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A case-control study of MRI features in pediatric atypical teratoid rhabdoid tumor and medulloblastoma
Zhiming Yang1, YaLi Yue1, Feixiao Wu2
1Department of Radiology, Children's Hospital, Fudan University, Shanghai, China.
Background:
Compared to medulloblastoma (MB), atypical teratoid rhabdoid tumor (AT/RT) is characterized by a lower incidence, younger age at onset, and a poorer prognosis. Preoperative clinical and neuroimaging differentiation between these tumors remains challenging. This study aimed to evaluate the diagnostic utility of conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in distinguishing AT/RT from MB in children.
Methods:
We retrospectively included 32 patients with AT/RT and 82 patients with MB confirmed by surgery and pathology in our hospital between 2010 and 2023. We analyzed the clinical data, preoperative MRI characteristics, and apparent diffusion coefficient (ADC) values of these patients to evaluate their diagnostic value.
Results:
The overall survival time of AT/RT patients was significantly shorter than that of MB patients (P < 0.001), with a higher mortality rate (81.4% vs. 35.5%, P = 0.007). Significant differences were found between AT/RT and MB in T2WI signal, off-midline growth, supratentorial ventriculomegaly, cystic degeneration, hemorrhage, peritumoral edema, tumor boundary clarity, and metastasis/dissemination (P < 0.05). No significant differences were observed in gender, age, lesion size, T1WI signal, or enhancement pattern (P > 0.05). The mean ADC value differed significantly between the two groups (P < 0.001), with an optimal cut-off value of 0.622 × 10⁻3 mm2/s.
Conclusion:
MRI features, including more cystic degeneration, hemorrhage, supratentorial ventriculomegaly, and peritumoral edema, combined with a lower ADC value may provide reliable information to differentiate AT/RT from MB in children.
Insights
Differentiating pediatric brain tumors like atypical teratoid rhabdoid tumors (AT/RT) from medulloblastoma (MB) is crucial. MRI features and lower apparent diffusion coefficient (ADC) values can help distinguish AT/RT from MB in children.
Area of Science:
- Pediatric neuro-oncology
- Neuroradiology
- Oncologic imaging
Background:
- Atypical teratoid rhabdoid tumor (AT/RT) and medulloblastoma (MB) are pediatric brain tumors with distinct prognoses.
- Preoperative differentiation between AT/RT and MB using clinical and neuroimaging data is challenging.
- This study evaluates the diagnostic utility of magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) for distinguishing these tumors in children.
Purpose of the Study:
- To assess the effectiveness of conventional MRI and DWI in differentiating pediatric AT/RT from MB.
- To identify key imaging features and apparent diffusion coefficient (ADC) values that distinguish between AT/RT and MB.
Main Methods:
- Retrospective analysis of 32 AT/RT and 82 MB cases diagnosed between 2010 and 2023.
- Evaluation of clinical data, preoperative MRI characteristics (T1WI, T2WI, enhancement), and ADC values.
- Statistical analysis to determine significant differences and diagnostic utility.
Main Results:
- AT/RT patients exhibited significantly shorter overall survival and higher mortality rates compared to MB patients.
- Significant MRI differences included T2WI signal, tumor location (off-midline), ventriculomegaly, cystic degeneration, hemorrhage, edema, and boundary clarity.
- Mean ADC values were significantly lower in AT/RT than in MB, with an optimal cutoff of 0.622 × 10⁻³ mm²/s.
Conclusions:
- Specific MRI findings such as cystic degeneration, hemorrhage, supratentorial ventriculomegaly, and peritumoral edema are indicative of AT/RT.
- Lower ADC values, in conjunction with these MRI features, can reliably differentiate AT/RT from MB in pediatric patients.
- Improved preoperative differentiation can guide treatment strategies and improve outcomes for children with these brain tumors.
