Diffusion-weighted imaging in pediatric extracranial germ cell tumors.

Autor: Cavalcante CEB; Department of Pediatric Radiology, Children's Cancer Hospital, Hospital de Amor, Barretos, São Paulo, Brazil.; Pediatric Oncology, Children's Cancer Hospital, Hospital de Amor, Barretos, São Paulo, Brazil.; Brazilian Germ Cell Pediatric Study Group, Hospital de Amor, Barretos, São Paulo, Brazil., Magalhães Pereira Souza F; Department of Pediatric Radiology, Children's Cancer Hospital, Hospital de Amor, Barretos, São Paulo, Brazil.; Pediatric Oncology, Children's Cancer Hospital, Hospital de Amor, Barretos, São Paulo, Brazil.; Brazilian Germ Cell Pediatric Study Group, Hospital de Amor, Barretos, São Paulo, Brazil., Eiras Martins G; Pediatric Oncology, Children's Cancer Hospital, Hospital de Amor, Barretos, São Paulo, Brazil.; Brazilian Germ Cell Pediatric Study Group, Hospital de Amor, Barretos, São Paulo, Brazil., Milone Silva M; Brazilian Germ Cell Pediatric Study Group, Hospital de Amor, Barretos, São Paulo, Brazil.; Centro de Tratamento Fabiana Macedo de Morais/GACC, São Jose dos Campos, São Paulo, Brazil., Pacheco Donato Macedo CR; Brazilian Germ Cell Pediatric Study Group, Hospital de Amor, Barretos, São Paulo, Brazil.; Instituto de Oncologia Pediatrica - GRAACC, Universidade Federal de São Paulo, São Paulo, Brazil., Lederman H; Brazilian Germ Cell Pediatric Study Group, Hospital de Amor, Barretos, São Paulo, Brazil.; Department of Radiology, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), Sao Paulo, Brazil., Lopes LF; Pediatric Oncology, Children's Cancer Hospital, Hospital de Amor, Barretos, São Paulo, Brazil.; Chairman, Brazilian Germ Cell Pediatric Study Group, Hospital de Amor, Barretos, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 Nov 30; Vol. 18 (11), pp. e0294976. Date of Electronic Publication: 2023 Nov 30 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0294976
Abstrakt: 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 mm2/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 mm2/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 mm2/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 mm2/s; p<0.001) compared to that exhibited at the time of diagnosis (780.00 ± 168.00 mm2/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.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2023 Cavalcante et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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