Diffusion MRI improves the accuracy of preoperative diagnosis of common pediatric cerebellar tumors among reviewers with different experience levels

• Published in: American journal of neuroradiology : AJNR 2013-12, Vol.34 (12), p.2360-2365
• Main Authors: Koral, K, Zhang, S, Gargan, L, Moore, W, Garvey, B, Fiesta, M, Seymour, M, Yang, L, Scott, D, Choudhury, N
• Format: Article
• Language: English
• Subjects: Adolescent; Cerebellar Neoplasms - pathology; Child; Child, Preschool; Clinical Competence; Diffusion Magnetic Resonance Imaging; Evidence-Based Medicine Level 2; FELLOWS' JOURNAL CLUB; Female; Humans; Infant; Male; Observer Variation; Pediatrics; Preoperative Care - methods; Reproducibility of Results; Sensitivity and Specificity; Young Adult
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A3596

Although utility of diffusion MR imaging in the preoperative diagnosis of common pediatric cerebellar tumors is generally recognized, its added value has not been systematically studied previously. The purpose of this study was to evaluate the impact of diffusion MR imaging on the accuracy of preoperative diagnosis of common pediatric cerebellar tumors among reviewers with different experience levels. Review of the neuro-oncology data base yielded 96 patients whose preoperative brain MR imaging included both diffusion MR imaging (b = 1000 s/mm(2)) and ADC maps. There were 38 pilocytic astrocytomas, 33 medulloblastomas, 17 ependymomas, and 8 atypical teratoid/rhabdoid tumors. Six reviewers (4 residents, 2 neuroradiologists) evaluated the examinations. Two sessions were conducted with each reviewer, without and with diffusion MR imaging data on 2 separate days. The impact of diffusion MR imaging on accuracy of diagnoses was assessed. In choosing the correct diagnosis of the 4 alternatives, performances of 5 of the 6 reviewers improved significantly with inclusion of the diffusion MR imaging data, from 63%-77% (P = .0003-.0233). The performance of 1 reviewer also improved, but the difference did not attain statistical significance (P = .1944). Inclusion of diffusion MR imaging data improved the likelihood of rendering a correct diagnosis (odds ratio = 3.16, 95% confidence interval = 2.07-4.00) over all tumor types. When embryonal tumors were regarded as a single group, the rate of correct diagnosis increased from 66%-83% with diffusion MR imaging data, and performances of all of the reviewers improved significantly (P = .0001-.05). The improvement in performances resulted from increased correct diagnoses of pilocytic astrocytomas, medulloblastomas, and atypical teratoid/rhabdoid tumors. There was no improvement in the correct diagnoses of ependymomas with inclusion of the diffusion MR imaging data. Diffusion MR imaging improves accuracy of preoperative diagnosis of common pediatric cerebellar tumors significantly among reviewers with differing experience levels.