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Research ArticlePediatrics
Open Access

Intravoxel Incoherent Motion MR Imaging of Pediatric Intracranial Tumors: Correlation with Histology and Diagnostic Utility

K. Kikuchi, A. Hiwatashi, O. Togao, K. Yamashita, R. Kamei, D. Momosaka, N. Hata, K. Iihara, S.O. Suzuki, T. Iwaki and H. Honda
American Journal of Neuroradiology May 2019, 40 (5) 878-884; DOI: https://doi.org/10.3174/ajnr.A6052
K. Kikuchi
aFrom the Departments of Clinical Radiology (K.K., A.H., O.T., K.Y., R.K., D.M., H.H.)
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A. Hiwatashi
aFrom the Departments of Clinical Radiology (K.K., A.H., O.T., K.Y., R.K., D.M., H.H.)
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O. Togao
aFrom the Departments of Clinical Radiology (K.K., A.H., O.T., K.Y., R.K., D.M., H.H.)
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K. Yamashita
aFrom the Departments of Clinical Radiology (K.K., A.H., O.T., K.Y., R.K., D.M., H.H.)
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R. Kamei
aFrom the Departments of Clinical Radiology (K.K., A.H., O.T., K.Y., R.K., D.M., H.H.)
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D. Momosaka
aFrom the Departments of Clinical Radiology (K.K., A.H., O.T., K.Y., R.K., D.M., H.H.)
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N. Hata
bNeurosurgery (N.H., K.I.)
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K. Iihara
bNeurosurgery (N.H., K.I.)
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S.O. Suzuki
cNeuropathology (S.O.S., T.I.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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T. Iwaki
cNeuropathology (S.O.S., T.I.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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H. Honda
aFrom the Departments of Clinical Radiology (K.K., A.H., O.T., K.Y., R.K., D.M., H.H.)
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    Fig 1.

    Comparison of the IVIM parameters of high- (WHO grades III and IV) and low-grade (WHO grades I and II) tumors. D and ADC were lower in high-grade than in low-grade tumors (D, 0.85 ± 0.40 versus 1.53 ± 0.21 × 10−3 mm2/s, P = .0003; ADC, 1.04 ± 0.33 versus 1.60 ± 0.21 × 10−3 mm2/s, P = .0007; A). D was significantly lower than the ADC in high- (P = .0010) and low-grade (P = .0004; A) tumors. D* showed wide variability and no significant differences between the high- and low-grade groups (P = .8337; B). The f was higher in high- than in low-grade tumors (21.7 ± 8.2% versus 7.6 ± 4.3%, P = .0003; C).

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    Fig 2.

    Images from an 11-year-old boy with histologically defined classic medulloblastoma (WHO grade IV). A, T2WI shows a heterogeneous, hyperintense mass in the vermis. B, Contrast-enhanced T1WI shows heterogeneous enhancement of the tumor. C, The D map shows the low D value (0.53 × 10−3 mm2/s) of the lesion, which is lower than the cutoff value (≤1.15 × 10−3 mm2/s; Table 3). D, The f map shows the f value (27.1%) of the lesion, which is higher than the cutoff value (>14.1%; Table 3). E, MIB-1 staining reveals a high MIB-1 index (72.6%). F, Immunohistochemical staining for anti-CD31 shows a high MVD (10.2%). Bar = 100 μm.

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    Fig 3.

    Images from a 6-year-old boy with pilocytic astrocytoma (WHO grade I). A, T2WI shows a homogeneous, hyperintense mass in the vermis. B, Contrast-enhanced T1WI shows mild, heterogeneous enhancement of the tumor. C, The D map shows the high D value (1.72 × 10−3 mm2/s) of the lesion, which is higher than the cutoff value (≤1.15 × 10−3 mm2/s; Table 3). D, The f map shows the low f value (4.2%) of the lesion, which is lower than the cutoff value (>14.1%; Table 3). E, MIB-1 staining reveals a low MIB-1 index (6.0%). F, Immunohistochemical staining for anti-CD31 reveals a low MVD (3.2%). Bar = 100 μm.

