The role of diffusion tensor imaging metrics in the discrimination between cerebellar medulloblastoma and brainstem glioma.

BACKGROUND: Differentiation between cerebellar medulloblastoma and brainstem glioma is necessary for certain clinical circumstances. We aimed to evaluate the function of diffusion tensor imaging (DTI) metrics in the differentiation between cerebellar medulloblastomas and brainstem gliomas in children.

PROCEDURE: The institutional review board approved this prospective study. Brain magnetic resonance imaging (MRI), including DTI, was assessed in 40 patients, who were divided into two groups: a medulloblastoma group (group 1, n = 25) and a brainstem glioma group (group 2, n = 15). The Mann-Whitney U test was utilized to compare tumoral fractional anisotropy (FA) and diffusivity (MD) values and tumor-to-parenchyma ratios for these values (rFA and rMD, respectively) between the two groups. Receiver-operating characteristic (ROC) curve analysis and the Youden index were exploited to calculate the cutoff value, along with the area under the curve (AUC), sensitivity, and specificity.

RESULTS: The FA value for medulloblastomas was significantly higher than that for brainstem gliomas (P < 0.05). In contrast, the MD and rMD values for medulloblastoma were significantly lower than those for brainstem gliomas (P < 0.05). A cutoff MD value of 0.97 was identified as the most effective factor for the differential diagnosis between medulloblastomas and brainstem gliomas, which reached a sensitivity of 96%, a specificity of 100%, and an AUC of 99.5%.

CONCLUSION: DTI metrics play a significant role in the differentiation between medulloblastoma and brainstem glioma in pediatric patients.