This study aimed to evaluate the application of apparent diffusion coefficient (ADC) histogram analysis to differentiate posterior fossa tumors (PFTs) in children.
A total of 175 pediatric patients with PFT, including 75 pilocytic astrocytomas (PA), 59 medulloblastomas, 16 ependymomas, and 13 atypical teratoid rhabdoid tumors (ATRT), were analyzed. Tumors were visually assessed using DWI trace and conventional MRI images and manually segmented and post-processed using parametric software (pMRI). Furthermore, tumor ADC values were normalized to the thalamus and cerebellar cortex. The following histogram metrics were obtained: entropy, minimum, 10th, and 90th percentiles, maximum, mean, median, skewness, and kurtosis to distinguish the different types of tumors. Kruskal Wallis and Mann-Whitney U tests were used to evaluate the differences. Finally, receiver operating characteristic (ROC) curves were utilized to determine the optimal cut-off values for differentiating the various PFTs.
Most ADC histogram metrics showed significant differences between PFTs (p < 0.001) except for entropy, skewness, and kurtosis. There were significant pairwise differences in ADC metrics for PA versus medulloblastoma, PA versus ependymoma, PA versus ATRT, medulloblastoma versus ependymoma, and ependymoma versus ATRT (all p < 0.05). Our results showed no significant differences between medulloblastoma and ATRT. Normalized ADC data showed similar results to the absolute ADC value analysis. ROC curve analysis for normalized ADCmedian values to thalamus showed 94.9% sensitivity (95% CI: 85–100%) and 93.3% specificity (95% CI: 87–100%) for differentiating medulloblastoma from ependymoma.
ADC histogram metrics can be applied to differentiate most types of posterior fossa tumors in children.
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Conflict of interest
F.G. Gonçalves, A. Zandifar, J.D. Ub Kim, L.O. Tierradentro-García, A. Ghosh, D. Khrichenko, S. Andronikou and A. Vossough declare that they have no competing interests.
This retrospective study was approved by our Institutional Review Board and is HIPPA compliant; a waiver for consent was granted. For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case. This retrospective study was performed after consultation with the institutional ethics committee and in accordance with national legal requirements.
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Gonçalves, F.G., Zandifar, A., Ub Kim, J.D. et al. Application of Apparent Diffusion Coefficient Histogram Metrics for Differentiation of Pediatric Posterior Fossa Tumors. Clin Neuroradiol 32, 1097–1108 (2022). https://doi.org/10.1007/s00062-022-01179-6
- Diffusion-weighted imaging
- Brain tumor
- Histogram radiometric metrics
- Advanced MRI