MRI evaluation of pediatric posterior fossa tumors and its correlation with histopathology: A prospective observational study

Abstract

Background: The commonest malignancy in the pediatric age group is leukemia, followed by brain tumors. Pediatric brain tumors are usually seen in children below 10 years. The incidence ranges from 1 to 3 per 100,000 cases. Primary intracranial tumors most commonly occur in the posterior fossa in children while infratentorial tumors are predominant in children over 4 years. Infratentorial tumors are more common overall, accounting for 45-60% of all cases. Physiologic characteristics of the pediatric posterior fossa tumors are well represented in advanced MRI techniques, which results in better pre-operative tumor evaluation, and often better results. Objectives: Primary intracranial tumors most commonly occur in the posterior fossa in children. Treatment and prognosis rely heavily on correct diagnosis. The most important modality for early diagnosis is MRI of the brain. This study aims to evaluate the role of MRI in pediatric posterior fossa tumors. Materials and methods: Thirty-three patients in the pediatric age group (<18 years) with a clinical suspicion of posterior fossa tumors, referred to the department of Radiology for undergoing MRI of the brain with contrast were included in the study. These patients underwent surgery followed by histopathological examination (HPE). Five parameters from conventional MRI were chosen and correlated with histopathology (gold standard). Statistical analysis was done subsequently. Results: Diffusion-weighted imaging (DWI) is the most accurate parameter (94%), followed by T2 weighted imaging (T2WI), gradient, and post-contrast sequence (91% each). Diffusion-weighted imaging and post-contrast sequence had the highest specificity (almost 96%) while DWI and T2WI had the highest sensitivity (90% each). All 5 parameters are useful in 85% of cases. Overall diagnostic accuracy of MRI was almost 94% compared to histopathology. Conclusion: DWI is the best parameter, followed by T2WI, gradient imaging, and post-contrast sequence. MRI is highly accurate in the evaluation of pediatric posterior fossa tumors. In centers where advanced MRI techniques cannot be performed, some parameters from conventional MRI can be selected that aid in diagnosis. Our study shows that judicious use of 5 parameters can increase sensitivity, specificity, and diagnostic accuracy of MRI for pediatric posterior fossa tumors.