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Recurrent medulloblastoma: frequency of tumor enhancement on Gd-DTPA MR imaging
N Rollins1, D Mendelsohn, A Mulne
1Department of Radiology, Children's Medical Center, Dallas, TX 75235.
Abstract:
Thirty-two children with medulloblastoma were evaluated postoperatively with conventional and gadolinium-enhanced MR imaging. Eleven patients had abnormal cranial MR studies; nine of these had recurrent tumor. In six patients recurrent tumor enhanced with Gd, while in the other three patients recurrent tumor did not enhance. The remaining two patients had areas of abnormal Gd enhancement that were caused by radiation-induced breakdown of the blood-brain barrier rather than by recurrent tumor. This study shows that not all recurrent medulloblastoma enhances and that the absence of Gd enhancement does not necessarily indicate the absence of recurrent tumor.
Insights
Not all medulloblastoma recurrences show on MRI scans after gadolinium contrast. Absence of enhancement on MRI does not rule out tumor recurrence in children.
Area of Science:
- Pediatric Oncology
- Neuroradiology
- Medical Imaging
Background:
- Medulloblastoma is a common pediatric brain tumor.
- Postoperative MRI is crucial for monitoring tumor recurrence.
- Gadolinium enhancement is a common indicator of tumor recurrence.
Purpose of the Study:
- To evaluate the utility of conventional and gadolinium-enhanced MRI in detecting medulloblastoma recurrence postoperatively.
- To determine if all recurrent medulloblastoma enhances with gadolinium.
Main Methods:
- Conventional and gadolinium-enhanced MRI scans were performed on 32 children postoperatively.
- Abnormal findings were correlated with clinical outcomes and further investigations.
Main Results:
- Eleven patients had abnormal cranial MRI findings.
- Nine of these eleven patients had recurrent medulloblastoma.
- Six of the nine recurrent tumors enhanced with gadolinium; three did not.
- Two patients showed abnormal enhancement due to radiation effects, not tumor recurrence.
Conclusions:
- Gadolinium enhancement is not a universal finding in recurrent medulloblastoma.
- Absence of gadolinium enhancement on postoperative MRI does not exclude medulloblastoma recurrence.
- Careful interpretation of MRI findings is essential in the postoperative surveillance of pediatric medulloblastoma.