Mariam S Aboian1, Cassie N Kline2, Yi Li1, David A Solomon3, Erin Felton2, Anu Banerjee1,4, Steve E Braunstein5, Sabine Mueller2,4, William P Dillon1, Soonmee Cha1. 1. Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA. 2. Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California San Francisco, San Francisco CA. 3. Department of Pathology, University of California San Francisco, San Francisco CA. 4. Department of Neurological Surgery, University of California San Francisco, San Francisco CA. 5. Department of Radiation Oncology, University of California San Francisco, San Francisco CA.
Abstract
BACKGROUND: Imaging diagnosis of medulloblastoma recurrence relies heavily on identifying new contrast-enhancing lesions on surveillance imaging, with diffusion-weighted imaging (DWI) being used primarily for detection of complications. We propose that DWI is more sensitive in detecting distal and leptomeningeal recurrent medulloblastoma than T1-weighted postgadolinium imaging. METHODS: We identified 53 pediatric patients with medulloblastoma, 21 of whom developed definitive disease recurrence within the brain. MRI at diagnosis of recurrence and 6 months prior was evaluated for new lesions with reduced diffusion on DWI, contrast enhancement, size, and recurrence location. RESULTS: All recurrent medulloblastoma lesions demonstrated reduced diffusion. Apparent diffusion coefficient (ADC) measurements were statistically significantly lower (P = .00001) in recurrent lesions (mean=0.658, SD=0.072) as compared to contralateral normal region of interest (mean=0.923, SD=0.146). Sixteen patients (76.2%) with disease recurrence demonstrated contrast enhancement within the recurrent lesions. All 5 patients with nonenhancing recurrence demonstrated reduced diffusion, with a mean ADC of 0.695 ± 0.101 (normal=0.893 ± 0.100, P = .0027). While group 3 and group 4 molecular subtypes demonstrated distal recurrence more frequently, nonenhancing metastatic disease was found in all molecular subtypes. CONCLUSION: Recurrent medulloblastoma lesions do not uniformly demonstrate contrast enhancement on MRI, but all demonstrate reduced diffusion. Our findings support that DWI is more sensitive than contrast enhancement for detection of medulloblastoma recurrence, particularly in cases of leptomeningeal nonenhancing disease and distal nonenhancing focal disease. As such, recurrent medulloblastoma can present as a reduced diffusion lesion in a patient with normal postgadolinium contrast MRI.
BACKGROUND: Imaging diagnosis of medulloblastoma recurrence relies heavily on identifying new contrast-enhancing lesions on surveillance imaging, with diffusion-weighted imaging (DWI) being used primarily for detection of complications. We propose that DWI is more sensitive in detecting distal and leptomeningeal recurrent medulloblastoma than T1-weighted postgadolinium imaging. METHODS: We identified 53 pediatric patients with medulloblastoma, 21 of whom developed definitive disease recurrence within the brain. MRI at diagnosis of recurrence and 6 months prior was evaluated for new lesions with reduced diffusion on DWI, contrast enhancement, size, and recurrence location. RESULTS: All recurrent medulloblastoma lesions demonstrated reduced diffusion. Apparent diffusion coefficient (ADC) measurements were statistically significantly lower (P = .00001) in recurrent lesions (mean=0.658, SD=0.072) as compared to contralateral normal region of interest (mean=0.923, SD=0.146). Sixteen patients (76.2%) with disease recurrence demonstrated contrast enhancement within the recurrent lesions. All 5 patients with nonenhancing recurrence demonstrated reduced diffusion, with a mean ADC of 0.695 ± 0.101 (normal=0.893 ± 0.100, P = .0027). While group 3 and group 4 molecular subtypes demonstrated distal recurrence more frequently, nonenhancing metastatic disease was found in all molecular subtypes. CONCLUSION: Recurrent medulloblastoma lesions do not uniformly demonstrate contrast enhancement on MRI, but all demonstrate reduced diffusion. Our findings support that DWI is more sensitive than contrast enhancement for detection of medulloblastoma recurrence, particularly in cases of leptomeningeal nonenhancing disease and distal nonenhancing focal disease. As such, recurrent medulloblastoma can present as a reduced diffusion lesion in a patient with normal postgadolinium contrast MRI.
Authors: Roger J Packer; Amar Gajjar; Gilbert Vezina; Lucy Rorke-Adams; Peter C Burger; Patricia L Robertson; Lisa Bayer; Deborah LaFond; Bernadine R Donahue; MaryAnne H Marymont; Karin Muraszko; James Langston; Richard Sposto Journal: J Clin Oncol Date: 2006-09-01 Impact factor: 44.544
Authors: Kristen W Yeom; Bret C Mobley; Robert M Lober; Jalal B Andre; Sonia Partap; Hannes Vogel; Patrick D Barnes Journal: AJR Am J Roentgenol Date: 2013-04 Impact factor: 3.959
Authors: Gloria Roldán; Penny Brasher; Giacomo Vecil; Donna Senger; Barry Rewcastle; Gregory Cairncross; Peter Forsyth; Mark Hamilton Journal: Can J Neurol Sci Date: 2008-05 Impact factor: 2.104
Authors: C F Torres; S Rebsamen; J H Silber; L N Sutton; L T Bilaniuk; R A Zimmerman; J W Goldwein; P C Phillips; B J Lange Journal: N Engl J Med Date: 1994-03-31 Impact factor: 91.245
Authors: Marta Penas-Prado; Brett J Theeler; Brittany Cordeiro; Ira J Dunkel; Peter Hau; Anita Mahajan; Giles W Robinson; Nicole Willmarth; Orwa Aboud; Kenneth Aldape; John A Butman; Amar Gajjar; William Kelly; Ganesh Rao; Margarita Raygada; Christine Siegel; Carlos G Romo; Terri S Armstrong; Mark R Gilbert Journal: Neurooncol Adv Date: 2020-08-17