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Journal of Neuro-Oncology

, Volume 134, Issue 1, pp 221–230 | Cite as

MRI features of pediatric intracranial germ cell tumor subtypes

  • Chih-Chun WuEmail author
  • Wan-Yuo Guo
  • Feng-Chi Chang
  • Chao-Bao Luo
  • Han-Jui Lee
  • Yi-Wei Chen
  • Yi-Yen Lee
  • Tai-Tong Wong
Clinical Study

Abstract

Intracranial germ cell tumors differ in histology and location, and require different clinical management strategies. We characterized the imaging features that may aid pre-operative differentiation of intracranial germinomas and non-germinomatous germ cell tumors (NGGCTs). This retrospective study analyzed 85 patients with intracranial germ cell tumors and adequate preoperative or pretreatment MRIs between 2000 and 2013 at our institution. Pretreatment MRI characteristics, apparent diffusion coefficient (ADC) values, tumor histopathology, and patient outcomes were compared. NGGCTs occurred in the pineal region and cerebral hemispheres more often than germinomas; all bifocal lesions were germinomas. NGGCTs (36.6 ± 17.0 mm) were significantly larger than germinomas (25.7 ± 11.6 mm; P = 0.002). The presence of pure solid tumor (45.5 vs. 20.0%, P = 0.033) and an infiltrative margin (20.0 vs. 3.3%, P = 0.035) were significantly more common in germinomas than NGGCTs. The presence of intratumoral T1 hyperintense foci (66.7 vs. 10.9%, P < 0.001) and moderate/marked enhancement (86.7 vs. 50.9%, P < 0.001) were significantly more common in NGGCTs than in germinomas. Mean ADCmean values (×10−3 mm2/s) were significantly lower in germinomas (1.113 ± 0.415) than in NGGCTs (2.011 ± 0.694, P = 0.001). Combined a lack of T1 hyperintense foci and an ADCmean threshold value (1.143 × 10−3 mm2/s) had the highest specificity (91.3%) and positive predictive value (92.3%), while the combination of lack of a T1 hyperintensense foci, no/mild enhancement, and an ADCmean threshold value had 100% sensitivity and 100% negative-predictive value for discriminating germinomas from NGGCTs. Pre-operative conventional MRI characteristics and diffusion-weighted MRI help clinicians to assess patients with intracranial germ cell tumors. Tumor size, location, T1 hyperintense foci, intratumoral cystic components, tumor margin and enhancing patterns demonstrate contrast between germinomas and NGGCTs. Serum tumor markers and adjunctive combination with T1 hyperintensity and/or enhancing pattern with ADC offer potential in preoperative differentiating intracranial germinomas and NGGCTs.

Keywords

Apparent diffusion coefficient Central nervous system Diffusion-weighted imaging Germ cell tumor Magnetic resonance imaging 

