Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-669899f699-7tmb6 Total loading time: 0 Render date: 2025-05-01T10:14:46.135Z Has data issue: false hasContentIssue false

Chapter 50 - Physiological MR of pediatric brain tumors

from Section 8 - Pediatrics

Published online by Cambridge University Press:  05 March 2013

By
Stefan Blüml  and
Ashok Panigrahy
Edited by
Jonathan H. Gillard ,
Adam D. Waldman  and
Peter B. Barker
Jonathan H. Gillard
Affiliation:
University of Cambridge
Adam D. Waldman
Affiliation:
Imperial College London
Peter B. Barker
Affiliation:
The Johns Hopkins University School of Medicine
Get access

Summary

Introduction

Childhood brain tumors are the second most frequent malignancy of childhood, exceeded only by leukemia, and the most common form of solid tumor. There are approximately 2500 new diagnoses per year in the USA and the incidence of brain tumors has increased slightly over the decades, possibly as a result of improved diagnostic imaging. Brain tumors comprise 20–25% of all malignancies occurring among children under 15 years of age and 10% of tumors occurring among those aged 15–19 years. Brain tumors are the leading cause of death from cancer in pediatric oncology. In addition, either because of the effects of the tumor or because of the treatment required to control it, survivors of childhood brain tumors often have severe neurological, neurocognitive, and psychosocial sequelae. Among those with brain tumors, approximately 35% are younger than 5 years and 75% are younger than 10 years. The type of tumor, the overall incidence of brain tumors, and the risks for poor outcome change with the age. Young children are at the highest risk since tumors tend to be more malignant in their behavior in this age group. Childhood brain tumors display a high pathological heterogeneity. Whereas most brain tumors in adults are gliomas (~70% malignant anaplastic astrocytoma and glioblastoma), a significant portion of pediatric brain tumors are primitive neuroectodermal tumors such as medulloblastoma, pilocytic astrocytomas, ependymomas, and others (Tables 50.1 and 50.2). Also, the behavior of pediatric brain tumors ranges from relatively indolent growth to rapid growth and a tendency to disseminate. Genetic risk factors for brain tumors include neurofibromatosis types 1 and 2 (pilocytic astrocytoma, low-grade gliomas, ependymoma), Turcot syndrome (medulloblastoma and high-grade glioma), Li–Fraumeni syndrome, Gorlin syndrome, and von Hippel–Lindau syndrome (hemangioblastoma). The only confirmed environmental risk factor is previous exposure to ionizing radiation.

Type
Chapter
Information
Clinical MR Neuroimaging
Physiological and Functional Techniques
 , pp. 766 - 783
Publisher: Cambridge University Press
Print publication year: 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