Tables

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    Table 1:

    Patient demographics and tumor characteristics

    No.Age, SexHistologyIVIM ParametersADC (× 10−3 mm2/s)
    Pathologic DiagnosisWHO GradeMIB-1 (%)MVDD (× 10−3 mm2/s)f (%)D* (× 10−3 mm2/s)
    16 yr, MDiffuse midline glioma, H3 K27M-mutantIV59.23.11.5016.45.61.61
    24 yr, MMedulloblastoma, classic, histologically definedIV15.634.70.3037.713.70.56
    311 yr, MMedulloblastoma, classic, histologically definedIV72.610.20.5327.130.20.87
    43 yr, MAtypical teratoid/rhabdoid tumorIV50.011.00.8614.19.00.98
    52 yr, FAnaplastic ependymomaIII23.212.50.8719.318.41.02
    63 yr, MAnaplastic ependymomaIII19.64.31.1516.85.51.30
    76 yr, FAnaplastic ependymomaIII58.410.10.7120.741.70.96
    812 yr, MDiffuse astrocytoma, IDH wild-typeII2.12.11.228.433.31.29
    91 yr, MPilocytic astrocytomaI4.45.81.453.55.51.50
    103 yr, FPilocytic astrocytomaI6.74.01.827.210.21.88
    113 yr, MPilocytic astrocytomaI8.04.71.5210.048.31.64
    126 yr, MPilocytic astrocytomaI6.03.21.724.258.41.78
    1311 yr, FPilocytic astrocytomaI4.05.61.555.512.81.61
    142 yr, MSubependymomaI0.11.91.585.111.31.60
    152 mo, FChoroid plexus papillomaI0.113.41.4717.411.61.62
    1610 yr, MDysembryoplastic neuroepithelial tumorI2.71.31.7610.94.31.82
    1715 yr, FGangliogliomaI1.01.11.213.622.41.24
    • Note:—IDH indicates isocitrate dehydrogenase.

    • View popup
    Table 2:

    Comparison of parameters between high- and low-grade tumorsa

    ParametersHigh-Grade TumorLow-Grade TumorP Value
    D (× 10−3 mm2/s)0.30–1.50, 0.86, 0.85 ± 0.401.21–1.82, 1.54, 1.53 ± 0.21.0003b
    ADC (× 10−3 mm2/s)0.56–1.61, 0.98, 1.04 ± 0.331.24–1.88, 1.62, 1.60 ± 0.21.0007b
    D* (× 10−3 mm2/s)5.5–41.7, 13.7, 17.7 ± 13.74.3–58.4, 12.8, 21.8 ± 18.8.8337c
    f (%)14.1–37.7, 19.3, 21.7 ± 8.23.5–17.4, 6.4, 7.6 ± 4.3.0003b
    MVD (%)3.1–34.7, 10.2, 12.3 ± 10.51.1–13.4, 3.6, 4.3 ± 3.6.0431c
    MIB-1 (%)15.6–72.6, 50.0, 42.7 ± 22.80.1–8.0, 3.4, 3.5 ± 2.8<.0001b
    • ↵a Data are expressed as range, median, mean.

    • ↵b Unpaired test.

    • ↵c Mann-Whitney U test.

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    Table 3:

    Diagnostic performance of parameters in differentiating high- and low-grade tumors

    ParametersCutoff ValueSensitivity (%)Specificity (%)AUC
    D (× 10−3 mm2/s)≤1.1585.785.70.943
    D* (× 10−3 mm2/s)>9.042.922.90.536
    f (%)>14.110090.00.957
    ADC (× 10−3 mm2/s)≤1.0271.471.40.907
    D + f≤1.50, >16.410090.00.986
    • Note:—AUC indicates area under the curve.

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American Journal of Neuroradiology: 40 (5)
American Journal of Neuroradiology
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K. Kikuchi, A. Hiwatashi, O. Togao, K. Yamashita, R. Kamei, D. Momosaka, N. Hata, K. Iihara, S.O. Suzuki, T. Iwaki, H. Honda
Intravoxel Incoherent Motion MR Imaging of Pediatric Intracranial Tumors: Correlation with Histology and Diagnostic Utility
American Journal of Neuroradiology May 2019, 40 (5) 878-884; DOI: 10.3174/ajnr.A6052

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Intravoxel Incoherent Motion MR Imaging of Pediatric Intracranial Tumors: Correlation with Histology and Diagnostic Utility
K. Kikuchi, A. Hiwatashi, O. Togao, K. Yamashita, R. Kamei, D. Momosaka, N. Hata, K. Iihara, S.O. Suzuki, T. Iwaki, H. Honda
American Journal of Neuroradiology May 2019, 40 (5) 878-884; DOI: 10.3174/ajnr.A6052
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