References

  1. 1.
    Ho DM, Liu HC (1992) Primary intracranial germ cell tumor. Pathologic study of 51 patients. Cancer 70:1577–1584CrossRefPubMedGoogle Scholar
  2. 2.
    Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N, Seto T (1997) Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg 86:446–455. doi: 10.3171/jns.1997.86.3.0446 CrossRefPubMedGoogle Scholar
  3. 3.
    Wong TT, Ho DM, Chang KP, Yen SH, Guo WY, Chang FC, Liang ML, Pan HC, Chung WY (2005) Primary pediatric brain tumors: statistics of Taipei VGH, Taiwan (1975–2004). Cancer 104:2156–2167. doi: 10.1002/cncr.21430 CrossRefPubMedGoogle Scholar
  4. 4.
    Matsutani M (2004) Clinical management of primary central nervous system germ cell tumors. Semin Oncol 31:676–683CrossRefPubMedGoogle Scholar
  5. 5.
    Echevarria ME, Fangusaro J, Goldman S (2008) Pediatric central nervous system germ cell tumors: a review. Oncologist 13:690–699. doi: 10.1634/theoncologist.2008-0037 CrossRefPubMedGoogle Scholar
  6. 6.
    Yen SH, Chen YW, Huang PI, Wong TT, Ho DM, Chang KP, Liang ML, Chiou SH, Lee YY, Chen HH (2010) Optimal treatment for intracranial germinoma: can we lower radiation dose without chemotherapy? Int J Radiat Oncol Biol Phys 77:980–987. doi: 10.1016/j.ijrobp.2009.06.035 CrossRefPubMedGoogle Scholar
  7. 7.
    Ogiwara H, Tsutsumi Y, Matsuoka K, Kiyotani C, Terashima K, Morota N (2015) Apparent diffusion coefficient of intracranial germ cell tumors. J Neurooncol 121:565–571. doi: 10.1007/s11060-014-1668-y CrossRefPubMedGoogle Scholar
  8. 8.
    Moon WK, Chang KH, Kim IO, Han MH, Choi CG, Suh DC, Yoo SJ, Han MC (1994) Germinomas of the basal ganglia and thalamus: MR findings and a comparison between MR and CT. AJR Am J Roentgenol 162:1413–1417. doi: 10.2214/ajr.162.6.8192009 CrossRefPubMedGoogle Scholar
  9. 9.
    Kim DI, Yoon PH, Ryu YH, Jeon P, Hwang GJ (1998) MRI of germinomas arising from the basal ganglia and thalamus. Neuroradiology 40:507–511CrossRefPubMedGoogle Scholar
  10. 10.
    Okamoto K, Ito J, Ishikawa K, Morii K, Yamada M, Takahashi N, Tokiguchi S, Furusawa T, Sakai K (2002) Atrophy of the basal ganglia as the initial diagnostic sign of germinoma in the basal ganglia. Neuroradiology 44:389–394. doi: 10.1007/s00234-001-0735-1 CrossRefPubMedGoogle Scholar
  11. 11.
    Oyama N, Terae S, Saitoh S, Sudoh A, Sawamura Y, Miyasaka K (2005) Bilateral germinoma involving the basal ganglia and cerebral white matter. AJNR Am J Neuroradiol 26:1166–1169PubMedGoogle Scholar
  12. 12.
    Phi JH, Cho BK, Kim SK, Paeng JC, Kim IO, Kim IH, Kim DG, Jung HW, Kim JE, Wang KC (2010) Germinomas in the basal ganglia: magnetic resonance imaging classification and the prognosis. J Neurooncol 99:227–236. doi: 10.1007/s11060-010-0119-7 CrossRefPubMedGoogle Scholar
  13. 13.
    Rasalkar DD, Chu WC, Cheng FW, Paunipagar BK, Shing MK, Li CK (2010) Atypical location of germinoma in basal ganglia in adolescents: radiological features and treatment outcomes. Br J Radiol 83:261–267. doi: 10.1259/bjr/25001856 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lee SM, Kim IO, Choi YH, Cheon JE, Kim WS, Cho HH, You SK (2016) Early imaging findings in germ cell tumors arising from the basal ganglia. Pediatr Radiol 46:719–726. doi: 10.1007/s00247-016-3542-x CrossRefPubMedGoogle Scholar
  15. 15.
    Smith AB, Rushing EJ, Smirniotopoulos JG (2010) From the archives of the AFIP: lesions of the pineal region: radiologic-pathologic correlation. Radiographics 30:2001–2020. doi: 10.1148/rg.307105131 CrossRefPubMedGoogle Scholar
  16. 16.
    Dumrongpisutikul N, Intrapiromkul J, Yousem DM (2012) Distinguishing between germinomas and pineal cell tumors on MR imaging. AJNR Am J Neuroradiol 33:550–555. doi: 10.3174/ajnr.A2806 CrossRefPubMedGoogle Scholar
  17. 17.
    Awa R, Campos F, Arita K, Sugiyama K, Tominaga A, Kurisu K, Yamasaki F, Karki P, Tokimura H, Fukukura Y, Fujii Y, Hanaya R, Oyoshi T, Hirano H (2014) Neuroimaging diagnosis of pineal region tumors-quest for pathognomonic finding of germinoma. Neuroradiology 56:525–534. doi: 10.1007/s00234-014-1369-4 CrossRefPubMedGoogle Scholar
  18. 18.
    Goodwin TL, Sainani K, Fisher PG (2009) Incidence patterns of central nervous system germ cell tumors: a SEER Study. J Pediatr Hematol Oncol 31:541–544. doi: 10.1097/MPH.0b013e3181983af5 CrossRefPubMedGoogle Scholar
