Brain tumors are the most common solid tumors in the pediatric population. Pediatric neuro-oncology has changed tremendously during the past decade owing to ongoing genomic advances. The diagnosis, prognosis, and treatment of pediatric brain tumors are now highly reliant on the genetic profile and histopathologic features of the tumor rather than the histopathologic features alone, which previously were the reference standard. The clinical information expected to be gleaned from radiologic interpretations also has evolved. Imaging is now expected to not only lead to a relevant short differential diagnosis but in certain instances also aid in predicting the specific tumor and subtype and possibly the prognosis. These processes fall under the umbrella of radiogenomics. Therefore, to continue to actively participate in patient care and/or radiogenomic research, it is important that radiologists have a basic understanding of the molecular mechanisms of common pediatric central nervous system tumors. The genetic features of pediatric low-grade gliomas, high-grade gliomas, medulloblastomas, and ependymomas are reviewed; differences between pediatric and adult gliomas are highlighted; and the critical oncogenic pathways of each tumor group are described. The role of the mitogen-activated protein kinase pathway in pediatric low-grade gliomas and of histone mutations as epigenetic regulators in pediatric high-grade gliomas is emphasized. In addition, the oncogenic drivers responsible for medulloblastoma, the classification of ependymomas, and the associated imaging correlations and clinical implications are discussed. © RSNA, 2018 • Abbreviations: CDK = cyclin-dependent kinase, CNS = central nervous system, DIPG = diffuse intrinsic pontine glioma, FGFR1 = fibroblast growth factor receptor 1, GBM = glioblastoma multiforme, HGG = high-grade glioma, IDH = isocitrate dehydrogenase, IDH1 = IDH 1, LGG = low-grade glioma, MAPK = mitogenactivated protein kinase, MEK = MAPK/extracellular signal-regulated kinase (ERK) kinase, PXA = pleomorphic xanthoastrocytoma, SHH = sonic hedgehog, SUFU = suppressor of fused, WHO = World Health Organization, Wnt = wingless RadioGraphics 2018; 38:2102-2122