World Health Organization. Classification of Tumors of the Central Nervous System. Geneva: World Health Organization, 2007.Google Scholar
Gupta, N, Banerjee, A, Haas-Kogan, D (eds.). Pediatric CNS tumors. Berlin: Springer, 2004.CrossRefGoogle Scholar
Central Brain Tumor Registry of the United States. Statistical Report: Primary Brain Tumors in the United States, 1997–2001. Washington, DC: Central Brain Tumor Registry, 2004.Google Scholar
Karren, EW.Molecularly targeted therapy for pediatric brain tumors. J Neurooncol 2005; 75: 335–343.Google Scholar
Farmer, JP, Montes, JL, Freeman, CR, et al. Brainstem gliomas. A 10-year institutional review. Pediatr Neurosurg 2001; 34: 206–214.CrossRefGoogle ScholarPubMed
Freeman, CR, Farmer, JP.Pediatric brain stem gliomas: a review. Int J Radiat Oncol Biol Phys 1998; 40: 265–271.CrossRefGoogle ScholarPubMed
Mandell, LR, Kadota, R, Freeman, C, et al. There is no role for hyperfractionated radiotherapy in the management of children with newly diagnosed diffuse intrinsic brainstem tumors: results of a Pediatric Oncology Group phase III trial comparing conventional vs. hyperfractionated radiotherapy. Int J Radiat Oncol Biol Phys 1999; 43: 959–964.CrossRefGoogle ScholarPubMed
Pan, E, Prados, M.Brainstem gliomas. In Pediatric CNS Tumors, eds. Gupta, N, Haas-Kogan, D, Banerjee, A. Berlin: Springer, 2004, pp. 49–61.CrossRefGoogle Scholar
Nelson, MD, Soni, D, Baram, TZ.Necrosis in pontine gliomas: radiation induced or natural history?Radiology 1994; 191: 279–282.CrossRefGoogle ScholarPubMed
Yoshimura, J, Onda, K, Tanaka, R, et al. Clinicopathological study of diffuse type brainstem gliomas: analysis of 40 autopsy cases. Neurol Med Chir (Tokyo) 2003; 43: 375–382; discussion 382.CrossRefGoogle ScholarPubMed
Wen, PY, Kesari, S.Malignant gliomas in adults. N Engl J Med 2008; 359: 492–507.CrossRefGoogle ScholarPubMed
Fisher, JL, Schwartzbaum, JA, Wrensch, M, et al. Epidemiology of brain tumors. Neurol Clin 2007; 25: 867–890, vii.CrossRefGoogle ScholarPubMed
Sands, SA, van Gorp, WG, Finlay, JL. Pilot neuropsychological findings from a treatment regimen consisting of intensive chemotherapy and bone marrow rescue for young children with newly diagnosed malignant brain tumors. Childs Nerv Syst 1998; 14: 587–589.CrossRefGoogle ScholarPubMed
Dhall, G, Grodman, H, Ji, L, et al. Outcome of children less than three years old at diagnosis with non-metastatic medulloblastoma treated with chemotherapy on the “Head Start” I and II protocols. Pediatr Blood Cancer 2008; 50: 1169–1175.CrossRefGoogle ScholarPubMed
Gardner, SL, Asgharzadeh, S, Green, A, et al. Intensive induction chemotherapy followed by high dose chemotherapy with autologous hematopoietic progenitor cell rescue in young children newly diagnosed with central nervous system atypical teratoid rhabdoid tumors. Pediatr Blood Cancer 2008; 51: 235–240.CrossRefGoogle ScholarPubMed
Fangusaro, J, Finlay, J, Sposto, R, et al. Intensive chemotherapy followed by consolidative myeloablative chemotherapy with autologous hematopoietic cell rescue (AuHCR) in young children with newly diagnosed supratentorial primitive neuroectodermal tumors (sPNETs): report of the Head Start I and II experience. Pediatr Blood Cancer 2008; 50: 312–318.CrossRefGoogle Scholar
Zacharoulis, S, Levy, A, Chi, SN, et al. Outcome for young children newly diagnosed with ependymoma, treated with intensive induction chemotherapy followed by myeloablative chemotherapy and autologous stem cell rescue. Pediatr Blood Cancer 2007; 49: 34–40.CrossRefGoogle ScholarPubMed
Poussaint, TY. Magnetic resonance imaging of pediatric brain tumors: state of the art. Top Magn Reson Imaging 2001; 12: 411–433.CrossRefGoogle ScholarPubMed
