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Objective:To evaluate the application of amide proton transfer weighted (APTw) magnetic resonance imaging(MRI) for grading of brainstem glioma (BSG) in children.Methods:Twenty-five children (16 males and 9 females) aged 0.7-12.4(5.6±3.3)years were diagnosed as BSG by surgery or biopsy in Beijing Children′s Hospital from December 2019 to March 2022, including 13 cases of low-grade BSG and 12 cases of high-grade BSG. APTw imaging and conventional MRI were performed on a 3.0 T MRI scanner. The differences in gender distribution, age, conventional MRI appearance, APTw signal intensity and apparent diffusion coefficient (ADC) between children with high and low grade BSG were analyzed. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of APTw signal intensity in the differential diagnosis of high and low grade BSG, and Youden index was calculated to obtain the optimal diagnostic threshold. Pearson′s correlation coefficient analysis was used to evaluate the correlation between APTw signal intensity and Ki-67 expression.Results:There was no significant difference in age and gender distribution between high-grade and low-grade BSG patients. The maximum diameter of high-grade BSG was significantly larger than that of low-grade BSG [(4.7±0.9) vs. (3.1±1.7)cm; t=-2.94, P=0.007]; the maximum signal intensity of APTw (APTw max) in high-grade BSG was significantly higher than that in low-grade BSG [(4.9±0.6)% vs. (3.0±1.2)%; t=-5.14, P<0.001]; the average signal intensity of APTw (APTw mean) in high-grade BSG was significantly higher than that in low-grade BSG[(3.6±0.4%) vs. (2.7±1.1)%; t=-2.66, P=0.014].The area under the curve(AUC)of APTw max in distinguishing high-and low-grade BSG was 0.897; with 4.07% as the optimal diagnostic threshold of APTw max, the sensitivity for the diagnosis of high-grade BSG was 0.917 and specificity was 0.846. The AUC of APTw mean in distinguishing high-and low-grade BSG was 0.769; with 2.85% as the optimal diagnostic threshold of APTw mean, the sensitivity for the diagnosis of high-grade BSG was 0.917 and specificity was 0.692. There was a positive correlation between the value of APTw max and Ki-67 expression( r=0.453, P=0.023). Conclusion:APTw imaging is helpful to distinguish high-grade and low-grade BSG in children. APTw max value can be used to effectively evaluate the proliferative activity of BSG in children.
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Objective To analyze the clinical and imaging features, surgical strategy and prognosis in patients with brainstem gangliogliomas (GG). Methods The clinical data of 46 patients with brainstem GG from February 2010 to August 2017 were retrospectively analyzed. The clinical and imaging features, surgical methods and prognosis were reviewed. Results The age of 46 brainstem GG patients was (22.5 ± 4.6) years, the duration was (38.1 ± 8.9) months, and the most common symptoms were dizziness and headache, accounting for 47.8％(22/46). The MRI results showed that endogeny type was in 5 cases, exogenesis type in 10 cases, and endogeny-exogenesis type in 31 cases. The exogenesis type was enrolled as non-infiltrate brainstem group (10 cases), and the endogeny type and endogeny-exogenesis type were enrolled as infiltrate brainstem group (36 cases). The axial T1WI showed that the crescent sign was in 20 cases (43.5％, 20/46), and the sagittal T1WI showed that the patching sign was in 31 cases (67.4％, 31/46). Among all patients, total resection was achieved in 13 cases, near total resection in 9 cases, subtotal resection in 16 cases, partial resection in 7 cases and biopsy in 1 case. No operative death occurred. The patients were followed up for 3 to 87 (40.6 ± 12.8) months, and 5 patients died (all in infiltrate brainstem group). The progression- free survival in non- infiltrate brainstem group was significantly longer than that in infiltrate brainstem group:(46.0 ± 13.1) months vs. (19.5 ± 8.9) months, and there was statistical difference (P<0.05). Conclusions Most brainstem GG has some unique MRI characteristics. Microsurgical resection might be preferred. Tumors that locate outside the brainstem can be fully removed. The long-term prognosis of brainstem GG is better.
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Objective To explore the value of diffusion tensor imaging (DTI) and diffusion tensor tracography (DTT) in assessment of Corticospinal tract (CST) and medial lemniscus (ML) in tumors involving brainstem.Methods A total of 35 cases with pathologically confirmed tumors involving brainstem were collected,and 35 volunteers matched with genders and ages were recruited as the normal group.DTI scanning was performed on all the patients and controls.The damage degrees of CST and ML were evaluated and graded by DTT,and the dysfunction degrees were evaluated for the patients.Spearman correlation was used to statistically analyze the relationships of limb movement,sensory dysfunction and CST and ML damage.Results According to the rating results,normal findings,shifting,edema or infiltration and damage of CST was found in 9,9,11,and 6 cases respectively.They were 8,9,15,3 cases for ML.Motor function was normal in 20 cases,slightly defective in 11 cases,and moderate defective in 4 cases.Sensory function was normal in 21 cases,slightly defective in 6 cases,and moderate defective in 8 cases.The patients' dyskinesia and CST damage degree,sensory dysfunction and ML damage degree were positively correlated (r was 0.786 and 0.686 respectively,P ＜ 0.01).The position relationship among tumor and CST and ML could be well displayed on images.None of the patients showed new symptoms of dysneuria after surgery.Conclusions DTI and DTT technology can be used to evaluate CST and ML damage degree in tumors involving brainstem.They can display the position relationship between tumor and the brainstem CST and ML,which is important in protecting the brainstem fiber tract during operation and evaluating the recovery after the operation.
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A seventeen-year-old pregnant woman with a mesencephalic tumor and ventriculoperitoneal (VP) drainage was admitted to the hospital at full term pregnancy to give birth. Elective cesarean section was performed because of her prime disease (mesencephalic tumor), breech position of the baby, gestational diabetes and expected weight of the baby of more than 4 kg. The operation was performed under spinal anesthesia. Spinal block was performed smoothly, using a pencil point spinal needle 27 G, at the L3-L4 intervertebral space, with hyperbaric bupivacaine 8 mg plus fentanyl 15 microg. Sensory block Th 5 was reached within 5 minutes. The patient was hemodynamically stabile during the anesthesia and the procedure was uneventful. The woman developed no neurologic symptoms, and a healthy female child was born. This is the first case of a pregnant woman with a cerebral tumor and VP drainage on whom a successful delivery was performed with C-section under spinal anesthesia.