The effect of semi-quantitative T1-perfusion parameters for the differentiation between pediatric medulloblastoma and ependymoma

Nguyen Minh Duc

doi:10.1186/s43055-020-00226-x

Abstract

BackgroundThe differentiation between medulloblastomas and ependymomas plays an important role in treatment planning and prognosis for children. This study aims to investigate the role of T1-perfusion parameters during the differentiation between medulloblastomas and ependymomas in children. The institutional review board approved this prospective study. The brain magnetic resonance imaging (MRI) protocol, including axial T1-perfusion, was assessed in 26 patients, divided into a medulloblastoma group (group 1, n = 22) and an ependymoma group (group 2, n = 4). The quantified region of interest (ROI) values for tumors and the tumor to parenchyma ratios were collected and compared between the two groups. Receiver operating characteristic (ROC) curve analysis and the Youden index were utilized to identify the best cut-off, sensitivity, specificity, and area under the curve (AUC) values for the independent T1-perfusion parameters.ResultsThe relative enhancement, maximum enhancement, maximum relative enhancement, time to peak, and AUC values for medulloblastomas were significantly higher than those for ependymomas (p < 0.05). Furthermore, the maximum enhancement and maximum relative enhancement for medulloblastoma to parenchyma ratios were also significantly higher than those for ependymomas. A cut-off maximum enhancement value of 100.25 was identified as sufficient to discriminate between medulloblastoma and ependymoma and resulted in a sensitivity of 90.9%, a specificity of 100%, and an AUC of 94.3%.ConclusionA cut-off maximum enhancement value of 100.25 derived from T1-perfusion was able to discriminate between medulloblastoma and ependymoma, with high sensitivity, specificity, and accuracy values.

Highlights

The differentiation between medulloblastomas and ependymomas plays an important role in treatment planning and prognosis for children
Several studies have utilized magnetic resonance imaging (MRI) to distinguish between medulloblastoma and ependymoma
A cut-off maximum enhancement value of 100.25 was able to distinguish between medulloblastomas and ependymomas, resulting in a sensitivity of 90.9%, a specificity of 100%, and an area under the curve (AUC) of 94.3% (Table 3, Fig. 3)

Summary

Introduction

The differentiation between medulloblastomas and ependymomas plays an important role in treatment planning and prognosis for children. This study aims to investigate the role of T1-perfusion parameters during the differentiation between medulloblastomas and ependymomas in children. The brain magnetic resonance imaging (MRI) protocol, including axial T1perfusion, was assessed in 26 patients, divided into a medulloblastoma group (group 1, n = 22) and an ependymoma group (group 2, n = 4). Receiver operating characteristic (ROC) curve analysis and the Youden index were utilized to identify the best cut-off, sensitivity, specificity, and area under the curve (AUC) values for the independent T1-perfusion parameters. Magnetic resonance imaging (MRI) is globally recognized as the best method for assessing brain tumors in children because it is noninvasive and does not expose the subject to radiation. The results of some studies have shown several overlapping imaging characteristics between these two tumor types; differentiating between medulloblastoma and ependymoma remains an ongoing concern that is currently being studied [7–13]

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