MR imaging of brain pilocytic astrocytoma: beyond the stereotype of benign astrocytoma

Gaudino, Simona; Martucci, Matia; Russo, Rosellina; Visconti, Emiliano; Gangemi, Emma; D’Argento, Francesco; Verdolotti, Tommaso; Lauriola, Libero; Colosimo, Cesare

doi:10.1007/s00381-016-3262-4

Cited by 42 publications

(31 citation statements)

References 81 publications

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“…With the typical location and appearance of a well-delineated cerebellar cystic mass with mural nodule, the diagnosis of PA is easy. However, when located in the supratentorial region, PA shares its typical “a supratentorial cystic mass with enhancing mural nodule” appearance with PXA [6]. As presented in the previous studies, this typical MR imaging feature was found in 43.8% of the supratentorial PA and in 50.0% of PXA in our study [1, 24–27].…”

Section: Discussionsupporting

confidence: 79%

“…PXA typically occurs in the supratentorial brain, most frequently affecting children and adolescent [4]. Both PA and PXA are potentially curable by total surgical resection and are associated with a longer overall survival [5, 6], but the patients with PXA have a far worse prognosis than those with PA, especially in younger patients [4]. Although PXA is considered a benign tumor, population-based studies suggested that this tumor was associated with higher risk of recurrence and anaplastic transformation compared with PA [1, 5, 7–10].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of diffusion weighted imaging for differentiation of supratentorial pilocytic astrocytoma and pleomorphic xanthoastrocytoma

et al. 2018

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PurposeSupratentorial pilocytic astrocytoma (PA) may mimic pleomorphic xanthoastrocytoma (PXA) on conventional MR imaging, and a differentiation is clinically important because of distinct recurrence rate and anaplastic transformation rate. The purpose of this study was to investigate the diagnostic potential of diffusion-weighted imaging (DWI) in differentiating supratentorial PA from PXA.MethodsWe retrospectively reviewed DWI and conventional MR imaging of 16 patients with supratentorial PA and 8 patients with PXA. Variables of mean ADC values (ADCmean) and minimum ADC values (ADCmin) were calculated from the ROIs containing the contrast-enhancing lesion on DWI. ADCmean values and ADCmin values were compared among all supratentorial PA and PXA as well as between the subgroup of lobar PA and PXA by using an unpaired Student’s t test. The optimum threshold, sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve (AUC) were determined.ResultsBoth ADCmean values (1542 ± 186 vs 1084 ± 201 × 10−6 mm2/s; P < 0.001) and ADCmin values (1355 ± 183 vs 988 ± 180 × 10−6 mm2/s; P < 0.001) were significantly higher in supratentorial PA compared with PXA. The ADCmean values and ADCmin values were also significantly higher in lobar PA than those in PXA. The ADCmean values were useful for differentiating supratentorial PA from PXA, with a threshold value of > 1189.8 × 10−6 mm2/s (sensitivity, 93.8%; specificity, 100%). The optimal threshold values of > 1189.8 × 10−6 mm2/s for ADCmean values provide sensitivity and specificity of 85.7 and 100%, respectively, for discriminating lobar PA from PXA. The optimum threshold value for ADCmin was > 1063.5 × 10−6 mm2/s.ConclusionDWI is helpful in characterization and differentiation of supratentorial PA from PXA.Electronic supplementary materialThe online version of this article (10.1007/s00234-018-2036-y) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of diffusion weighted imaging for differentiation of supratentorial pilocytic astrocytoma and pleomorphic xanthoastrocytoma

et al. 2018

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“…In the pediatric neuro-oncology setting, pseudo-response mainly refers to reduction of enhancement following anti-angiogenic therapy and the response assessment in this setting is based on measurement on the T2 and FLAIR sequences [131]. In LGG the change in contrast enhancement is not relevant for volume assessment ("staging") [37,38].…”

Section: Follow-up Mrimentioning

confidence: 99%

SIOP-E-BTG and GPOH Guidelines for Diagnosis and Treatment of Children and Adolescents with Low Grade Glioma

et al. 2019

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Low grade gliomas (LGGs) constitute the largest, yet clinically and (molecular-) histologically heterogeneous group of pediatric brain tumors of WHO grades I and II occurring throughout all pediatric age groups and at all central nervous system (CNS) sites. The tumors are characterized by a slow growth rate and may show periods of growth arrest. Around 40% of all LGG patients can be cured by complete neurosurgical resection and are followed by close observation. In case of relapse, second resection often is possible. Following incomplete resection observation is recommended, as long as there is no radiologic tumor growth and the patient does not suffer from significant, tumor-related symptoms. This also applies to patients with a diagnosis of LGG on the basis of radiological criteria. By contrast, clinical worsening and / or radiologic progression are an indication to treatment with either chemo- or radiotherapy. Overall survival is around 90%, and many patients survive with residual tumor, i. e. they suffer from chronic disease. All patients need comprehensive neuro-oncological care, the principles and details of which are summarized in the current guidelines. These represent standard of care for diagnostic work-up (including neuroimaging and neuropathology), and for therapeutic decisions (including the indications to non-surgical treatment) as well as concepts for neurosurgical intervention, chemotherapy and radiotherapy as well as surveillance and rehabilitation. The current treatment algorithm was compiled by members of the LGG working group of the SIOP-E brain tumor group (SIOP-E-BTG) and is based upon the results of previous European LGG studies and international reports.

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“…[ 7 ] However, just like our case, the imaging findings of the lesions can be atypical in other areas. [ 7 ] Instead of typical contrast enhancement under MRI, they showed an atypical solid mass without cystic change and infiltration.…”

Section: Discussionmentioning

confidence: 55%

Dysembryoplastic neuroepithelial tumor-like pilocytic astrocytoma

Jia-Ming¹,

Wang

Xie

et al. 2018

Medicine

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Rationale:Pilocytic astrocytoma (PA) typically shows biphasic pattern with a mixture of loose microcystic and compact regions, in which it is not uncommon to see heterogeneous morphology. However, there has not been reported in the literatures of the PA type that shows similarity to dysembryoplastic neuroepithelial tumor (DNT) in both histological morphology and immunophenotype.Patient concerns:The present study described a case of PA affecting the right temporal-occipital lobe in a 22-year-old male patient. Morphologically, it composed of totally distinctive microcystic pattern. The classical biphasic pattern of PA was not observed. Immunohistochemically, neuronal marker NeuN was expressed in tumor cells scattered in the background which simulated its expression morphology in DNT. However, KIAA1549-BRAF fusion gene was identified by fluorescence in situ hybridization (FISH), supporting for the diagnosis of PA.Diagnoses:DNT-like PA (WHO grade I).Interventions:The tumor was totally removed via a right temporal-occipital craniotomy.Outcomes:The patient is free of local recurrence and dissemination eleven months after surgical resection of the lesion.Lessons:We herein report a rare case of DNT-like PA. For diagnosis, KIAA1549-BRAF fusion gene should be detected under similar situation.

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MR imaging of brain pilocytic astrocytoma: beyond the stereotype of benign astrocytoma

Cited by 42 publications

References 81 publications

Diagnostic accuracy of diffusion weighted imaging for differentiation of supratentorial pilocytic astrocytoma and pleomorphic xanthoastrocytoma

Diagnostic accuracy of diffusion weighted imaging for differentiation of supratentorial pilocytic astrocytoma and pleomorphic xanthoastrocytoma

SIOP-E-BTG and GPOH Guidelines for Diagnosis and Treatment of Children and Adolescents with Low Grade Glioma

Dysembryoplastic neuroepithelial tumor-like pilocytic astrocytoma

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