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

• Published in: European radiology 2023-12, Vol.33 (12), p.9120-9129
• Main Authors: Pons-Escoda, Albert, Garcia-Ruiz, Alonso, Garcia-Hidalgo, Clemente, Gil-Solsona, Ruben, Naval-Baudin, Pablo, Martin-Noguerol, Teodoro, Fernandez-Coello, Alejandro, Flores-Casaperalta, Susanie, Fernandez-Viñas, Montserrat, Gago-Ferrero, Pablo, Oleaga, Laura, Perez-Lopez, Raquel, Majos, Carles
• Format: Article
• Language: English
• Subjects: Astrocytoma; Blood volume; Brain cancer; Cerebellum; Cerebral blood flow; Classifiers; Data analysis; Data processing; Decision making; Diagnosis; Diagnostic Radiology; Image segmentation; Imaging; Internal Medicine; Interventional Radiology; Magnetic resonance imaging; Medical imaging; Medicine; Medicine & Public Health; Medulloblastoma; Metastases; Metastasis; Neuro; Neuroimaging; Neuroradiology; Perfusion; Radiology; Signal reconstruction; Signatures; Statistical analysis; Substantia alba; Training; Tumors; Ultrasound
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-023-09892-7

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