Diagnostic Value of Diffusion-Weighted MRI for Tumor Characterization, Differentiation and Monitoring in Pediatric Patients with Neuroblastic Tumors

 

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Abstract

Purpose We explored the diagnostic value of diffusion-weighted MRI (DWI) for tumor characterization, differentiation and therapy monitoring in pediatric patients with extracranial neuroblastic tumors.

Materials and Methods All 29 patients (14 girls, median age: 3 years) with neuroblastoma (NB, n = 19), ganglioneuroblastoma (GNB, n = 4) and ganglioneuroma (GN, n = 6) who had had at least one in-house DWI examination since 2005 were identified and retrospectively analyzed. Two independent blinded readers measured ADC values (unit: 10−3 mm²/s) and signal intensity ratios (SIRs) of the primary tumor and, if applicable, of the tumor after chemotherapy, metastases and tumor relapse.

Results The pre-treatment ADC was 0.90 ± 0.23 in NB/GNB and 1.70 ± 0.36 in GN without overlap between the two entities for both readers, 0.67 ± 0.14 in metastases and 0.72 ± 0.18 in tumor relapse. With chemotherapy, mean ADC increased to 1.54 ± 0.33 in NB/GNB and to 1.23 ± 0.27 in metastases (p < 0.05). The median SIRs of various tumor lesions vs. liver, vs. muscle tissue and vs. adjacent tissue were significantly higher on DWI (range: 2.4 – 9.9) than on ce-T1w (range: 1.0 – 1.8, all p < 0.05). The coefficient of variation (CV) was ≤ 8.0 % for ADC and ≤ 16.4 % for signal intensity data.

Conclusion Based on mean ADC, DWI distinguishes between NB/GNB and GN with high certainty and provides plausible quantitative data on tumor response to therapy. Lesion conspicuity, as measured by SIR, is superior on DWI, compared to ce-T1w. DWI as a noninvasive, radiation-free and widely available imaging technique should be an integral part of MR imaging for neuroblastic tumors and should undergo prospective evaluation in multicenter studies.

Key Points 

• DWI reliably distinguishes neuroblastoma/ganglioneuroblastoma from ganglioneuroma, based on the mean ADC.

• DWI provides plausible quantitative data on tumor response to chemotherapy.

• DWI offers highly superior lesion conspicuity compared to contrast-enhanced T1w imaging.

• DWI should be considered a standard for imaging neuroblastic tumors.

Citation Format

• Neubauer H, Li M, Müller VR et al. Diagnostic Value of Diffusion-Weighted MRI for Tumor Characterization, Differentiation and Monitoring in Pediatric Patients with Neuroblastic Tumors. Fortschr Röntgenstr 2017; 189: 640 – 650

Zusammenfassung

Ziel Untersucht wurde die diagnostische Aussagekraft der diffusionsgewichteten MRT (DWI) für die Tumorcharakterisierung, Tumordifferenzierung und Verlaufskontrolle bei Kindern mit extrakraniellen neuroblastischen Tumoren.

Material und Methoden Alle 29 Patienten (14 Mädchen, medianes Alter 3 Jahre) mit Neuroblastom (NB, n = 19), Ganglioneuroblastom (GNB, n = 4) und Ganglioneurom (GN, n = 6) und mindestens einer DWI-Studie in domo seit 2005 wurden retrospektiv analysiert. Zwei unabhängige geblindete Untersucher bestimmten die ADC-Werte (Einheit: 10−3 mm²/s) und Signalintensitätsquotienten (SIR) für Primärtumor und, falls zutreffend, für Tumor nach Chemotherapie, Metastasen und Tumorrezidiv.

Ergebnisse Initial betrugen der ADC-Wert 0,90 ± 0,23 für NB/GNB und 1,70 ± 0,36 für GN ohne Überlappung beider Entitäten bei beiden Untersuchern, 0,67 ± 0,14 für Metastasen und 0,72 ± 0,18 für Rezidive. Unter Chemotherapie stieg der ADC auf 1,54 ± 0,33 bei NB/GNB und 1,23 ± 0,27 bei Metastasen (p < 0,05). Die medianen SIR der Tumorläsionen vs. Leber, vs. Muskel und vs. benachbartes Gewebe waren signifikant höher in der DWI (min...max 2,4...9,9) als in ce-T1w (1,0...1,8, alle p < 0,05). Der Variationskoeffizient (CV) lag ≤ 8,0 % für ADC und ≤ 16,4 % für SIR.

Schlussfolgerung DWI unterscheidet anhand des ADC zuverlässig zwischen NB/GNB und GN und liefert plausible quantitative Daten zum Therapieansprechen. Die Sichtbarkeit von Tumorherden, gemessen als SIR, ist in der DWI deutlich besser als in der ce-T1w. DWI als nicht-invasive und weithin verfügbare Bildgebungstechnik ohne Strahlenexposition sollte integraler Bestandteil jeder MR-Bildgebung bei neuroblastischen Tumoren sein und sollte in multizentrischen Studien prospektiv evaluiert werden.

Kernaussagen 

• DWI differenziert anhand des ADC-Werts zuverlässig zwischen Neuroblastom/Ganglioneuroblastom und Ganglioneurom.

• Die DWI liefert plausible quantitative Daten zum Therapieansprechen.

• Die Erkennbarkeit von Tumorherden ist höher mit DWI als mit ce-T1w.

• DWI sollte als Standardtechnik für die MR-Bildgebung neuroblastischer Tumoren betrachtet werden.

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