  19. 19.
    Villano JL, Virk IY, Ramirez V, Propp JM, Engelhard HH, McCarthy BJ (2010) Descriptive epidemiology of central nervous system germ cell tumors: nonpineal analysis. Neuro-oncol 12:257–264. doi: 10.1093/neuonc/nop029 CrossRefPubMedGoogle Scholar
  20. 20.
    Sugiyama K, Uozumi T, Arita K, Kiya K, Kurisu K, Sumida M, Harada K (1994) Clinical evaluation of 33 patients with histologically verified germinoma. Surg Neurol 42:200–210CrossRefPubMedGoogle Scholar
  21. 21.
    Lafay-Cousin L, Millar BA, Mabbott D, Spiegler B, Drake J, Bartels U, Huang A, Bouffet E (2006) Limited-field radiation for bifocal germinoma. Int J Radiat Oncol Biol Phys 65:486–492. doi: 10.1016/j.ijrobp.2005.12.011 CrossRefPubMedGoogle Scholar
  22. 22.
    Cuccia V, Alderete D (2010) Suprasellar/pineal bifocal germ cell tumors. Child’s Nerv Syst 26:1043–1049. doi: 10.1007/s00381-010-1120-3 CrossRefGoogle Scholar
  23. 23.
    Aizer AA, Sethi RV, Hedley-Whyte ET, Ebb D, Tarbell NJ, Yock TI, Macdonald SM (2013) Bifocal intracranial tumors of nongerminomatous germ cell etiology: diagnostic and therapeutic implications. Neuro-oncol 15:955–960. doi: 10.1093/neuonc/not050 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Phi JH, Kim SK, Lee J, Park CK, Kim IH, Ahn HS, Shin HY, Kim IO, Jung HW, Kim DG, Paek SH, Wang KC (2013) The enigma of bifocal germ cell tumors in the suprasellar and pineal regions: synchronous lesions or metastasis? J Neurosurg Pediatr 11:107–114. doi: 10.3171/2012.10.PEDS11487 CrossRefPubMedGoogle Scholar
  25. 25.
    Chen YW, Huang PI, Ho DM, Hu YW, Chang KP, Chiou SH, Guo WY, Chang FC, Liang ML, Lee YY, Chen HH, Hsu TR, Lin SC, Wong TT, Yen SH (2012) Change in treatment strategy for intracranial germinoma: long-term follow-up experience at a single institute. Cancer 118:2752–2762. doi: 10.1002/cncr.26564 CrossRefPubMedGoogle Scholar
  26. 26.
    Wang Y, Zou L, Gao B (2010) Intracranial germinoma: clinical and MRI findings in 56 patients. Child’s Nerv Syst 26:1773–1777. doi: 10.1007/s00381-010-1247-2 CrossRefGoogle Scholar
  27. 27.
    Kakigi T, Okada T, Kanagaki M, Yamamoto A, Fushimi Y, Sakamoto R, Arakawa Y, Mikami Y, Shimono T, Takahashi JC, Togashi K (2014) Quantitative imaging values of CT, MR, and FDG-PET to differentiate pineal parenchymal tumors and germinomas: are they useful? Neuroradiology 56:297–303. doi: 10.1007/s00234-014-1334-2 CrossRefPubMedGoogle Scholar
  28. 28.
    Wu CC, Guo WY, Chen MH, Ho DM, Hung AS, Chung HW (2012) Direct measurement of the signal intensity of diffusion-weighted magnetic resonance imaging for preoperative grading and treatment guidance for brain gliomas. J Chin Med Assoc 75:581–588. doi: 10.1016/j.jcma.2012.08.019 CrossRefPubMedGoogle Scholar
  29. 29.
    Kinoshita Y, Yamasaki F, Tominaga A, Ohtaki M, Usui S, Arita K, Sugiyama K, Kurisu K (2016) Diffusion-weighted imaging and the apparent diffusion coefficient on 3 T MR imaging in the differentiation of craniopharyngiomas and germ cell tumors. Neurosurg Rev 39: 207–213; discussion 213. doi: 10.1007/s10143-015-0660-0 CrossRefPubMedGoogle Scholar
  30. 30.
    Takeuchi S, Takasato Y (2011) Can stereotactic sample biopsies accurately diagnose mixed germ cell tumors? Acta Neurochir 153: 1535; author reply 1537–1538. doi: 10.1007/s00701-011-1032-3 CrossRefPubMedGoogle Scholar
  31. 31.
    Balossier A, Blond S, Touzet G, Lefranc M, de Saint-Denis T, Maurage CA, Reyns N (2015) Endoscopic versus stereotactic procedure for pineal tumour biopsies: comparative review of the literature and learning from a 25-year experience. Neurochirurgie 61:146–154. doi: 10.1016/j.neuchi.2014.06.002 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of RadiologyTaipei Veterans General HospitalTaipeiTaiwan, ROC
  2. 2.School of MedicineNational Yang-Ming UniversityTaipeiTaiwan, ROC
  3. 3.Division of Radiation Oncology, Cancer CenterTaipei Veterans General HospitalTaipeiTaiwan, ROC
  4. 4.Division of Pediatric Neurosurgery, Neurological InstituteTaipei Veterans General HospitalTaipeiTaiwan, ROC
  5. 5.Department of NeurosurgeryTaipei Medical University HospitalTaipeiTaiwan, ROC
  6. 6.Taipei Cancer CenterTaipei Medical UniversityTaipeiTaiwan, ROC

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