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Assessment of Cerebral Lateralization in Children using Functional Transcranial Doppler Ultrasound fTCD
Published on: September 27, 2010
Reliability of Imaging-Based Diagnosis of Lateral Ventricular Masses in Children
Sanjeev Kumar Pandey1, Sunithi Elizabeth Mani2, Sniya Valsa Sudhakar2
1Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
Insights
Radiologists accurately diagnosed benign pediatric lateral ventricular tumors but struggled with malignant ones. Interobserver variability was noted, highlighting challenges in imaging diagnosis for these rare pediatric brain tumors.
Area of Science:
- Pediatric Radiology
- Neuroradiology
- Pediatric Neuro-oncology
Background:
- Lateral ventricular masses in children represent a diverse group of pathologies.
- Accurate radiologic diagnosis is crucial for guiding treatment and prognosis in pediatric patients.
Purpose of the Study:
- To evaluate the diagnostic accuracy of radiologic imaging for lateral ventricular masses in children.
- To identify specific tumor types that are challenging to diagnose pre-operatively.
Main Methods:
- Retrospective analysis of 43 pediatric patients (8 months to 20 years) with lateral ventricular masses.
- Review of Magnetic Resonance Imaging (MRI) and contrast-enhanced Computed Tomography (CT) scans by three blinded radiologists.
- Calculation of inter-radiologist agreement using the Fleiss κ statistic.
Main Results:
- The study identified common pathologies including subependymal giant cell astrocytoma (SEGA), low-grade astrocytoma, and choroid plexus papilloma.
- Radiologic diagnosis achieved an overall accuracy of 94.2%, with high accuracy for benign tumors (e.g., SEGA, low-grade gliomas).
- Malignant tumors (e.g., high-grade gliomas, choroid plexus carcinomas) and cavernous angiomas were difficult to diagnose accurately, and inter-radiologist agreement was only fair (κ = 0.24).
Conclusions:
- The radiologic diagnosis of pediatric lateral ventricular masses is accurate for benign entities but challenging for malignant neoplasms.
- Significant interobserver variability exists in the interpretation of these imaging studies.
- Further refinement of imaging criteria and potentially advanced techniques may improve diagnostic accuracy for difficult-to-diagnose pediatric brain tumors.
Objective:
We studied the accuracy of the radiologic diagnosis of lateral ventricular masses in children (<20 years of age).
Methods:
In this retrospective study, data were collected from children with lateral ventricular masses managed in our unit between 2001 and 2016. There were 43 patients (26 boys and 17 girls; mean age, 12.1 years; range, 8 months to 20 years). Magnetic resonance imaging was available for 36 patients, whereas in 7 patients only a contrast-enhanced computed tomography scan was available. The images were read independently by 3 radiologists, who were blinded to the pathology. Two differential diagnoses were offered for each patient. The agreement between the 3 radiologists was calculated using the Fleiss κ statistic.
Results:
The common pathologic diagnoses were subependymal giant cell astrocytoma (SEGA) (20.9%), low-grade astrocytoma (16.3%), high-grade astrocytoma (9.3%), choroid plexus papilloma (9.3%), and meningioma (9.3%). The sensitivity, specificity, and accuracy of the radiologic diagnoses were 62%, 96.7%, and 94.2%, respectively. Low-grade tumors such as low-grade gliomas, SEGAs, choroid plexus papillomas, and meningiomas were diagnosed with a high level of accuracy. High-grade gliomas, choroid plexus carcinomas, and other malignant neoplasms were difficult to diagnose on imaging. Cavernous angiomas were also difficult to diagnose. There was only fair agreement between the 3 radiologists (Fleiss κ = 0.24).
Conclusions:
The pathologic spectrum of lateral ventricular tumors in children is wide, and identifying the pathology on imaging is difficult for malignant tumors. Benign tumors such as SEGAs, low-grade astrocytomas, and choroid plexus papillomas are relatively easier to diagnose. There is significant interobserver variability in the radiologic diagnosis of these tumors.
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