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MR dynamic-susceptibility-contrast perfusion metrics in the presurgical discrimination of adult solitary intra-axial cerebellar tumors

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Abstract

Objectives

Adult solitary intra-axial cerebellar tumors are uncommon. Their presurgical differentiation based on neuroimaging is crucial, since management differs substantially. Comprehensive full assessment of MR dynamic-susceptibility-contrast perfusion-weighted imaging (DSC-PWI) may reveal key differences between entities. This study aims to provide new insights on perfusion patterns of these tumors and to explore the potential of DSC-PWI in their presurgical discrimination.

Methods

Adult patients with a solitary cerebellar tumor on presurgical MR and confirmed histological diagnosis of metastasis, medulloblastoma, hemangioblastoma, or pilocytic astrocytoma were retrospectively retrieved (2008–2023). Volumetric segmentation of tumors and normal-appearing white matter (for normalization) was semi-automatically performed on CE-T1WI and coregistered with DSC-PWI. Mean normalized values per patient tumor-mask of relative cerebral blood volume (rCBV), percentage of signal recovery (PSR), peak height (PH), and normalized time-intensity curves (nTIC) were extracted. Statistical comparisons were done. Then, the dataset was split into training (75%) and test (25%) cohorts and a classifier was created considering nTIC, rCBV, PSR, and PH in the model.

Results

Sixty-eight patients (31 metastases, 13 medulloblastomas, 13 hemangioblastomas, and 11 pilocytic astrocytomas) were included. Relevant differences between tumor types’ nTICs were demonstrated. Hemangioblastoma showed the highest rCBV and PH, pilocytic astrocytoma the highest PSR. All parameters showed significant differences on the Kruskal–Wallis tests (p < 0.001). The classifier yielded an accuracy of 98% (47/48) in the training and 85% (17/20) in the test sets.

Conclusions

Intra-axial cerebellar tumors in adults have singular and significantly different DSC-PWI signatures. The combination of perfusion metrics through data-analysis rendered excellent accuracies in discriminating these entities.

Clinical relevance statement

In this study, the authors constructed a classifier for the non-invasive imaging presurgical diagnosis of adult intra-axial cerebellar tumors. The resultant tool can be a support for decision-making in the clinical practice and enables optimal personalized patient management.

Key Points

• Adult intra-axial cerebellar tumors exhibit specific, singular, and statistically significant different MR dynamic-susceptibility-contrast perfusion-weighted imaging (DSC-PWI) signatures.

• Data-analysis, applied to MR DSC-PWI, could provide added value in the presurgical diagnosis of solitary cerebellar metastasis, medulloblastoma, hemangioblastoma, and pilocytic astrocytoma.

• A classifier based on DSC-PWI metrics yields excellent accuracy rates and could be used as a support tool for radiologic diagnosis with clinician-friendly displays.

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Abbreviations

DSC-PWI:

Dynamic-susceptibility-contrast perfusion-weighted imaging

nTIC:

Normalized time-intensity curves

PH:

Peak height

PSR:

Percentage of signal recovery

rCBV:

Relative cerebral blood volume

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Acknowledgements

Albert Pons-Escoda and Carles Majos acknowledge a grant from the Instituto de Salud Carlos III (PI20/00360). Pablo Gago-Ferrero acknowledges a Ramón y Cajal grant (RYC2019-027913-I). The authors want to acknowledge Pilar Lopez-Ubeda, PhD, from HT Medica. She participated in retrospective patient recruitment through advanced natural language processing methods. The authors thank CERCA Programme/Generalitat de Catalunya for institutional support.

Funding

No funding was received.

Author information

Author notes

  1. Albert Pons-Escoda and Alonso Garcia-Ruiz are first authors with equal contributions.

Authors and Affiliations

  1. Radiology Department, Hospital Universitari de Bellvitge, Feixa Llarga SN, 08907, L’Hospitalet de Llobregat, Barcelona, Spain

    Albert Pons-Escoda, Pablo Naval-Baudin, Susanie Flores-Casaperalta, Montserrat Fernandez-Viñas & Carles Majos

  2. Neuro-Oncology Unit, Institut d’Investigació Biomedica de Bellvitge, IDIBELL, Barcelona, Spain

    Albert Pons-Escoda, Alejandro Fernandez-Coello & Carles Majos

  3. Radiomics Group, Vall d’Hebron Institut d’Oncologia, Barcelona, Spain

    Alonso Garcia-Ruiz & Raquel Perez-Lopez

  4. Universidad de Murcia, Murcia, Spain

    Clemente Garcia-Hidalgo

  5. Institut de Diagnostic Ambiental i Estudis de l’Aigua (IDAEA) – CSIC, Barcelona, Spain

    Ruben Gil-Solsona & Pablo Gago-Ferrero

  6. Magnetic Resonance Unit, HT Medica, Jaen, Spain

    Teodoro Martin-Noguerol

  7. Neurosurgery Department, Hospital Universitari de Bellvitge, Barcelona, Spain

    Alejandro Fernandez-Coello

  8. Biomedical Research Networking Centers of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain

    Alejandro Fernandez-Coello

  9. Radiology Department, Hospital Clinic de Barcelona, Barcelona, Spain

    Laura Oleaga

Authors
  1. Albert Pons-Escoda
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  2. Alonso Garcia-Ruiz
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Corresponding author

Correspondence to Albert Pons-Escoda.

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Guarantor

The scientific guarantor of this publication is Albert Pons-Escoda.

Conflict of interest

Albert Pons-Escoda is a member of the European Radiology Scientific Editorial Board. He has not taken part in review or selection process for this article. The remaining authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Several authors have significant statistical expertise; mainly Alonso Garcia-Ruiz and Ruben Gil-Solsona have expertise in statistics, data analysis, and machine learning.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained. This study has been approved by The Research Ethics Committee of the Hospital Universitari de Bellvitge (PR306/22).

Study subjects or cohorts overlap

None of the study subjects or cohorts has been previously reported.

Methodology

• retrospective

• diagnostic study

• performed at one institution

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Twitter: @PonsEscoda

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Pons-Escoda, A., Garcia-Ruiz, A., Garcia-Hidalgo, C. et al. MR dynamic-susceptibility-contrast perfusion metrics in the presurgical discrimination of adult solitary intra-axial cerebellar tumors. Eur Radiol 33, 9120–9129 (2023). https://doi.org/10.1007/s00330-023-09892-7

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