Neuroimaging in pediatric brain tumors: Gd-DTPA-enhanced, hemodynamic, and diffusion MR imaging compared with MR spectroscopic imaging
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Tzika, A. A.
Zarifi, M. K.
Goumnerova, L.
Astrakas, L. G.
Zurakowski, D.
Young-Poussaint, T.
Anthony, D. C.
Scott, R. M.
Black, P. M.
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peer-reviewed
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AJNR Am J Neuroradiol
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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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Adolescent, *Blood Volume, Brain Neoplasms/*diagnosis/*physiopathology, *Cerebrovascular Circulation, Child, Child, Preschool, Choline/metabolism, *Contrast Media, Diffusion, Disease Progression, Gadolinium DTPA/*diagnostic use, Humans, Infant, Lipid Metabolism, Magnetic Resonance Imaging/*methods, Magnetic Resonance Spectroscopy/*diagnostic use, Neoplasm Recurrence, Local/diagnosis, Neoplasm, Residual/diagnosis
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http://www.ncbi.nlm.nih.gov/pubmed/11847064
http://www.ajnr.org/content/23/2/322.full.pdf
http://www.ajnr.org/content/23/2/322.full.pdf
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en
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Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής