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Imaging features to distinguish posterior fossa ependymoma subgroups
Thomas Leclerc1,2,3, Raphael Levy1,2,3, Arnault Tauziède-Espariat4
1Pediatric Radiology Department, Assistance-Publique Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France.
European Radiology
|September 2, 2023
Summary
Posterior fossa ependymoma subtypes (EPN_PFA and EPN_PFB) exhibit distinct MRI features. These imaging differences can aid in preoperative differentiation, guiding tailored therapeutic strategies for improved patient outcomes.
Area of Science:
- Neuroradiology
- Pediatric Oncology
- Molecular Pathology
Background:
- Posterior fossa ependymomas (PFAs) are classified into molecular groups A (EPN_PFA) and B (EPN_PFB), which have different prognoses.
- Distinguishing between EPN_PFA and EPN_PFB preoperatively is crucial for adapting treatment strategies.
Purpose of the Study:
- To compare the MRI characteristics of EPN_PFA and EPN_PFB.
- To identify imaging features that can differentiate between these two PFA subtypes.
Main Methods:
- Retrospective review of preoperative MRI scans from 68 patients with posterior fossa ependymoma.
- Three blinded readers assessed tumor location, extension, volume, hydrocephalus, calcifications, tissue component, and enhancement patterns.
- Histopathological data were correlated with imaging findings.
- Statistical analysis included Fisher's exact tests and Mann-Whitney tests with Benjamini-Hochberg correction.
Main Results:
- EPN_PFA (n=56) occurred in younger children (median age 2) compared to EPN_PFB (n=12, median age 20).
- EPN_PFA showed larger tumor volume, more pronounced hydrocephalus, frequent intratumoral calcifications, and invasion of posterior fossa foramina.
- EPN_PFB were predominantly cystic, non-calcified, and showed total, homogeneous enhancement, typically in adolescents and adults.
- Relative ADC values were slightly lower in EPN_PFA.
Conclusions:
- MRI characteristics significantly differ between EPN_PFA and EPN_PFB.
- Imaging features can assist in the preoperative distinction of posterior fossa ependymoma subtypes.
- This differentiation facilitates early adaptation of therapeutic strategies.
