Affiliation:
1. Department of Radiology Taipei Veterans General Hospital Taipei Taiwan
2. School of Medicine, National Yang Ming Chiao Tung University Taipei Taiwan
3. Institute of Clinical Medicine, National Yang Ming Chiao Tung University Taipei Taiwan
4. Department of Pathology and Laboratory Medicine Taipei Veterans General Hospital Taipei Taiwan
5. Division of Pediatric Neurosurgery, Department of Neurosurgery, Neurological Institute Taipei Veterans General Hospital Taipei Taiwan
6. Department of Oncology Taipei Veterans General Hospital Taipei Taiwan
7. Department of Medical Imaging and Radiological Technology Yuanpei University of Medical Technology Hsinchu City Taiwan
Abstract
AbstractBackgroundAtypical teratoid rhabdoid tumor (AT/RT) occurs at a younger age and is associated with a worse prognosis than medulloblastoma; however, these two tumor entities are mostly indistinguishable on neuroimaging. The aim of our study was to differentiate AT/RT and medulloblastoma based on their clinical and MRI features to enhance treatment planning and outcome prediction.MethodsFrom 2005–2021, we retrospectively enrolled 16 patients with histopathologically diagnosed AT/RT and 57 patients with medulloblastoma at our institute. We evaluated their clinical data and MRI findings, including lesion signals, intratumoral morphologies, and peritumoral/distal involvement.ResultsThe age of children with AT/RT was younger than that of children with medulloblastoma (2.8 ± 4.9 [0–17] vs. 6.5 ± 4.0 [0–18], p < 0.001), and the overall survival rate was lower (21.4% vs. 66.0%, p = 0.005). Regarding lesion signals on MRI, AT/RT had a lower ADCmin (cutoff value ≤544.7 × 10−6 mm2/s, p < 0.001), a lower ADC ratio (cutoff value ≤0.705, p < 0.001), and a higher DWI ratio (cutoff value ≥1.595, p < 0.001) than medulloblastoma. Regarding intratumoral morphology, the “tumor central vein sign” was mostly exclusive to medulloblastoma (24/57, 42.1%; AT/RT 1/16, 6.3%; p = 0.007). Regarding peritumoral invasion on T2WI, AT/RT was more prone to invasion of the brainstem (p < 0.001) and middle cerebellar peduncle (p < 0.001) than medulloblastoma.ConclusionsMRI findings of a lower ADC value, more peritumoral invasion, and absence of the “tumor central vein sign” may be helpful to differentiate AT/RT from medulloblastoma. These distinct MRI findings together with the younger age of AT/RT patients may explain the worse outcomes in AT/RT patients.
Funder
Ministry of Science and Technology, Taiwan
Taipei Veterans General Hospital
Yen Tjing Ling Medical Foundation
Subject
Cancer Research,Radiology, Nuclear Medicine and imaging,Oncology