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Application of Apparent Diffusion Coefficient Histogram Metrics for Differentiation of Pediatric Posterior Fossa Tumors

A Large Retrospective Study and Brief Review of Literature

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Abstract

Purpose

This study aimed to evaluate the application of apparent diffusion coefficient (ADC) histogram analysis to differentiate posterior fossa tumors (PFTs) in children.

Methods

A total of 175 pediatric patients with PFT, including 75 pilocytic astrocytomas (PA), 59 medulloblastomas, 16 ependymomas, and 13 atypical teratoid rhabdoid tumors (ATRT), were analyzed. Tumors were visually assessed using DWI trace and conventional MRI images and manually segmented and post-processed using parametric software (pMRI). Furthermore, tumor ADC values were normalized to the thalamus and cerebellar cortex. The following histogram metrics were obtained: entropy, minimum, 10th, and 90th percentiles, maximum, mean, median, skewness, and kurtosis to distinguish the different types of tumors. Kruskal Wallis and Mann-Whitney U tests were used to evaluate the differences. Finally, receiver operating characteristic (ROC) curves were utilized to determine the optimal cut-off values for differentiating the various PFTs.

Results

Most ADC histogram metrics showed significant differences between PFTs (p < 0.001) except for entropy, skewness, and kurtosis. There were significant pairwise differences in ADC metrics for PA versus medulloblastoma, PA versus ependymoma, PA versus ATRT, medulloblastoma versus ependymoma, and ependymoma versus ATRT (all p < 0.05). Our results showed no significant differences between medulloblastoma and ATRT. Normalized ADC data showed similar results to the absolute ADC value analysis. ROC curve analysis for normalized ADCmedian values to thalamus showed 94.9% sensitivity (95% CI: 85–100%) and 93.3% specificity (95% CI: 87–100%) for differentiating medulloblastoma from ependymoma.

Conclusion

ADC histogram metrics can be applied to differentiate most types of posterior fossa tumors in children.

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Funding

No funds, grants, or other support were received.

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Authors and Affiliations

  1. Department of Radiology, Division of Neuroradiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Fabrício Guimarães Gonçalves, Alireza Zandifar, Jorge Du Ub Kim, Luis Octavio Tierradentro-García, Adarsh Ghosh, Dmitry Khrichenko, Savvas Andronikou & Arastoo Vossough

  2. Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Savvas Andronikou & Arastoo Vossough

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  1. Fabrício Guimarães Gonçalves
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  2. Alireza Zandifar
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  3. Jorge Du Ub Kim
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  4. Luis Octavio Tierradentro-García
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  5. Adarsh Ghosh
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  6. Dmitry Khrichenko
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  7. Savvas Andronikou
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  8. Arastoo Vossough
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Fabrício Guimarães Gonçalves, Alireza Zandifar, Jorge Du Ub Kim, Adarsh Ghosh, Luis Octavio Tierradentro-García and Dmitry Khrichenko. The first draft of the manuscript was written by Fabrício Guimarães Gonçalves, Alireza Zandifar, Jorge Du Ub Kim and Luis Octavio Tierradentro-Garcia. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alireza Zandifar.

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Conflict of interest

F.G. Gonçalves, A. Zandifar, J.D. Ub Kim, L.O. Tierradentro-García, A. Ghosh, D. Khrichenko, S. Andronikou and A. Vossough declare that they have no competing interests.

Ethical standards

This retrospective study was approved by our Institutional Review Board and is HIPPA compliant; a waiver for consent was granted. For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case. This retrospective study was performed after consultation with the institutional ethics committee and in accordance with national legal requirements.

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Gonçalves, F.G., Zandifar, A., Ub Kim, J.D. et al. Application of Apparent Diffusion Coefficient Histogram Metrics for Differentiation of Pediatric Posterior Fossa Tumors. Clin Neuroradiol 32, 1097–1108 (2022). https://doi.org/10.1007/s00062-022-01179-6

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