Bader Ahmad, Heran Manraj, Dunham Christopher, Steinbok Paul
Divisions of 1 Neurosurgery and.
Department of Radiology and.
J Neurosurg Pediatr. 2015 Aug;16(2):119-25. doi: 10.3171/2014.10.PEDS13634. Epub 2015 May 8.
OBJECT Two of the more common infantile brain tumors, glioblastoma multiforme (GBM) and desmoplastic infantile tumors (DITs), can be difficult to distinguish on MRI. Both tumors occur in the supratentorial compartment and both have solid and cystic components. Differentiating between the 2 on MRI studies could assist the surgeon in discussions with family and child management. The authors report on their institutional experience with both tumors, focusing on radio-graphic features, especially the diffusion studies, which might be useful in distinguishing between infantile GBM and DIT. METHODS A retrospective review was undertaken of all infantile brain tumors treated at British Columbia's Children's Hospital between 1982 and 2012, and cases of GBM and DIT were recorded. Only cases that had imaging were included in the study. A literature review was completed to identify reported cases of infantile GBM and DIT. Only reports that described or included radiological studies (particularly MRI) of the tumors were included. Certain radiographic features of the tumors were reviewed, including location, size, consistency, pattern of enhancement, and features on MR diffusion studies. RESULTS Of 70 cases of infantile brain tumors, 2 GBM cases and 3 DIT cases (all 3 of which were desmoplastic infantile gangliogliomas [DIGs]) met the inclusion criteria. The radiological studies obtained in all 5 cases were reviewed by a neuroradiologist. All 5 patients had supratentorial tumors with cystic-solid consistency. Diffusion MRI studies showed restricted diffusion in the 2 GBM cases, but no evidence of restricted diffusion in the DIG tumors. The GBM tumors were heterogeneously enhancing, and the DIG tumors showed avid and homogeneous enhancement. The literature review revealed 29 cases of infantile GBM and 32 cases of DIG/DIT that met the inclusion criteria. The tumors were large in both groups. The tumors were cystic-solid in consistency in 10 of 30 (33%) of GBM cases and 28 of 32 (87.5%) of DIT cases. The contrast enhancement was heterogeneous in 9 of 30 (30%) GBM cases, and it was homogeneous and avid in 27 of 32 (84%) of DIT cases. Diffusion studies were recorded in 2 published infantile GBM cases, and in both of them diffusion was restricted. The authors only found 1 report that discussed DIG tumor features on MR diffusion studies, but the interpretation was difficult and unclear. CONCLUSIONS Magnetic resonance imaging, especially diffusion-weighted imaging, may be a useful aid in distinguishing between infantile GBM and DIT tumors, with infantile GBM demonstrating restricted diffusion.
两种较为常见的婴幼儿脑肿瘤，多形性胶质母细胞瘤（GBM）和促结缔组织增生性婴幼儿肿瘤（DIT），在磁共振成像（MRI）上可能难以区分。这两种肿瘤均发生于幕上腔室，且都有实性和囊性成分。在MRI研究中区分这两者有助于外科医生与患儿家属讨论病情及进行患儿管理。作者报告了他们在这两种肿瘤方面的机构经验，重点关注影像学特征，尤其是扩散研究，这可能有助于区分婴幼儿GBM和DIT。方法：对1982年至2012年在不列颠哥伦比亚省儿童医院接受治疗的所有婴幼儿脑肿瘤进行回顾性研究，并记录GBM和DIT病例。该研究仅纳入有影像学检查的病例。完成文献综述以确定已报道的婴幼儿GBM和DIT病例。仅纳入描述或包含肿瘤放射学研究（特别是MRI）的报告。对肿瘤的某些影像学特征进行了回顾，包括位置、大小、质地、强化模式以及MR扩散研究的特征。结果：在70例婴幼儿脑肿瘤病例中，2例GBM病例和3例DIT病例（其中3例均为促结缔组织增生性婴幼儿节细胞胶质瘤[DIG]）符合纳入标准。一名神经放射科医生对所有5例病例的放射学研究进行了评估。所有5例患者均有幕上肿瘤，质地为囊实性。扩散加权MRI研究显示2例GBM病例存在扩散受限，但DIG肿瘤未见扩散受限的证据。GBM肿瘤强化不均匀，而DIG肿瘤强化明显且均匀。文献综述显示有29例婴幼儿GBM和32例DIG/DIT符合纳入标准。两组肿瘤均较大。3 / 30（3%）的GBM病例和28 / 32（87.5%）的DIT病例质地为囊实性。30例GBM病例中有9例（30%）对比增强不均匀，32例DIT病例中有27例（84%）对比增强均匀且明显。在2例已发表的婴幼儿GBM病例中记录了扩散研究，两者均显示扩散受限。作者仅找到1篇讨论DIG肿瘤MR扩散研究特征的报告，但解读困难且不明确。结论：磁共振成像，尤其是扩散加权成像，可能有助于区分婴幼儿GBM和DIT肿瘤，婴幼儿GBM表现为扩散受限。
