Article
The suitability of ADC-mapping to differentiate between recurrent tumor and radiation necrosis in malignant pediatric brain tumors
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Authors
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Sevgi Sarikaya-Seiwert
- Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf, Germany
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Thomas Beez
- Paediatric Neurosurgery, Royal Hospital for Children, Glasgow, United Kingdom
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Gisela Janßen
- Klinik für Kinderonkologie, -Hämatologie und Klinische Immunologie, Heinrich-Heine-Universität, Düsseldorf, Germany
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Jörg Schaper
- Institut für diagnostische und interventionelle Radiologie, Düsseldorf, Germany
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Hans-Jakob Steiger
- Institut für diagnostische und interventionelle Radiologie, Düsseldorf, Germany
| Published: | June 8, 2016 |
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Outline
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Objective: Malignant brain tumors in children may show recurrence after initial gross total resection and adjuvant treatment. To differentiate recurrent tumor from changes due to radio- and chemotherapy gadolinium enhanced MRI sequences are generally used. These sequences cannot conclusively differentiate between both situations. It is known that diffusion weighted images (DWI) with apparent diffusion coefficient mapping (ADC) may distinguish between benign and malignant tumor tissue in children. The goal of this study was to evaluate the role of ADC-mapping to differentiate recurrent tumor tissue from radiation necrosis.
Method: We retrospectively reviewed all patients identified with a recurrent malignant brain tumor after initial treatment who presented during 2008 to 2015 in our department. MRI imaging, clinical presentation, operative procedures and pathology were analyzed. For ADC-mapping of the MRI scans the examiner was blinded to patient’s data. In all cases at least two ROI were assigned. ADC-values between 600 and 800 were defined as malignant tumor and ADC-values between 1000 and 1200 as benign changes.
Results: Of the 21 patients (11male, 10 female) identified 17 (81%) had diffusion weighted images (DWI) with ADC-mapping. The most common tumor location was in the posterior fossa and in the parietal region (10 versus 7 cases) retrospectively. In 15 cases the mean ADC-value was 759 (group A). The mean ADC-value of the remaining two cases was 1090 (group B). 16 patients underwent second surgery. The histology of group A showed malignant tumor tissue whereas group B showed radiation necrosis (p<0.05).
Conclusions: This analysis demonstrates that ADC-mapping may distinguish between recurrent malignant brain tumor and radiation necrosis in the pediatric population. As it is non-invasive this method may help in decision-making whether surgery is indicated or not. Further data in a larger prospective cohort is needed.