Moreno-Torres, A, Martinez-Perez, I, Baquero, M, et al. Taurine detection by proton magnetic resonance spectroscopy in medulloblastoma: contribution to noninvasive differential diagnosis with cerebellar astrocytomas. Neurosurgery 2004; 55: 824–829.CrossRefGoogle Scholar
Wilke, M, Eidenschink, A, Muller-Weihrich, S, et al. MR diffusion imaging and 1H spectroscopy in a child with medulloblastoma. A case report. Acta Radiol 2001; 42: 39–42.Google Scholar
Tong, Z, Yamaki, T, Harada, K, et al. In vivo quantification of the metabolites in normal brain and brain tumors by proton MR spectroscopy using water as an internal standard. Magn Reson Imaging 2004; 22: 1017–1024.CrossRefGoogle ScholarPubMed
Kovanlikaya, A, Panigrahy, A, Krieger, MD, et al. Untreated pediatric primitive neuroectodermal tumor in vivo: quantitation of taurine with MR spectroscopy. Radiology 2005; 236: 1020–1025.CrossRefGoogle ScholarPubMed
Wang, Z, Sutton, LN, Cnaan, A, et al. Proton MR spectroscopy of pediatric cerebellar tumors. AJNR Am J Neuroradiol 1995; 16: 1821–1833.Google ScholarPubMed
Panigrahy, A, Krieger, MD, Gonzalez-Gomez, I, et al. Quantitative short echo time 1H-MR spectroscopy of untreated pediatric brain tumors: preoperative diagnosis and characterization. AJNR Am J Neuroradiol 2006; 27: 560–572.Google ScholarPubMed
Rumboldt, Z, Camacho, DL, Lake, D, et al. Apparent diffusion coefficients for differentiation of cerebellar tumors in children. AJNR Am J Neuroradiol 2006; 27: 1362–1369.Google ScholarPubMed
Ball, WS, Holland, SK. Perfusion imaging in the pediatric patient. Magn Reson Imaging Clin N Am 2001; 9: 207–230, ix.Google ScholarPubMed
Cha, S.Dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging in pediatric patients. Neuroimaging Clin N Am 2006; 16: 137–147, ix.CrossRefGoogle ScholarPubMed
Albright, AL, Packer, RJ, Zimmerman, R, et al. Magnetic resonance scans should replace biopsies for the diagnosis of diffuse brain stem gliomas: a report from the Children’s Cancer Group. Neurosurgery 1993; 33: 1026–1029; discussion 1029–1030.Google Scholar
Jallo, GI, Biser-Rohrbaugh, A, Freed, D.Brainstem gliomas. Childs Nerv Syst 2004; 20: 143–153.CrossRefGoogle ScholarPubMed
Barkovich, AJ, Krischer, J, Kun, LE, et al. Brain stem gliomas: a classification system based on magnetic resonance imaging. Pediatr Neurosurg 1990; 16: 73–83.CrossRefGoogle ScholarPubMed
Seymour, ZA, Panigrahy, A, Finlay, JL, et al. Citrate in pediatric CNS tumors?AJNR Am J Neuroradiol 2008; 29: 1006–1011.CrossRefGoogle ScholarPubMed
Panigrahy, A, Nelson, MD, Finlay, JL, et al. Metabolism of diffuse intrinsic brainstem gliomas in children. Neuro Oncol 2008; 10: 32–44.CrossRefGoogle ScholarPubMed
Panigrahy, A, Krieger, M, Gonzalez-Gomez, I, et al. Differentiation of encephalitis from astrocytomas in pediatric patients by quantitative in vivo MRS spectroscopy. In Proceedings of the American Society of Neuroradiology, Chicago, 2007.Google Scholar
Shiroishi, MS, Panigrahy, A, Moore, KR, et al. Combined MR imaging and MR spectroscopy provides more accurate pretherapeutic diagnoses of pediatric brain tumors than MR imaging alone. In Proceedings of the American Society of Neuroradiology, New Orleans, 2008.Google Scholar
Arle, JE, Morriss, C, Wang, ZJ, et al. Prediction of posterior fossa tumor type in children by means of magnetic resonance image properties, spectroscopy, and neural networks. J Neurosurg 1997; 86: 755–761.CrossRefGoogle ScholarPubMed
