ARRS 2022 Abstracts

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E1386. Assessment of Pediatric Brain Tumors
Authors
  1. Ibraheem Shaikh; Rutgers New Jersey Medical School
  2. Gagandeep Singh; Newark Beth Israel Medical Center
  3. Chintan Rajput; Newark Beth Israel Medical Center
  4. Tejasvi Kainth; Newark Beth Israel Medical Center
  5. John Matthews; Newark Beth Israel Medical Center
  6. Anatoliy Vaysberg; Newark Beth Israel Medical Center
Background
Neoplastic CNS masses are the most commonly lethal solid tumors in pediatric patients. They differ from those seen in adults in terms of frequency, location, histology, and spectroscopy findings. Imaging plays a pivotal role in evaluation but may not be able to establish a definite diagnosis. Accurate identification of CNS masses may help prevent delays in diagnosis and unnecessary studies or procedures.

Educational Goals / Teaching Points
A majority of pediatric CNS tumors are located within the posterior fossa, including pilocytic astrocytoma, medulloblastoma, and ependymoma. MRI is generally preferred for diagnostic evaluation over CT due to superior resolution, absence of radiative dosage, and lack of beam-hardening artifact near the petrous bone, which may limit visualization of the posterior fossa. In this exhibit, we will discuss the practical approach to pediatric brain tumor imaging interpretation. Through a systematic approach, we will show a wide spectrum of pediatric brain tumors, ranging from common lesions to more complex rare cases, and their associated key imaging findings.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Pilocytic astrocytoma, a low-grade glioma (LGG) that represents up to 15% of pediatric CNS tumors, is seen most often in the cerebellum. When present in the optic chiasm, it is strongly associated with type 1 neurofibromatosis (NF). Medulloblastoma is the most common malignant pediatric solid tumor, and frequently displays drop metastases and/or leptomeningeal spread on presentation. Ependymoma, which accounts for 10% of pediatric CNS tumors, may develop anywhere among the neuroaxis but commonly appears in the posterior fossa, followed by the supratentorial compartment. Meningiomas, tumors of the meninges, are commonly located in the supratentorial compartment. Although they are significantly more common in adults, they may be more aggressive in pediatric patients, especially when associated with type 2 NF. Other pediatric CNS tumors include craniopharyngioma, malignant glioma, and various LGGs. Imaging findings that are critical in helping narrow a differential diagnosis include tumor volume, location, invasiveness, enhancement pattern, and the presence of cysts or calcifications. These findings also provide crucial tumor subclassification information that may help determine prognosis.

Conclusion
Intracranial masses in imaging of pediatric brains may represent a range of disease, including pilocytic astrocytoma, medulloblastoma, ependymoma, meningioma, and a variety of other pathologies. Careful evaluation of imaging findings may allow for early narrowing of the differential diagnosis and faster treatment.