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Diffusion-weighted imaging in pediatric extracranial germ cell tumors

BACKGROUND: Germ cell tumors (GCTs) comprise a rare and heterogeneous group of neoplasms presenting different clinical and histological characteristics, leading to a challenging scenario in clinical practice. Diffusion-weighted imaging (DWI) has been suggested as an indirect marker of tumor density...

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Autores principales: Cavalcante, Carlos Eduardo Bezerra, Magalhães Pereira Souza, Fernanda, Eiras Martins, Gisele, Milone Silva, Marcelo, Pacheco Donato Macedo, Carla Renata, Lederman, Henrique, Lopes, Luiz Fernando
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10688858/
https://www.ncbi.nlm.nih.gov/pubmed/38033015
http://dx.doi.org/10.1371/journal.pone.0294976
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author Cavalcante, Carlos Eduardo Bezerra
Magalhães Pereira Souza, Fernanda
Eiras Martins, Gisele
Milone Silva, Marcelo
Pacheco Donato Macedo, Carla Renata
Lederman, Henrique
Lopes, Luiz Fernando
author_facet Cavalcante, Carlos Eduardo Bezerra
Magalhães Pereira Souza, Fernanda
Eiras Martins, Gisele
Milone Silva, Marcelo
Pacheco Donato Macedo, Carla Renata
Lederman, Henrique
Lopes, Luiz Fernando
author_sort Cavalcante, Carlos Eduardo Bezerra
collection PubMed
description BACKGROUND: Germ cell tumors (GCTs) comprise a rare and heterogeneous group of neoplasms presenting different clinical and histological characteristics, leading to a challenging scenario in clinical practice. Diffusion-weighted imaging (DWI) has been suggested as an indirect marker of tumor density and cellularity and could be used to monitor therapeutic response. However, its role in pediatric GCTs needs to be clarified. PURPOSE: Here, we evaluated the features of DWI in pediatric extracranial GCTs in a reference Brazilian institution. MATERIAL AND METHODS: We included 43 pediatric patients with primary GCTs treated between 2008 and 2022 in Hospital de Amor de Barretos. The patients’ MRI images included T1-weighted without contrast, T2-weighted, DWI and apparent diffusion coefficient (ADC) maps. DWI was evaluated in the section that exhibited the greatest restricted diffusion in the largest hypersignal area of the image. The lowest ADC value was determined to define the region of interest (ROI). We used a small ROI, avoiding necrotic, adipose tissue, noisy or nonenhancing lesion voxels as recommended. ROI determination was established by visual inspection by two radiologists in accordance. We used two values of b (b = 50 mm(2)/s or b = 800) for ADC values. RESULTS: The highest mean ADC (mADC) value was observed in pure teratomas (1,403.50 ± 161.76 x10(-3) mm(2)/s; mean ± SD) compared to other histologies (yolk sac, mixed teratoma, dysgerminoma and mixed GCT) of GCT (p<0.001). Furthermore, ROC analysis determined a cutoff mADC value of 1,179.00 x 10(−3) mm(2)/s that differentiated pure teratomas from the other GCT histologies with a sensitivity of 95.8% and a specificity of 92.9% (AUC = 0.979; p<0.01). A significant increase in mADC was observed for malignant GCTs in treatment (1,197.00 ± 372.00 mm(2)/s; p<0.001) compared to that exhibited at the time of diagnosis (780.00 ± 168.00 mm(2)/s; mean ± SD. Our findings suggest that mADC assessment could be used as a tool to distinguish pure teratomas from malignant CGT histologies at diagnosis. Additionally, we demonstrated reasonable evidence that it could be used as a complementary tool to monitor treatment response in patients with malignant GCT.
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spelling pubmed-106888582023-12-01 Diffusion-weighted imaging in pediatric extracranial germ cell tumors Cavalcante, Carlos Eduardo Bezerra Magalhães Pereira Souza, Fernanda Eiras Martins, Gisele Milone Silva, Marcelo Pacheco Donato Macedo, Carla Renata Lederman, Henrique Lopes, Luiz Fernando PLoS One Research Article BACKGROUND: Germ cell tumors (GCTs) comprise a rare and heterogeneous group of neoplasms presenting different clinical and histological characteristics, leading to a challenging scenario in clinical practice. Diffusion-weighted imaging (DWI) has been suggested as an indirect marker of tumor density and cellularity and could be used to monitor therapeutic response. However, its role in pediatric GCTs needs to be clarified. PURPOSE: Here, we evaluated the features of DWI in pediatric extracranial GCTs in a reference Brazilian institution. MATERIAL AND METHODS: We included 43 pediatric patients with primary GCTs treated between 2008 and 2022 in Hospital de Amor de Barretos. The patients’ MRI images included T1-weighted without contrast, T2-weighted, DWI and apparent diffusion coefficient (ADC) maps. DWI was evaluated in the section that exhibited the greatest restricted diffusion in the largest hypersignal area of the image. The lowest ADC value was determined to define the region of interest (ROI). We used a small ROI, avoiding necrotic, adipose tissue, noisy or nonenhancing lesion voxels as recommended. ROI determination was established by visual inspection by two radiologists in accordance. We used two values of b (b = 50 mm(2)/s or b = 800) for ADC values. RESULTS: The highest mean ADC (mADC) value was observed in pure teratomas (1,403.50 ± 161.76 x10(-3) mm(2)/s; mean ± SD) compared to other histologies (yolk sac, mixed teratoma, dysgerminoma and mixed GCT) of GCT (p<0.001). Furthermore, ROC analysis determined a cutoff mADC value of 1,179.00 x 10(−3) mm(2)/s that differentiated pure teratomas from the other GCT histologies with a sensitivity of 95.8% and a specificity of 92.9% (AUC = 0.979; p<0.01). A significant increase in mADC was observed for malignant GCTs in treatment (1,197.00 ± 372.00 mm(2)/s; p<0.001) compared to that exhibited at the time of diagnosis (780.00 ± 168.00 mm(2)/s; mean ± SD. Our findings suggest that mADC assessment could be used as a tool to distinguish pure teratomas from malignant CGT histologies at diagnosis. Additionally, we demonstrated reasonable evidence that it could be used as a complementary tool to monitor treatment response in patients with malignant GCT. Public Library of Science 2023-11-30 /pmc/articles/PMC10688858/ /pubmed/38033015 http://dx.doi.org/10.1371/journal.pone.0294976 Text en © 2023 Cavalcante et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Cavalcante, Carlos Eduardo Bezerra
Magalhães Pereira Souza, Fernanda
Eiras Martins, Gisele
Milone Silva, Marcelo
Pacheco Donato Macedo, Carla Renata
Lederman, Henrique
Lopes, Luiz Fernando
Diffusion-weighted imaging in pediatric extracranial germ cell tumors
title Diffusion-weighted imaging in pediatric extracranial germ cell tumors
title_full Diffusion-weighted imaging in pediatric extracranial germ cell tumors
title_fullStr Diffusion-weighted imaging in pediatric extracranial germ cell tumors
title_full_unstemmed Diffusion-weighted imaging in pediatric extracranial germ cell tumors
title_short Diffusion-weighted imaging in pediatric extracranial germ cell tumors
title_sort diffusion-weighted imaging in pediatric extracranial germ cell tumors
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10688858/
https://www.ncbi.nlm.nih.gov/pubmed/38033015
http://dx.doi.org/10.1371/journal.pone.0294976
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