Evaluating Pediatric Brain Tumor Cellularity with Diffusion-Tensor Imaging
Karen M. Gauvain1,
Robert C. McKinstry2,
Pratik Mukherjee2,
Arie Perry3,
Jeffrey J. Neil4,
Bruce A. Kaufman5 and
Robert J. Hayashi6
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.
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Fig. 1A. —8-year-old girl with juvenile pilocytic astrocytoma.
Gadolinium-enhanced T1-weighted image reveals mass in mid cerebellum with
large enhancing nodule.
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Fig. 1B. —8-year-old girl with juvenile pilocytic astrocytoma. Turbo
spin-echo T2-weighted image obtained at same level as A shows cystic
component of mass and surrounding edema in cerebellum.
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Fig. 1C. —8-year-old girl with juvenile pilocytic astrocytoma. Apparent
diffusion coefficient image obtained at the same level as A with
regions of interest (ROIs) shows that one ROI represents solid portion of
mass. Other two ROIs are averaged to represent normal cerebellum.
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Fig. 2A. —10-year-old girl with glioblastoma multiforme.
Gadolinium-enhanced T1-weighted image shows mass in right thalamus with
heterogeneous enhancement.
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Fig. 2B. —10-year-old girl with glioblastoma multiforme. Turbo
spin-echo T2-weighted image obtained at same level as A shows
hyperintense mass and surrounding edema.
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Fig. 2C. —10-year-old girl with glioblastoma multiforme. Apparent
diffusion coefficient image obtained at same level as A with regions of
interest (ROIs) shows that one ROI represents solid enhancing portion of mass,
whereas other ROI represents normal brain in contralateral hemisphere.
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Fig. 3A. —2-year-old boy with atypical teratoid-rhabdoid tumor.
Gadolinium-enhanced T1-weighted image reveals lobulated mass in basal ganglia
region of left lateral ventricle with heterogeneous enhancement.
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Fig. 3B. —2-year-old boy with atypical teratoid-rhabdoid tumor. Turbo
spin-echo T2-weighted image obtained at same level as A shows that mass
is isointense to gray matter.
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Fig. 3C. —2-year-old boy with atypical teratoid-rhabdoid tumor.
Apparent diffusion coefficient image obtained at same level as A with
three regions of interest (ROIs) shows that ROIs in left hemisphere are
averaged to represent solid enhancing portion of mass. Single ROI in right
hemisphere serves as control region in normal brain.
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Fig. 4A. —Photomicrographs of histopathologic specimen from each of
tumor categories. Tumor in 8-year-old girl with juvenile pilocytic astrocytoma
is characterized by low cellularity, small nuclear size, and microcystic
stroma. (H and E, x 400)
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Fig. 4B. —Photomicrographs of histopathologic specimen from each of
tumor categories. Glioblastoma multiforme in 10-year-old girl has moderate
cellularity and moderate nuclear size. (H and E, x200)
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Fig. 4C. —Photomicrographs of histopathologic specimen from each of
tumor categories. Tumor in 14-year-old boy with medulloblastoma has high
cellularity with small cells containing minimal cytoplasm. (H and E,
x200)
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Fig. 4D. —Photomicrographs of histopathologic specimen from each of
tumor categories. Tumor in 13-year-old girl with large cell medulloblastoma is
highly cellular with large cells containing moderate cytoplasm. (H and E,
x400)
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Fig. 5. —Graph shows comparison of apparent diffusion coefficient
ratio and tumor classification. Analysis of variance data is the following:
n = 12, mean = 1.577 ± 0.5196, and p = 0.001. ADC =
apparent diffusion coefficient.
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Fig. 6. —Graph shows comparison of apparent diffusion coefficient
value and tumor cellularity. Pearson's correlation coefficient is -0.684, with
a significance of 0.014. ADC = apparent diffusion coefficient.
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Fig. 7. —Graph shows comparison between apparent diffusion coefficient
value and total nuclear area. Pearson's correlation coefficient is -0.752,
with a significance of 0.005. ADC = apparent diffusion coefficient.
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Copyright © 2001 by the American Roentgen Ray Society.