Brown, WD, Gilles, FH, Tavare, CJ, et al. Prognostic limitations of the Daumas–Duport grading scheme in childhood supratentorial astroglial tumors. J Neuropathol Exp Neurol 1998; 57: 1035–1040.CrossRefGoogle ScholarPubMed
Gilles, FH, Leviton, A, Tavare, CJ, et al. Definitive classes of childhood supratentorial neuroglial tumors. The Childhood Brain Tumor Consortium. Pediatr Dev Pathol. 2000; 3: 126–139.CrossRefGoogle ScholarPubMed
Hockel, M, Schlenger, K, Mitze, M, et al. Hypoxia and radiation response in human tumors. Semin Radiat Oncol 1996; 6: 3–9.CrossRefGoogle ScholarPubMed
Hockel, M, Schlenger, K, Aral, B, et al. Association between tumor hypoxia and malignant progression in advanced cancer of the uterine cervix. Cancer Res 1996; 56: 4509–4515.Google ScholarPubMed
Sutherland, RM, Ausserer, WA, Murphy, BJ, et al. Tumor hypoxia and heterogeneity: challenges and opportunities for the future. Semin Radiat Oncol 1996; 6: 59–70.CrossRefGoogle ScholarPubMed
Jain, RK, di Tomaso, E, Duda, DG, et al. Angiogenesis in brain tumours. Nat Rev Neurosci 2007; 8: 610–622.CrossRefGoogle ScholarPubMed
Winkler, F, Kozin, SV, Tong, RT, et al. Kinetics of vascular normalization by VEGFR2 blockade governs brain tumor response to radiation: role of oxygenation, angiopoietin-1, and matrix metalloproteinases. Cancer Cell 2004; 6: 553–563.Google ScholarPubMed
Peet, AC, Davies, NP, Ridley, L, et al. Magnetic resonance spectroscopy suggests key differences in the metastatic behaviour of medulloblastoma. Eur J Cancer 2007; 43: 1037–1044.CrossRefGoogle ScholarPubMed
Broniscer, A, Baker, SJ, West, AN, et al. Clinical and molecular characteristics of malignant transformation of low-grade glioma in children. J Clin Oncol 2007; 25: 682–689.CrossRefGoogle ScholarPubMed
Law, M, Young, RJ, Babb, JS, et al. Gliomas: predicting time to progression or survival with cerebral blood volume measurements at dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. Radiology 2008; 247: 490–498.CrossRefGoogle ScholarPubMed
Murakami, R, Sugahara, T, Nakamura, H, et al. Malignant supratentorial astrocytoma treated with postoperative radiation therapy: prognostic value of pretreatment quantitative diffusion-weighted MR imaging. Radiology 2007; 243: 493–499.CrossRefGoogle ScholarPubMed
Castillo, M, Smith, JK, Kwock, L. Correlation of myo-inositol levels and grading of cerebral astrocytomas. AJNR Am J Neuroradiol 2000; 21: 1645–1649.Google ScholarPubMed
Tzika, AA, Vigneron, DB, Dunn, RS, et al. Intracranial tumors in children: small single-voxel proton MR spectroscopy using short- and long-echo sequences. Neuroradiology 1996; 38: 254–263.CrossRefGoogle Scholar
Negendank, WG. Studies of human tumors by MRS: a review. NMR Biomed 1992; 5: 303–324.CrossRefGoogle ScholarPubMed
Negendank, WG, Sauter, R, Brown, TR, et al. Proton magnetic resonance spectroscopy in patients with glial tumors: a multicenter study. J Neurosurg 1996; 84: 449–458.CrossRefGoogle ScholarPubMed
Nelson, SJ, Vigneron, DB, Dillon, WP. Serial evaluation of patients with brain tumors using volume MRI and 3D 1H MRSI. NMR Biomed 1999; 12: 123–138.3.0.CO;2-Y>CrossRefGoogle ScholarPubMed
Sijens, PE, Knopp, MV, Brunetti, A, et al. 1H MR spectroscopy in patients with metastatic brain tumors: a multicenter trial. Magn Reson Med 1995; 33: 818–826.CrossRefGoogle Scholar
Taylor, JS, Ogg, RJ, Langston, JW. Proton MR spectroscopy of pediatric brain tumors. Neuroimaging Clin N Am 1998; 8: 753–779.Google ScholarPubMed
Taylor, JS, Langston, JW, Reddick, WE, et al. Clinical value of proton magnetic resonance spectroscopy for differentiating recurrent or residual brain tumor from delayed cerebral necrosis. Int J Radiat Oncol Biol Phys 1996; 36: 1251–1261.CrossRefGoogle ScholarPubMed
