSE: Gadolinium-enhanced MR images assist in defining tumor borders; however, the relation between tumor cell extent and contrast-enhanced regions is unclear. Our aim was to improve conventional neuroimaging of pediatric brain tumors with hemodynamic, diffusion, and spectroscopic MR imaging.

METHODS: We performed conventional MR and MR spectroscopic imaging in 31 children with neuroglial brain tumors. Hemodynamic MR imaging was performed in 16 patients with a first-pass intravenous bolus of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA); apparent diffusion coefficients (ADCs) were measured in 12 patients. To account for multiple measurements in a patient, we used a nested analysis of variance.

RESULTS: At MR spectroscopy, choline (Cho)-containing compounds (indicating tumor) and lipid levels (indicating necrosis) did not correlate with percent Gd-DTPA enhancement on MR images. Percent enhancement was positively correlated with relative cerebral blood volumes (rCBVs) (P = .05) and negatively correlated with ADCs (P < .001). Stepwise multiple linear regression revealed that rCBV (P = .008), ADC (P = .022), and lipid (P < .001) levels were significant independent predictors of percent enhancement. Tumor spectral patterns were detected in tumor regions and outside enhancing tumor beds in patients with clinical progression; these were confirmed at neuropathologic analysis.

CONCLUSION: MR spectroscopic imaging improves the assessment of pediatric brain tumors by adding biochemical information regarding tumor involvement and by depicting residual or recurrent tumor outside the Gd-DTPA–enhanced tumor bed. rCBV and ADC mapping complemented MR spectroscopic imaging. We recommend the use of MR spectroscopic imaging in addition to conventional MR imaging in assessing pediatric brain tumors.

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