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Detecting non-germinomatous germ cell tumor component by arterial spin labeling perfusion weighted MR imaging in central nervous system germ cell tumor

髙野 元気 広島大学

2021.03.23

概要

Central nervous system (CNS) germ cell tumors (GCTs) account
for2–3 % of all primary CNS neoplasms and 8–15 % of pediatric
CNS tumors in series from Japan, Taiwan, China and Republic
of Korea [1–4]. CNS-GCT develops most often in children aged
10–14 years, with a clear majority in males [1,2,5]. The CNSGCTs are sub-classified into germinoma and non-germinomatous germ cell tumors (NGGCT). NGGCT consists of teratoma,
yolk sac tumor, choriocarcinoma, embryonal carcinoma and
mixed tumor of CNS-GCT components, including germinoma
component. As the prognosis and sensitivity to treatment are
much different between germinoma and NGGCT, physicians
need to choose the appropriate treatment considering these two
subtypes of GCTs [6]. Previous reports tried to differentiate germinoma and NGGCT by using different MR parameters including T1 hyperintense foci, intratumoral cystic components, tumor
margin shape, enhancing pattern, and apparent diffusion coefficient (ADC) calculation and were moderately useful for the differential diagnosis [7–9]. However, differentiation between germinoma and NGGCT is still sometimes difficult because imaging characteristics are not always specific, and biopsy specimens
obtained by neuroendoscopic or stereotactic biopsy may not represent the entire tumor and are susceptible to diagnostic errors
for mixed GCTs [10]. Arterial spin labeling (ASL) MR imaging
is perfusion-weighted imaging (PWI) which uses magnetically
labeled arterial blood water protons as an endogenous tracer to
allow visualization of perfusion. ASL-PWI can evaluate arterial
blood flow without requiring intravenous gadolinium, in other
word, non-invasively, therefore, the clinical advantage of ASLPWI is obviously high compared to other PWI techniques. It has
been reported that the ASL-PWI was applied for evaluating
acute and chronic neurovascular diseases [11–13], differentiating hemangioblastoma from metastatic brain tumors [14] and
determining the degree of the malignancy [15]. However, there
has been no report evaluating the histological subtype of GCT
using ASL-PWI or other PWI techniques for the differential diagnosis of germinoma and NGGCT. In this study, we showed
the utility of ASL-PWI for detecting NGGCT component. ...

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