Skip to main content
Log in

Applicability of apparent diffusion coefficient ratios in preoperative diagnosis of common pediatric cerebellar tumors across two institutions

  • Paediatric Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

The purpose of our study was to test the accuracy and applicability of decision rules utilizing apparent diffusion coefficient (ADC) ratios on accurate preoperative diagnosis of common pediatric cerebellar tumors across two institutions.

Methods

In this HIPAA-compliant, IRB-approved study, performed at two institutions, 140 pediatric cerebellar tumors were included. Two separate reviewers placed regions of interest on the solid components of 140 tumors (98 at site A and 42 at site B) and normal brain on the ADC maps. The third reviewer who was blinded to the histopathological diagnoses made the same measurements on 140 patients to validate the data. Tumor to normal brain ADC ratios were calculated. Receiver operator curve (ROC) analysis was performed to generate thresholds to discriminate tumors. Utility of decision rules based on these thresholds was tested.

Results

While ADC values of medulloblastomas were different between the sites, there was no difference among the ADC ratios of medulloblastomas, pilocytic astrocytomas, ependymomas, and atypical teratoid rhabdoid tumors between the sites. ADC ratio of ≥1.8 correctly discriminated pilocytic astrocytomas from ependymomas with a sensitivity of 0.83 and a specificity of 0.78. ADC ratio of <1.2 correctly discriminated ependymomas from embryonal tumors with a sensitivity of 0.87 and a specificity of 0.83. The proposed decision rules correctly discriminated 120 of the 140 tumors (85.71 %). Age ≥2 years criterion correctly sorted medulloblastomas in 84.48 % of patients and age <2 years correctly distinguished atypical teratoid rhabdoid tumors in 90.00 % of patients with embryonal tumors.

Conclusions

Decision rules based on ADC ratios are applicable across two institutions in the accurate preoperative diagnosis of common pediatric cerebellar tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Dolecek TA, Propp JM, Stroup NE, Kruchko C (2012) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2005-2009. Neuro Oncol 14(Suppl 5):v1–v49. doi:10.1093/neuonc/nos218

    Article  PubMed Central  PubMed  Google Scholar 

  2. Harwood-Nash DC (1991) Primary neoplasms of the central nervous system in children. Cancer 67(4 Suppl):1223–1228

    Article  CAS  PubMed  Google Scholar 

  3. Gimi B, Cederberg K, Derinkuyu B, Gargan L, Koral KM, Bowers DC, Koral K (2012) Utility of apparent diffusion coefficient ratios in distinguishing common pediatric cerebellar tumors. Acad Radiol 19(7):794–800. doi:10.1016/j.acra.2012.03.004

    Article  PubMed  Google Scholar 

  4. Jaremko JL, Jans LB, Coleman LT, Ditchfield MR (2010) Value and limitations of diffusion-weighted imaging in grading and diagnosis of pediatric posterior fossa tumors. AJNR Am J Neuroradiol 31(9):1613–1616. doi:10.3174/ajnr.A2155

    Article  CAS  PubMed  Google Scholar 

  5. Rumboldt Z, Camacho DL, Lake D, Welsh CT, Castillo M (2006) Apparent diffusion coefficients for differentiation of cerebellar tumors in children. AJNR Am J Neuroradiol 27(6):1362–1369

    CAS  PubMed  Google Scholar 

  6. Gauvain KM, McKinstry RC, Mukherjee P, Perry A, Neil JJ, Kaufman BA, Hayashi RJ (2001) Evaluating pediatric brain tumor cellularity with diffusion-tensor imaging. AJR Am J Roentgenol 177(2):449–454

    Article  CAS  PubMed  Google Scholar 

  7. Koral K, Mathis D, Gimi B, Gargan L, Weprin B, Bowers DC, Margraf L (2013) Common pediatric cerebellar tumors: correlation between cell densities and apparent diffusion coefficient metrics. Radiology 268(2):532–537. doi:10.1148/radiol.13121362

    Article  PubMed  Google Scholar 

  8. Yamashita Y, Kumabe T, Higano S, Watanabe M, Tominaga T (2009) Minimum apparent diffusion coefficient is significantly correlated with cellularity in medulloblastomas. Neurol Res 31(9):940–946. doi:10.1179/174313209X382520

    Article  PubMed  Google Scholar 

  9. Jin B, Feng XY (2013) MRI features of atypical teratoid/rhabdoid tumors in children. Pediatr Radiol 43(8):1001–1008. doi:10.1007/s00247-013-2646-9

    Article  PubMed  Google Scholar 

  10. Koral K, Gargan L, Bowers DC, Gimi B, Timmons CF, Weprin B, Rollins NK (2008) Imaging characteristics of atypical teratoid-rhabdoid tumor in children compared with medulloblastoma. AJR Am J Roentgenol 190(3):809–814. doi:10.2214/AJR.07.3069

    Article  PubMed  Google Scholar 

  11. Meyers SP, Khademian ZP, Biegel JA, Chuang SH, Korones DN, Zimmerman RA (2006) Primary intracranial atypical teratoid/rhabdoid tumors of infancy and childhood: MRI features and patient outcomes. AJNR Am J Neuroradiol 27(5):962–971

    CAS  PubMed  Google Scholar 

  12. Warmuth-Metz M, Bison B, Dannemann-Stern E, Kortmann R, Rutkowski S, Pietsch T (2008) CT and MR imaging in atypical teratoid/rhabdoid tumors of the central nervous system. Neuroradiology 50(5):447–452. doi:10.1007/s00234-008-0369-7

