DIPGs in the molecular era has resulted in a proportion being reclassified as pontine embryonal t... more DIPGs in the molecular era has resulted in a proportion being reclassified as pontine embryonal tumors; lesions with contrasting management and potential outcomes. We postulated whether integrating modern multi-parametric imaging could discriminate between the two tumors at presentation. METHODS: A retrospective diagnostic MRI analysis of children that had undergone biopsy for presumed DIPG at Manchester and Liverpool Pediatric Neuro-oncology Centers over the last decade was performed. Perfusion was assessed by both arterial spin labeling and dynamic contrast susceptibility weighted techniques. RESULTS: Thirteen patients were identified (median age 4.2 (2.6-7.8) years). All lesions had characteristic, non-differentiating T1, T2 and FLAIR appearances, with varying contrast enhancement. Ten were confirmed DIPG (Grade II (3), Grade III (2), Grade IV (4), NOS (1)), while three were embryonal tumors. Reduced perfusion was identified in all embryonal lesions and Grade II DIPGs, whereas increased perfusion was observed in Grade III and IV DIPGs. Diffusion restriction was observed in embryonal lesions compared to Grade II DIPGs. CONCLUSIONS: Low perfusion within a presumed DIPG may reflect a lower grade of glioma or indeed an embryonal pontine tumor, particularly if accompanied by overt intra-lesional diffusion. While requiring validation in larger cohorts, we propose perfusion imaging is a vital adjunct in DIPG radiological phenotyping and should be employed at presentation.
NEURO-ONCOLOGY • JUNE 2018 went PT, post-surgery on the primary tumour and intensive myeloablativ... more NEURO-ONCOLOGY • JUNE 2018 went PT, post-surgery on the primary tumour and intensive myeloablative chemotherapy: both are two potential risk factors in the appearance of premature radionecrosis. All the patients also underwent MRI on the brain and bone marrow, before and after proton therapy treatment, at an interval of 1 month at the end of PT and then every 3 months. RESULTS: In our clinical records in a median follow up of 4.9 months we did not encounter cases of radionecrosis according to the definition criteria as discussed or published in the consulted publications. CONCLUSIONS: The paediatric patients with high risk medulloblastoma undergoing treatment with proton therapy, the subjects of our study, presented a lower risk to premature radionecrosis in respect to the data present in current publications.
DIPGs in the molecular era has resulted in a proportion being reclassified as pontine embryonal t... more DIPGs in the molecular era has resulted in a proportion being reclassified as pontine embryonal tumors; lesions with contrasting management and potential outcomes. We postulated whether integrating modern multi-parametric imaging could discriminate between the two tumors at presentation. METHODS: A retrospective diagnostic MRI analysis of children that had undergone biopsy for presumed DIPG at Manchester and Liverpool Pediatric Neuro-oncology Centers over the last decade was performed. Perfusion was assessed by both arterial spin labeling and dynamic contrast susceptibility weighted techniques. RESULTS: Thirteen patients were identified (median age 4.2 (2.6-7.8) years). All lesions had characteristic, non-differentiating T1, T2 and FLAIR appearances, with varying contrast enhancement. Ten were confirmed DIPG (Grade II (3), Grade III (2), Grade IV (4), NOS (1)), while three were embryonal tumors. Reduced perfusion was identified in all embryonal lesions and Grade II DIPGs, whereas increased perfusion was observed in Grade III and IV DIPGs. Diffusion restriction was observed in embryonal lesions compared to Grade II DIPGs. CONCLUSIONS: Low perfusion within a presumed DIPG may reflect a lower grade of glioma or indeed an embryonal pontine tumor, particularly if accompanied by overt intra-lesional diffusion. While requiring validation in larger cohorts, we propose perfusion imaging is a vital adjunct in DIPG radiological phenotyping and should be employed at presentation.
NEURO-ONCOLOGY • JUNE 2018 went PT, post-surgery on the primary tumour and intensive myeloablativ... more NEURO-ONCOLOGY • JUNE 2018 went PT, post-surgery on the primary tumour and intensive myeloablative chemotherapy: both are two potential risk factors in the appearance of premature radionecrosis. All the patients also underwent MRI on the brain and bone marrow, before and after proton therapy treatment, at an interval of 1 month at the end of PT and then every 3 months. RESULTS: In our clinical records in a median follow up of 4.9 months we did not encounter cases of radionecrosis according to the definition criteria as discussed or published in the consulted publications. CONCLUSIONS: The paediatric patients with high risk medulloblastoma undergoing treatment with proton therapy, the subjects of our study, presented a lower risk to premature radionecrosis in respect to the data present in current publications.
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