Abstract
BackgroundThe therapeutic planning varies for different grades of choroid plexus tumours (CPTs). The aim of this study was to define the similarities and distinctions among MRIs for different grades of CPTs, providing more guidance for clinical decisions.MethodsWe reviewed the MRI findings in 35 patients with CPT verified by surgical pathology, including 18 choroid plexus papillomas (CPPs, grade I), 11 atypical choroid plexus papillomas (aCPPs, grade II), and 6 choroid plexus carcinomas (CPCs, grade III). Nonparametric testing based on ranks was performed to evaluate the association of pathological grade with MRI findings.ResultsAmong the 35 CPTs, 29 were located in the ventricular system. The tumours were generally slightly hypo- or isointense on T1WI, slightly hyper- or isointense on T2WI, and moderately or strongly enhanced in post-contrast imaging. Twenty cases were accompanied by hydrocephalus. The median tumour longest diameters of CPPs, aCPPs, and CPCs were 28.6, 44.6, and 60.6 mm, respectively. Four cases were purely cystic, 6 were papillary, 10 were lobulated, and 2 were irregular. Three cases had necrosis. The median oedema diameters of CPPs, aCPPs, and CPCs were 0, 0, and 24.1 mm, respectively. The grades of CPTs were statistically associated with tumour longest diameter (rs = 0.68, P < 0.001), internal morphology (χ2 = 10.32, P = 0.016), necrosis (Z = 2.27, P = 0.023), and oedema diameter (rs = 0.72, P < 0.001).ConclusionCPTs typically appeared as intraventricular papillary or lobulated lesions, often accompanied by hydrocephalus. Larger tumour, irregular or fuzzy internal morphology, presentation of necrosis and wide-ranging peritumoural oedema might increase the likelihood of malignancy.
Highlights
The therapeutic planning varies for different grades of choroid plexus tumours (CPTs)
According to the latest WHO classification system in 2016 [3], CPTs can be classified into 3 subtypes: choroid plexus papilloma (CPP, grade I), atypical choroid plexus papilloma, and choroid plexus carcinoma (CPC, grade III)
MRI findings Among the 35 CPTs, 14 were located in the lateral ventricle (7 Choroid plexus papilloma (CPP), 3 Atypical choroid plexus papilloma (aCPP), 4 Choroid plexus carcinoma (CPC)), 12 in the fourth ventricle (7 CPPs, 5 aCPPs, 0 CPCs), and 3 each were found in the third ventricle (1 CPP, 2 aCPPs, 0 CPCs), cerebellopontine angle (2 CPPs, 1 aCPP, 0 CPCs), and brain parenchyma (1 CPP, 0 aCPPs, 2 CPCs)
Summary
The therapeutic planning varies for different grades of choroid plexus tumours (CPTs). The aim of this study was to define the similarities and distinctions among MRIs for different grades of CPTs, providing more guidance for clinical decisions. ACPP was a new subtype introduced in 2007 [1] and is surgical resection has remained the standard of care for each grade of CPTs [7], pretreatment imaging diagnosis is essential for surgical planning and therapeutic decisions [2, 7]. We reviewed the MRI findings of 35 CPTs with the goal of defining the MRI similarities and distinctions among grades.
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