Abstract
Introduction
We describe the magnetic resonance (MR) imaging characteristics of dysembryoplastic neuroepithelial tumors (DNT) and discuss their differential diagnosis.
Material and methods
Proton MR spectroscopy (TE 30 and 136 ms), diffusion-weighted and perfusion images were retrospectively evaluated in 22 patients with pathologically proven DNT (17 male and 5 female, mean age 18.7 years) and 14 control subjects (10 male and 4 female, mean age 16.9 years). The results from the DNT patients and from the control subjects were compared using an independent sample t-test and the degree of correlation was tested by Pearson’s correlation.
Results
All DNTs were solitary and in a supratentorial cortical or subcortical location (ten temporal, eight frontal and four parietal). They had low-signal on T1-weighted images and high-signal on T2-weighted images without a prominent mass effect. Additionally a cystic appearance (six patients, 27.3%), cortical dysplasia (six patients, 27.3%) and contrast enhancement (four patients, 18.2%) were also noted. No significant differences were detected in NAA/Cho, NAA/Cr, NAA/Cho+Cr or Cho/Cr ratios between DNT and normal brain. DNTs had a significantly higher mI/Cr ratio and apparent diffusion coefficient (ADC) values and lower cerebral blood values than normal parenchyma (P < 0.001). ADC had the highest correlation with the diagnosis of DNT (r = 0.996) followed by relative cerebral blood volume (rCBV) (r = −0.883) and mI/Cr ratio (r = 0.663).
Conclusion
Proton MR spectroscopy, diffusion-weighted and perfusion imaging characteristics of DNTs provide additional information to their MR imaging findings. The MR spectrum showing a slight increase in mI/Cr ratio, and higher ADC and lower rCBV values than normal parenchyma help to differentiate DNTs from other cortical tumors, which had higher rCBV and lower ADC values than DNTs.
Similar content being viewed by others
References
Daumas-Duport C, Pietsch T, Lantos PL (2000) Dysembryoplastic neuroepithelial tumour. In: Kleihues P, Cavenee WK (eds) WHO classification of tumours: pathology and genetics of tumours of the nervous system. IARC, Lyon, pp 103–106
Daumas-Duport C, Scheithauer BW, Chodkiewicz JP, Laws ER Jr, Vedrenne C (1988) Dysembryoplastic neuroepithelial tumor: a surgically curable tumor of young patients with intractable partial seizures. Report of thirty-nine cases. Neurosurgery 23:545–556
Stanescu Cosson R, Varlet P, Beuvon F, Daumas Duport C, Devaux B, Chassoux F, Fredy D, Meder JF (2001) Dysembryoplastic neuroepithelial tumors: CT, MR findings and imaging follow-up: a study of 53 cases. J Neuroradiol 28:230–240
Fernandez C, Girard N, Paz Paredes A, Bouvier-Labit C, Lena G, Figarella-Branger D (2003) The usefulness of MR imaging in the diagnosis of dysembryoplastic neuroepithelial tumor in children: a study of 14 cases. AJNR Am J Neuroradiol 24:829–834
Koeller KK, Dillon WP (1992) Dysembryoplastic neuroepithelial tumors: MR appearance. AJNR Am J Neuroradiol 13:1319–1325
Guesmi H, Houtteville JP, Courtheoux P, Derlon JM, Chapon F (1999) Dysembryoplastic neuroepithelial tumors. Report of 8 cases including two with unusual localization. Neurochirurgie 45:190–200
Baisden BL, Brat DJ, Melhem ER, Rosenblum MK, King AP, Burger PC (2001) Dysembryoplastic neuroepithelial tumor-like neoplasm of the septum pellucidum: a lesion often misdiagnosed as glioma: report of 10 cases. Am J Surg Pathol 25:494–499
Cervera-Pierot P, Varlet P, Chodkiewicz JP, Daumas-Duport C (1997) Dysembryoplastic neuroepithelial tumors located in the caudate nucleus area: report of four cases. Neurosurgery 40:1065–1069
Lee MC, Kang JY, Seol MB, Kim HS, Woo JY, Lee JS, Jung S, Kim JH, Woo YJ, Kim MK, Kim HI, Kim SU (2006) Clinical features and epileptogenesis of dysembryoplastic neuroepithelial tumor. Childs Nerv Syst 22:1611–1618
Raybaud C, Shroff M, Rutka JT, Chuang SH (2006) Imaging surgical epilepsy in children. Childs Nerv Syst 22:786–809
Chan CH, Bittar RG, Davis GA, Kalnins RM, Fabinyi GC (2006) Long-term seizure outcome following surgery for dysembryoplastic neuroepithelial tumor. J Neurosurg 104:62–69
Kuroiwa T, Kishikawa T, Kato A, Ueno M, Kudo S, Tabuchi K (1994) Dysembryoplastic neuroepithelial tumors: MR findings. J Comput Assist Tomogr 18:352–356
Kimura S, Kobayashi T, Hara M (1996) A case of dysembryoplastic neuroepithelial tumor of the parietal lobe with characteristic magnetic resonance imaging. Acta Paediatr Jpn 38:168–171