    Article  PubMed  Google Scholar 

  13. Giangaspero F, Eberhart CG, Haapasalo H, Pietsch T, Wiestler OD, Ellison DW (2007) Medulloblastoma. In: Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (eds) WHO classification of tumours of the central nervous system, 4th edn. IACR, Lyon, pp 132–140

    Google Scholar 

  14. Judkins AR, Eberhart CG, Wesseling P (2007) Atypical teratoid/rhabdoid tumor. In: Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (eds) WHO classification of tumours of the central nervous system, 4th edn. IACR, Lyon, pp 147–149

    Google Scholar 

  15. Scheithauer BW, Hawkins C, Tihan T, VandenBerg SR, Burger PC (2007) Pilocytic astrocytoma. In: Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (eds) WHO classification of tumours of the central nervous system. IACR, Lyon, pp 14–21

    Google Scholar 

  16. McLendon RE, Wiestler OD, Kros JM, Korshunov A, Ng H-K (2007) Ependymoma. In: Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (eds) WHO classification of tumours of the central nervous system, 4th edn. IACR, Lyon, pp 74–78

    Google Scholar 

  17. Sasaki M, Yamada K, Watanabe Y, Matsui M, Ida M, Fujiwara S, Shibata E (2008) Variability in absolute apparent diffusion coefficient values across different platforms may be substantial: a multivendor, multi-institutional comparison study. Radiology 249(2):624–630. doi:10.1148/radiol.2492071681

    Article  PubMed  Google Scholar 

  18. Malyarenko D, Galban CJ, Londy FJ, Meyer CR, Johnson TD, Rehemtulla A, Ross BD, Chenevert TL (2013) Multi-system repeatability and reproducibility of apparent diffusion coefficient measurement using an ice-water phantom. J Magn Reson Imaging 37(5):1238–1246. doi:10.1002/jmri.23825

    Article  PubMed Central  PubMed  Google Scholar 

  19. Taylor MD, Northcott PA, Korshunov A, Remke M, Cho YJ, Clifford SC, Eberhart CG, Parsons DW, Rutkowski S, Gajjar A, Ellison DW, Lichter P, Gilbertson RJ, Pomeroy SL, Kool M, Pfister SM (2012) Molecular subgroups of medulloblastoma: the current consensus. Acta Neuropathol 123(4):465–472. doi:10.1007/s00401-011-0922-z

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Northcott PA, Korshunov A, Witt H, Hielscher T, Eberhart CG, Mack S, Bouffet E, Clifford SC, Hawkins CE, French P, Rutka JT, Pfister S, Taylor MD (2011) Medulloblastoma comprises four distinct molecular variants. J Clin Oncol 29(11):1408–1414. doi:10.1200/JCO.2009.27.4324

    Article  PubMed  Google Scholar 

  21. Yeom KW, Mobley BC, Lober RM, Andre JB, Partap S, Vogel H, Barnes PD (2013) Distinctive MRI features of pediatric medulloblastoma subtypes. AJR Am J Roentgenol 200(4):895–903. doi:10.2214/AJR.12.9249

    Article  PubMed  Google Scholar 

  22. Fruehwald-Pallamar J, Puchner SB, Rossi A, Garre ML, Cama A, Koelblinger C, Osborn AG, Thurnher MM (2011) Magnetic resonance imaging spectrum of medulloblastoma. Neuroradiology 53(6):387–396. doi:10.1007/s00234-010-0829-8

    Article  PubMed  Google Scholar 

  23. De Amorim Bernstein K, Sethi R, Trofimov A, Zeng C, Fullerton B, Yeap BY, Ebb D, Tarbell NJ, Yock TI, MacDonald SM (2013) Early clinical outcomes using proton radiation for children with central nervous system atypical teratoid rhabdoid tumors. Int J Radiat Oncol Biol Phys 86(1):114–120. doi:10.1016/j.ijrobp.2012.12.004

    Article  PubMed  Google Scholar 

  24. Koral K, Zhang S, Gargan L, Moore W, Garvey B, Fiesta M, Seymour M, Yang L, Scott D, Choudhury N (2013) Diffusion MRI improves the accuracy of preoperative diagnosis of common pediatric cerebellar tumors among reviewers with different experience levels. AJNR Am J Neuroradiol 34(12):2360–2365. doi:10.3174/ajnr.A3596

    Article  CAS  PubMed  Google Scholar 

  25. Rodriguez Gutierrez D, Awwad A, Meijer L, Manita M, Jaspan T, Dineen RA, Grundy RG, Auer DP (2013) Metrics and textural features of MRI diffusion to improve classification of pediatric posterior fossa tumors. AJNR Am J Neuroradiol. doi:10.3174/ajnr.A3784

    PubMed  Google Scholar 

Download references

Ethical standards and patient consent

We declare that all human and animal studies have been approved by the Institutional Review Boards of the University of Texas Southwestern Medical Center and The Johns Hopkins University and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. This study was compliant with Health Insurance Portability and Accountability Act. Patient consent was waived for this retrospective study based on chart review.

Conflict of interest

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Korgün Koral.

Additional information

A preliminary form of this work was presented at the 99th Scientific Assembly and Annual Meeting of RSNA, 2013.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koral, K., Alford, R., Choudhury, N. et al. Applicability of apparent diffusion coefficient ratios in preoperative diagnosis of common pediatric cerebellar tumors across two institutions. Neuroradiology 56, 781–788 (2014). https://doi.org/10.1007/s00234-014-1398-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-014-1398-z

Keywords

Navigation