Shimizu, H, Kumabe, T, Tominaga, T, et al. Noninvasive evaluation of malignancy of brain tumors with proton MR spectroscopy. AJNR Am J Neuroradiol 1996; 17: 737–747.Google ScholarPubMed
Chang, YW, Yoon, HK, Shin, HJ, et al. MR imaging of glioblastoma in children: usefulness of diffusion/perfusion-weighted MRI and MR spectroscopy. Pediatr Radiol 2003; 33: 836–842.CrossRefGoogle ScholarPubMed
Tzika, AA, Astrakas, LG, Zarifi, MK, et al. Multiparametric MR assessment of pediatric brain tumors. Neuroradiology 2003; 45: 1–10.CrossRefGoogle ScholarPubMed
Thakur, SB, Karimi, S, Dunkel, IJ, et al. Longitudinal MR spectroscopic imaging of pediatric diffuse pontine tumors to assess tumor aggression and progression. AJNR Am J Neuroradiol 2006; 27: 806–809.Google ScholarPubMed
Laprie, A, Pirzkall, A, Haas-Kogan, DA, et al. Longitudinal multivoxel MR spectroscopy study of pediatric diffuse brainstem gliomas treated with radiotherapy. Int J Radiat Oncol Biol Phys 2005; 62: 20–31.CrossRefGoogle ScholarPubMed
Lazareff, JA, Gupta, RK, Alger, J. Variation of post-treatment H-MRSI choline intensity in pediatric gliomas. J Neurooncol 1999; 41: 291–298.CrossRefGoogle ScholarPubMed
Warren, KE, Frank, JA, Black, JL, et al. Proton magnetic resonance spectroscopic imaging in children with recurrent primary brain tumors. J Clin Oncol 2000; 18: 1020–1026.CrossRefGoogle ScholarPubMed
Tzika, AA, Astrakas, LG, Zarifi, MK, et al. Spectroscopic and perfusion magnetic resonance imaging predictors of progression in pediatric brain tumors. Cancer 2004; 100: 1246–1256.CrossRefGoogle ScholarPubMed
Wald, LL, Nelson, SJ, Day, MR, et al. Serial proton magnetic resonance spectroscopy imaging of glioblastoma multiforme after brachytherapy. J Neurosurg 1997; 87: 525–534.CrossRefGoogle ScholarPubMed
Preul, MC, Leblanc, R, Caramanos, Z, et al. Magnetic resonance spectroscopy guided brain tumor resection: differentiation between recurrent glioma and radiation change in two diagnostically difficult cases. Can J Neurol Sci 1998; 25: 13–22.CrossRefGoogle ScholarPubMed
Isobe, T, Matsumura, A, Anno, I, et al. [Changes in 1H-MRS in glioma patients before and after irradiation: the significance of quantitative analysis of choline-containing compounds.]No Shinkei Geka 2003; 31: 167–172.Google Scholar
Schlemmer, HP, Bachert, P, Herfarth, KK, et al. Proton MR spectroscopic evaluation of suspicious brain lesions after stereotactic radiotherapy. AJNR Am J Neuroradiol 2001; 22: 1316–1324.Google ScholarPubMed
Ross, BD, Moffat, BA, Lawrence, TS, et al. Evaluation of cancer therapy using diffusion magnetic resonance imaging. Mol Cancer Ther 2003; 2: 581–587.Google ScholarPubMed
Mardor, Y, Roth, Y, Lidar, Z, et al. Monitoring response to convection-enhanced taxol delivery in brain tumor patients using diffusion-weighted magnetic resonance imaging. Cancer Res 2001; 61: 4971–4973.Google ScholarPubMed
Sugahara, T, Korogi, Y, Tomiguchi, S, et al. Posttherapeutic intraaxial brain tumor: the value of perfusion-sensitive contrast-enhanced MR imaging for differentiating tumor recurrence from nonneoplastic contrast-enhancing tissue. AJNR Am J Neuroradiol 2000; 21: 901–909.Google ScholarPubMed
Panigrahy, A, Finlay, J, Dhall, G, et al. Post-therapeutic metabolic changes in diffuse intrinsic brain stem glioma: initial experience. In Proceedings of the 13th International Symposium on Pediatric Neuro-Oncology 2008, p. 393.Google Scholar
Ananthnarayan, S, Bahng, J, Roring, J, et al. Time course of imaging changes of GBM during extended bevacizumab treatment. J Neurooncol 2008; 88: 339–347.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×