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Paediatric intra-axial posterior fossa tumours: pictorial review
Darshana D Rasalkar1, Winnie Chiu-Wing Chu, Bhawan K Paunipagar
1Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing St, Shatin, New Territories, Hong Kong.
Insights
Diagnosing paediatric brain tumours in the posterior cranial fossa is challenging. Magnetic resonance (MR) imaging features, including diffusion-weighted imaging, help differentiate tumour types and grades for improved prognosis.
Area of Science:
- Neuroradiology
- Paediatric Oncology
- Neuro-oncology
Background:
- Paediatric brain tumours frequently occur in the posterior cranial fossa.
- Early diagnosis is difficult due to non-specific symptoms, particularly in infants.
- Common tumours include medulloblastoma, ependymoma, astrocytoma, glioma, and teratoid-rhabdoid tumour.
Purpose of the Study:
- To illustrate typical Magnetic Resonance (MR) features of posterior cranial fossa tumours in children.
- To highlight the utility of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values in tumour characterization.
- To introduce a practical MR-based diagnostic flowchart for differentiating these tumours.
Main Methods:
- Review of MR imaging characteristics of various posterior cranial fossa tumours.
- Correlation of signal intensities on conventional MR sequences with DWI and ADC values.
- Development of a diagnostic algorithm based on imaging findings.
Main Results:
- Specific MR signal patterns and ADC values aid in distinguishing between different tumour types.
- Low-grade and high-grade tumours show discernible differences on DWI and ADC maps.
- The proposed flowchart effectively differentiates common posterior cranial fossa paediatric tumours.
Conclusions:
- MR imaging, especially with DWI and ADC analysis, is crucial for the early and accurate diagnosis of paediatric posterior cranial fossa tumours.
- Timely diagnosis facilitates surgical planning and improves patient outcomes.
- The MR flowchart provides a valuable tool for clinicians in managing these complex cases.
Abstract:
Paediatric brain tumours commonly arise in the posterior cranial fossa. Early diagnosis is often challenging due to initial non-specific clinical symptoms, especially in very young children. The typical MR features of tumours in this region including medulloblastoma, ependymoma, juvenile pilocytic subtype of cerebellar astrocytoma, brain stem glioma and atypical teratoid-rhabdoid tumour are illustrated. Diffusion-weighted imaging and apparent diffusion coefficient values combined with signal characteristics on conventional MR sequences can usually differentiate low-grade from high-grade tumours. Prompt diagnosis is crucial as total surgical resection, which is only possible in localised disease, improves prognosis. A practical MR flow chart is introduced for differentiating different types of posterior cranial fossa tumours, which might be useful in clinical practice.
