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Comparative Study
. 2015 Aug;17(8):1157-65.
doi: 10.1093/neuonc/nov063. Epub 2015 Apr 26.

Systematic comparison of MRI findings in pediatric ependymoblastoma with ependymoma and CNS primitive neuroectodermal tumor not otherwise specified

Johannes Nowak  1 , Carolin Seidel  1 , Torsten Pietsch  1 , Balint Alkonyi  1 , Taylor Laura Fuss  1 , Carsten Friedrich  1 , Katja von Hoff  1 , Stefan Rutkowski  1 , Monika Warmuth-Metz  1
Affiliations
Comparative Study

Systematic comparison of MRI findings in pediatric ependymoblastoma with ependymoma and CNS primitive neuroectodermal tumor not otherwise specified

Johannes Nowak et al. Neuro Oncol. 2015 Aug.

Abstract

Background: Ependymoblastoma (EBL), ependymoma (EP), and primitive neuroectodermal tumors of the central nervous system not otherwise specified (CNS-PNET NOS) are pediatric brain tumors that can be differentiated by histopathology in the clinical setting. Recently, we described specific MRI features of EBL. In this study, we compare standardized MRI characteristics of EBL with EP and CNS-PNET NOS in a series comprising 22 patients in each group.

Methods: All 66 centrally reviewed cases were obtained from the database of the German multicenter HIT trials. We systematically analyzed the initial MRI scans at diagnosis according to standardized criteria, and paired comparison was performed for EBL and EP, as well as for EBL and CNS-PNET NOS.

Results: We found differences between EBL and EP regarding age at diagnosis, MR signal intensity, tumor margin and surrounding edema, presence and size of cysts, and contrast enhancement pattern. Although MRI appearance of EBL shares many features with CNS-PNET NOS, we revealed significant differences in terms of age at diagnosis, tumor volume and localization, tumor margins, edema, and contrast enhancement.

Conclusion: This is the first study that systematically compares multiple parameters of MRI in pediatric EBL with findings in EP and CNS-PNET NOS. Although a definite differentiation by means of MRI alone might not be feasible in the individual case, we identify significant differences between these tumor entities.

Keywords: CNS-PNET NOS; MRI; ependymoblastoma; ependymoma; magnetic resonance imaging.

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Figures

Fig. 1.
Fig. 1.
Example of MRI in EBL (3T Siemens Trio). (A) T2WI shows a hyperintense, well-demarcated tumor in the right hemisphere with no surrounding edema. (B) There is low signal in the apparent diffusion coefficient map, indicative of high cellularity (white asterisk). (C) Mild to moderate inhomogeneous enhancement can be found after gadolinium administration on T1WI (white arrow).
Fig. 2.
Fig. 2.
MRI study of a large supratentorial EP (3T Philips Achieva). (A) The tumor has an inhomogeneous signal in T2WI with multiple cysts and minimal surrounding edema. (B) Apparent diffusion coefficient map shows restricted diffusion in parts of the tumor (white asterisk). (C) After gadolinium administration, there is strong enhancement of the capsule and of some parts of the solid tumor component (white arrow).
Fig. 3.
Fig. 3.
Exemplary MRI findings in CNS-PNET NOS (1.5T Siemens Symphony). (A) T2WI shows an iso- to hyperintense central mass with moderate peripheral edema (white arrow). (B) Some parts of the tumor show low apparent diffusion coefficient, suggestive of high cellularity (white asterisk). (C) Only the posterior portions of the tumor moderately enhance on T1WI after gadolinium administration (white arrow).
See this image and copyright information in PMC

References

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