Apparent Diffusion Coefficients for Differentiation of Cerebellar Tumors in Children
Z. Rumboldta,
D.L.A. Camachoc,
D. Lakea,
C.T. Welshb and
M. Castilloc
a Departments of Radiology, Medical University of South Carolina, Charleston, SC
b Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
c Department of Radiology, University of North Carolina, Chapel Hill, NC
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Fig 1. Scatter diagram of average ADC tumor values for all pilocytic astrocytomas (JPA), ependymomas (Epend) and medulloblastomas (Medullo) (open circles) along with their respective mean (full circles) and standard deviation (bars) values. ADC values are expressed in 10–3 mm2/s.
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Fig 2. Eleven-year-old boy with cerebellar juvenile pilocytic astrocytoma (JPA) (patient 4).
A, Axial T2-weighted image at the level of middle cerebellar peduncles shows slightly heterogeneous, predominantly hyperintense midline mass without significant surrounding edema. There is associated effacement of the fourth ventricle.
B, Contrast-enhanced T1-weighted image at same levels as A demonstrates strong, slightly heterogeneous enhancement of the tumor.
C, Apparent diffusion coefficient (ADC) map corresponding to A and B reveals that lesion is very hyperintense compared with normal brain parenchyma, representing increased diffusion of water.
D, Photomicrograph shows area of pilocytic astrocytoma with denser stroma and numerous Rosenthal fibers (arrows) (hematoxylin-eosin stain, 20x).
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Fig 3. Sixteen-year-old boy with cerebellar medulloblastoma (patient 23).
A, Axial T2-weighted image at level of medulla oblongata shows heterogeneous mass in left paramedian location that is predominantly hyperintense. There is surrounding edema and compression of fourth ventricle.
B, Contrast-enhanced T1-weighted image corresponding to A demonstrates avid, slightly heterogeneous, enhancement of tumor.
C, ADC map corresponding to A and B reveals that mass is hypointense to normal cerebellar parenchyma, consistent with decreased diffusion. Hyperintense ring surrounding tumor (arrowhead) represents increased diffusion of vasogenic edema.
D, Photomicrograph shows densely packed nuclei in medulloblastoma with scattered apoptosis and mitoses (arrows). Some nuclei show prominent nucleoli (arrowheads) (hematoxylin-eosin stain, 40x).
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Fig 4. Fifteen-year-old girl with cerebellar JPA (patient 5). ADC map in axial plane at level of middle cerebellar peduncles shows well defined, oval mass in right paramedian location with increased diffusion.
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Fig 5. 22-year-old woman with desmoplastic cerebellar medulloblastoma (patient 25). Axial ADC map at level of middle cerebellar peduncles reveals lesion of decreased diffusion in left cerebellar hemisphere. No significant surrounding edema is seen.
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Fig 6. 15-month-old boy with atypical teratoid/rhabdoid tumor (AT/RT) (Patient 32).
A, Axial T2-weighted image at level of middle cerebellar peduncles shows a large heterogeneous mass of predominantly low to isointense signal intensity that is almost completely effacing the fourth ventricle. The temporal horns of the lateral ventricles are dilated with signs of transependymal CSF flow (arrowheads), consistent with obstructive hydrocephalus.
B, Contrast-enhanced T1-weighted image with fat saturation corresponding to A shows heterogeneous enhancement of the tumor. A nonenhancing cystic area (arrow) is also seen that is likely to correspond to trapped CSF adjacent to the tumor.
C, ADC at a similar level as A and B reveals that the lesion is of lower diffusion than the normal brain parenchyma. The lateral cystic area shows diffusion properties of CSF.
D, Photomicrograph of AT/RT shows high cellularity and cytoplasmic pink densities (arrows) (hematoxylin-eosin stain, 40x).
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Fig 7. Sixteen-year-old boy with ependymoma (patient 19).
A, Axial T2-weighted image at level of middle cerebellar peduncles shows a very heterogeneous abnormality (arrows) within the fourth ventricle.
B, Corresponding contrast-enhanced T1-weighted image demonstrates enhancement of the solid portion of this mass (arrows).
C, ADC map at a level similar to that of A and B shows that diffusion within the solid portion of the tumor (arrows) is slightly higher compared with normal cerebellum.
D, Photomicrograph of ependymoma shows moderate cellularity with perivascular pseudorosettes (arrows) (hematoxylin-eosin stain, 10x).
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