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1
Department of Pediatrics, St. Louis Children's Hospital, Rm. 3S34, One
Children's PI., St. Louis, MO 63110.
2
Department of Neuroradiology, Mallinckrodt Institute of Radiology, Washington
University Medical Center, Box 8131, 510 S. Kingshighway Blvd., St. Louis, MO
63110.
3
Departments of Pathology and Neuropathology, Washington University School of
Medicine, Box 8118, 660 S. Euclid Ave., St. Louis, MO 63110.
4
Department of Pediatric Neurology, St. Louis Children's Hospital, St. Louis,
MO 63110.
5
Department of Pediatric Neurosurgery, Medical College of Wisconsin, 9000 W.
Wisconsin Ave., P. O. Box 1997, Milwaukee, WI 53201.
6
Department of Pediatrics, Washington University School of Medicine, Box 8116,
St. Louis, MO 63110.
OBJECTIVE. MR imaging of central nervous system (CNS) malignancies falls short of a definitive evaluation. Tissue diagnosis remains the gold standard. Diffusion-tensor MR imaging measures the apparent diffusion coefficient and diffusion anisotropy of water in tissue. The purpose of this study was to test the hypothesis that the apparent diffusion coefficient may improve the MR imaging evaluation of newly diagnosed CNS neoplasms. We examined the relationship between the apparent diffusion coefficient, anisotropy, and tumor cellularity in 12 pediatric patients.
MATERIALS AND METHODS. On the basis of histopathologic evaluation, tumors in this case series were segregated into three types: low-grade gliomas, embryonal tumors, and nonembryonal high-grade tumors. Mean apparent diffusion coefficient and anisotropy values obtained from the solid components of each tumor were compared with cellularity, total cellular area, and total nuclear area derived from biopsy material.
RESULTS. The apparent diffusion coefficient ratio (tumor to normal brain) correlated well with tumor classification (p = 0.001). Anisotropy was decreased similarly in all tumor classifications. The absolute apparent diffusion coefficient correlated well with cellularity (p = 0.014) and total nuclear area (p = 0.005) per high-power field. The correlation between apparent diffusion coefficient and total cellular area per high-power field was not statistically significant.
CONCLUSION. The apparent diffusion coefficient may be predictive of tumor classification and may be a useful tool in characterizing tumor cellularity and total nuclear area. These parameters are not available in standard MR imaging. Therefore, diffusion-tensor imaging may enhance the diagnostic process in pediatric CNS malignancies.
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