Abstract
For certain clinical circumstances, the differentiation between cerebellar medulloblastoma and brainstem glioma is essential. We aimed to evaluate the role played by the apparent diffusion coefficient (ADC) values in the differentiation between cerebellar medulloblastomas and brainstem gliomas in children. The institutional review board approved this prospective study. Brain magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) and ADC, was assessed in 32 patients (median age: 7.0 years), divided into two groups, a medulloblastoma group (group 1, n = 22) and a brainstem glioma group (group 2, n = 10). The Mann–Whitney U test was utilized to compare tumor ADCmax, ADCmin, ADCmean, and ADCsd values, and their ratios with the parenchyma values between the two groups. Receiver operating characteristic (ROC) curve analysis and the Youden index were used to calculate the cut-off value, along with the area under the curve (AUC), sensitivity, and specificity. The median ADCmax, ADCmin, and ADCmean values were significantly higher in group 2 than in group 1 (p < 0.05). The median ratios of ADCmin and ADCmean to the parenchyma were significantly higher in group 2 than in group 1 (p < 0.05). The ROC analysis showed that the AUC for the ADCmean ratio was the highest among these parameters, at 98.2%. The ADCmean tumor to parenchyma ratio was a significant and effective parameter for the differentiation between pediatric medulloblastomas and brainstem gliomas.
Highlights
Brain tumors, including supratentorial and infratentorial tumors, are the second-most common malignancies in children, after acute leukemia
Brainstem glioma is a common tumor in the brainstem area, whereas medulloblastoma is common in the cerebellar region [1,2]
Several studies have reported that some medulloblastomas can infiltrate the brainstem or originate in the brainstem, which can cause misdiagnosis with brainstem glioma [1,3,4]
Summary
Brain tumors, including supratentorial and infratentorial tumors, are the second-most common malignancies in children, after acute leukemia. The infratentorial region is the primary site for approximately 60% of brain tumors in children. Brainstem glioma is a common tumor in the brainstem area, whereas medulloblastoma is common in the cerebellar region [1,2]. Several studies have reported that some medulloblastomas can infiltrate the brainstem or originate in the brainstem, which can cause misdiagnosis with brainstem glioma [1,3,4]. After radiotherapy treatments for medulloblastomas, many cases have been reported where the appearance of brainstem glioma has resulted in confusion about whether to diagnose the recurrence of medulloblastoma or a new brainstem glioma [5,6]. The appropriate treatments and prognoses for brainstem glioma and medulloblastoma are completely different; the diagnostic distinction between these two types of tumors is essential for proper treatment planning and better outcomes [1,2,3,4,5,6]
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