Lee DY, Chung CK, Hwang YS, Choe G, Chi JG, Kim HJ, Cho BK (2000) Dysembryoplastic neuroepithelial tumor: radiological findings (including PET, SPECT, and MRS) and surgical strategy. J Neurooncol 47:167–174
Ostertun B, Wolf HK, Campos MG, Matus C, Solymosi L, Elger CE, Schramm J, Schild HH (1996) Dysembryoplastic neuroepithelial tumors: MR and CT evaluation. AJNR Am J Neuroradiol 17:419–430
Jensen RL, Caamano E, Jensen EM, Couldwell WT (2006) Development of contrast enhancement after long-term observation of a dysembryoplastic neuroepithelial tumor. J Neurooncol 78:59–62
Sherburn EW, Bahn MM, Gokden M, Silbergeld DL, Rich KM (1998) Dysembryoplastic neuroepithelial tumor and oligodendroglioma: the diagnostic value of magnetic resonance spectroscopy. Case report and review of the literature. Neurosurg Focus 4(4):e6
Rushing EJ, Thompson LD, Mena H (2003) Malignant transformation of a dysembryoplastic neuroepithelial tumor after radiation and chemotherapy. Ann Diagn Pathol 7:240–244
Bulakbasi N, Kocaoglu M, Ors F, Tayfun C, Ucoz T (2003) Combination of single voxel proton MR spectroscopy and apparent diffusion coefficients calculation in the evaluation of common brain tumors. AJNR Am J Neuroradiology 24:225–233
Vuori K, Kankaanranta L, Hakkinen AM, Gaily E, Valanne L, Granstrom ML, Joensuu H, Blomstedt G, Paetau A, Lundbom N (2004) Low-grade gliomas and focal cortical developmental malformations: differentiation with proton MR spectroscopy. Radiology 230:703–708
Wang L, Li K, Chen L, Lu D, Zhang G, Li Y (2005) Perfusion MR imaging and proton MR spectroscopy in a case of dysembryoplastic neuroepithelial tumor. Chin Med J (Engl) 118:1134–1136
Takahashi A, Hong SC, Seo DW, Hong SB, Lee M, Suh YL (2005) Frequent association of cortical dysplasia in dysembryoplastic neuroepithelial tumor treated by epilepsy surgery. Surg Neurol 64:419–427
Pierce GB (1983) The cancer cell and its control by the embryo. Rous-Whipple Award lecture. Am J Pathol 113:117–124
Di Costanzo A, Scarabino T, Trojsi F, Giannatempo GM, Popolizio T, Catapano D, Bonavita S, Maggialetti N, Tosetti M, Salvolini U, d’Angelo VA, Tedeschi G (2006) Multiparametric 3T MR approach to the assessment of cerebral gliomas: tumor extent and malignancy. Neuroradiology 48:622–631
Rollin N, Guyotat J, Streichenberger N, Honnorat J, Tran Minh VA, Cotton F (2006) Clinical relevance of diffusion and perfusion magnetic resonance imaging in assessing intra-axial brain tumors. Neuroradiology 48:150–159
Knopp EA, Cha S, Johnson G, Mazumdar A, Golfinos JG, Zagzag D, Miller DC, Kelly PJ, Kricheff II (1999) Glial neoplasms: dynamic contrast enhanced T2*-weighted MR imaging. Radiology 211:791–798
Law M, Yang S, Wang H, Babb JS, Johnson G, Cha S, Knopp EA, Zagzag D (2003) Glioma grading: sensitivity, specificity, and predictive values of perfusion MR imaging and proton MR spectroscopic imaging compared with conventional MR imaging. AJNR Am J Neuroradiol 24:1989–1998
Aronen HJ, Gazit IE, Louis DN, Buchbinder BR, Pardo FS, Weisskoff RM, Harsh GR, Cosgrove GR, Halpern EF, Hochberg FH, Rosen BR (1994) Cerebral blood volume maps of gliomas: comparison with tumor grade and histologic findings. Radiology 191:41–51
Yang D, Korogi Y, Sugahara T, Kitajima M, Shigematsu Y, Liang L, Ushio Y, Takahashi M (2002) Cerebral gliomas: prospective comparison of multivoxel 2D chemical-shift imaging proton MR spectroscopy, echoplanar perfusion and diffusion-weighted MRI. Neuroradiology 44:656–666
Castillo M, Smith JK, Kwock L (2000) Correlation of myo-inositol levels and grading of cerebral astrocytoma. AJNR Am J Neuroradiol 21:1645–1649
Cha S (2006) Update on brain tumor imaging: from anatomy to physiology. AJNR Am J Neuroradiol 27:475–487
Kim JH, Chang KH, Na DG, Song IC, Kwon BJ, Han MH, Kim K (2006) 3T 1H-MR spectroscopy in grading of cerebral gliomas: comparison of short and intermediate echo time sequences. AJNR Am J Neuroradiol 27:1412–1418
Chiang IC, Kuo YT, Lu CY, Yeung KW, Lin WC, Sheu FO, Liu GC (2004) Distinction between high-grade gliomas and solitary metastases using peritumoral 3-T magnetic resonance spectroscopy, diffusion, and perfusion imagings. Neuroradiology 46:619–627
Conflict of interest statement
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bulakbasi, N., Kocaoglu, M., Sanal, T.H. et al. Dysembryoplastic neuroepithelial tumors: proton MR spectroscopy, diffusion and perfusion characteristics. Neuroradiology 49, 805–812 (2007). https://doi.org/10.1007/s00234-007-0263-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-007-0263-8