Choroid Plexus Neoplasms: Toward a Distinction between Carcinoma and Papilloma Using Arterial Spin-Labeling

Area of Science:

• Neuro-oncology
• Pediatric Radiology
• Medical Imaging

Background:

• Pediatric choroid plexus papillomas and carcinomas are highly vascularized brain tumors.
• Distinguishing between these neoplasms using conventional imaging is challenging.
• Perfusion-weighted imaging (PWI) offers potential for improved diagnostic accuracy.

Purpose of the Study:

• To evaluate the diagnostic accuracy of PWI in differentiating pediatric choroid plexus papillomas and carcinomas.
• To compare the efficacy of pseudocontinuous arterial spin-labeling (ASL) and dynamic susceptibility contrast-PWI (DSC-PWI).

Main Methods:

• Retrospective review of PWI data from 13 children with choroid plexus neoplasms (7 papillomas, 6 carcinomas).
• Quantification of cerebral blood flow (CBF), relative CBF, and relative cerebral blood volume (rCBV) in lesions.
• Comparison of perfusion parameters between papillomas and carcinomas using both ASL and DSC-PWI.

Main Results:

• Arterial spin-labeling demonstrated significantly higher relative CBF values in carcinomas compared to papillomas (P = .028).
• Median relative CBF was 1.7 for carcinomas versus 0.4 for papillomas.
• While CBF values showed a trend (P = .056), DSC-PWI measures were more variable and not significantly different (P = .393).

Conclusions:

• Arterial spin-labeling is a promising non-invasive technique for differentiating pediatric choroid plexus carcinomas from papillomas.
• ASL-derived relative CBF appears to be a key differentiating parameter.
• DSC-PWI was less effective in distinguishing between these tumor types in this cohort.