Imaging Biomarkers for Adult Medulloblastomas: Genetic Entities May Be Identified by Their MR Imaging Radiophenotype

• Published in: American journal of neuroradiology : AJNR Vol. 38; no. 10; pp. 1892 - 1898
• Main Authors: Keil, V C, Warmuth-Metz, M, Reh, C, Enkirch, S J, Reinert, C, Beier, D, Jones, D T W, Pietsch, T, Schild, H H, Hattingen, E, Hau, P
• Format: Journal Article
• Language: English
• Published: United States American Society of Neuroradiology 01-10-2017
• Subjects: Adult; Adult Brain; Adults; Biomarkers; Cerebellar Neoplasms - diagnostic imaging; Cerebellar Neoplasms - genetics; Cerebellar Neoplasms - pathology; Children; Clinical Trials as Topic; Cohort Studies; Criteria; Edema; Female; Genetic Markers; Hedgehog protein; Hemorrhage; Humans; Hydrocephalus; Lesions; Magnetic Resonance Imaging; Male; Medulloblastoma; Medulloblastoma - diagnostic imaging; Medulloblastoma - genetics; Medulloblastoma - pathology; Middle Aged; Neuroimaging; p53 Protein; Pediatrics; Physical characteristics; Pilot Projects; Prognosis; Retrospective Studies; Sensitivity and Specificity; Tumors; Ventricle; Ventricles (cerebral); Wnt protein; Young Adult; β-Catenin
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A5313

The occurrence of medulloblastomas in adults is rare; nevertheless, these tumors can be subdivided into genetic and histologic entities each having distinct prognoses. This study aimed to identify MR imaging biomarkers to classify these entities and to uncover differences in MR imaging biomarkers identified in pediatric medulloblastomas.
Eligible preoperative MRIs from 28 patients (11 women; 22-53 years of age) of the Multicenter Pilot-study for the Therapy of Medulloblastoma of Adults (NOA-7) cohort were assessed by 3 experienced neuroradiologists. Lesions and perifocal edema were volumetrized and multiparametrically evaluated for classic morphologic characteristics, location, hydrocephalus, and Chang criteria. To identify MR imaging biomarkers, we correlated genetic entities
(
)
wild type,
(
), and non
non
medulloblastomas (in adults, Group 4), and histologic entities were correlated with the imaging criteria. These MR imaging biomarkers were compared with corresponding data from a pediatric study.
There were 19
wild type (69%), 4
-activated (14%), and 5 Group 4 (17%) medulloblastomas. Six potential MR imaging biomarkers were identified, 3 of which, hydrocephalus (
= .03), intraventricular macrometastases (
= .02), and hemorrhage (
= .04), when combined, could identify
medulloblastoma with 100% sensitivity and 88.3% specificity (95% CI, 39.8%-100.0% and 62.6%-95.3%).
-activated nuclear β-catenin accumulating medulloblastomas were smaller than the other entities (95% CI, 5.2-22.3 cm
versus 35.1-47.6 cm
;
= .03). Hemorrhage was exclusively present in non
non
medulloblastomas (
= .04;
= 2/5). MR imaging biomarkers were all discordant from those identified in the pediatric cohort. Desmoplastic/nodular medulloblastomas were more rarely in contact with the fourth ventricle (4/15 versus 7/13;
= .04).
MR imaging biomarkers can help distinguish histologic and genetic medulloblastoma entities in adults and appear to be different from those identified in children.