TY - JOUR
T1 - Imaging biomarkers for adult medulloblastomas
T2 - Genetic entities may be identified by their MR imaging radiophenotype
AU - Keil, V. C.
AU - Warmuth-Metz, M.
AU - Reh, C.
AU - Enkirch, S. J.
AU - Reinert, C.
AU - Beier, D.
AU - Jones, D. T. W.
AU - Pietsch, T.
AU - Schild, H. H.
AU - Hattingen, E.
AU - Hau, P.
N1 - © 2017 by American Journal of Neuroradiology.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - BACKGROUND AND PURPOSE: The occurrence of medulloblastomas in adults is rare; nevertheless, these tumors can be subdivided into genetic and histologic entities each having distinct prognoses. This study aimed to identifyMRimaging biomarkers to classify these entities and to uncover differences in MR imaging biomarkers identified in pediatric medulloblastomas. MATERIALSANDMETHODS: Eligible preoperative MRIs from 28 patients (11 women; 22-53 years of age) of the Multicenter Pilot-study for the Therapy of Medulloblastoma of Adults (NOA-7) cohort were assessed by 3 experienced neuroradiologists. Lesions and perifocal edema were volumetrized and multiparametrically evaluated for classic morphologic characteristics, location, hydrocephalus, and Chang criteria. To identify MR imaging biomarkers, we correlated genetic entities sonic hedgehog (SHH) TP53 wild type, wingless (WNT), and non-WNT/non-SHH medulloblastomas (in adults, Group 4), and histologic entities were correlated with the imaging criteria. These MR imaging biomarkers were compared with corresponding data from a pediatric study. RESULTS: There were 19 SHH TP53 wild type (69%), 4 WNT-Activated (14%), and 5 Group 4 (17%) medulloblastomas. Six potential MR imaging biomarkers were identified, 3 of which, hydrocephalus (P=.03), intraventricular macrometastases (P=.02), and hemorrhage (P= .04), when combined, could identify WNT medulloblastoma with 100% sensitivity and 88.3% specificity (95% CI, 39.8%-100.0% and 62.6%-95.3%). WNT-Activated nuclear -catenin accumulating medulloblastomas were smaller than the other entities (95% CI, 5.2-22.3 cm3 versus 35.1- 47.6 cm3; P = .03). Hemorrhage was exclusively present in non-WNT/non-SHH medulloblastomas (P= .04; n = 2/5). MR imaging biomarkers were all discordant from those identified in the pediatric cohort. Desmoplastic/nodular medulloblastomas were more rarely in contact with the fourth ventricle (4/15 versus 7/13; P = .04). CONCLUSIONS: MR imaging biomarkers can help distinguish histologic and genetic medulloblastoma entities in adults and appear to be different from those identified in children.
AB - BACKGROUND AND PURPOSE: The occurrence of medulloblastomas in adults is rare; nevertheless, these tumors can be subdivided into genetic and histologic entities each having distinct prognoses. This study aimed to identifyMRimaging biomarkers to classify these entities and to uncover differences in MR imaging biomarkers identified in pediatric medulloblastomas. MATERIALSANDMETHODS: Eligible preoperative MRIs from 28 patients (11 women; 22-53 years of age) of the Multicenter Pilot-study for the Therapy of Medulloblastoma of Adults (NOA-7) cohort were assessed by 3 experienced neuroradiologists. Lesions and perifocal edema were volumetrized and multiparametrically evaluated for classic morphologic characteristics, location, hydrocephalus, and Chang criteria. To identify MR imaging biomarkers, we correlated genetic entities sonic hedgehog (SHH) TP53 wild type, wingless (WNT), and non-WNT/non-SHH medulloblastomas (in adults, Group 4), and histologic entities were correlated with the imaging criteria. These MR imaging biomarkers were compared with corresponding data from a pediatric study. RESULTS: There were 19 SHH TP53 wild type (69%), 4 WNT-Activated (14%), and 5 Group 4 (17%) medulloblastomas. Six potential MR imaging biomarkers were identified, 3 of which, hydrocephalus (P=.03), intraventricular macrometastases (P=.02), and hemorrhage (P= .04), when combined, could identify WNT medulloblastoma with 100% sensitivity and 88.3% specificity (95% CI, 39.8%-100.0% and 62.6%-95.3%). WNT-Activated nuclear -catenin accumulating medulloblastomas were smaller than the other entities (95% CI, 5.2-22.3 cm3 versus 35.1- 47.6 cm3; P = .03). Hemorrhage was exclusively present in non-WNT/non-SHH medulloblastomas (P= .04; n = 2/5). MR imaging biomarkers were all discordant from those identified in the pediatric cohort. Desmoplastic/nodular medulloblastomas were more rarely in contact with the fourth ventricle (4/15 versus 7/13; P = .04). CONCLUSIONS: MR imaging biomarkers can help distinguish histologic and genetic medulloblastoma entities in adults and appear to be different from those identified in children.
KW - Adult
KW - Cerebellar Neoplasms/diagnostic imaging
KW - Clinical Trials as Topic
KW - Cohort Studies
KW - Female
KW - Genetic Markers
KW - Humans
KW - Magnetic Resonance Imaging
KW - Male
KW - Medulloblastoma/diagnostic imaging
KW - Middle Aged
KW - Neuroimaging
KW - Pilot Projects
KW - Prognosis
KW - Retrospective Studies
KW - Sensitivity and Specificity
KW - Young Adult
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85031724964&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/28798218
U2 - https://doi.org/10.3174/ajnr.A5313
DO - https://doi.org/10.3174/ajnr.A5313
M3 - Article
C2 - 28798218
SN - 0195-6108
VL - 38
SP - 1892
EP - 1898
JO - American journal of neuroradiology
JF - American journal of neuroradiology
IS - 10
ER -