Summary
Introduction
Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) technique that measures the degree of water diffusion in vivo. DWI abnormalities are frequently observed on immediate postoperative imaging following surgical resection of gliomas in adults. These abnormalities subsequently demonstrate contrast enhancement, which may be confused with lesion recurrence. The purpose of this study was to investigate the occurrence of these postoperative abnormalities in pediatric patients with intracranial mass lesions.
Methods
Thirty-three consecutive patients ≤18 years old with a newly diagnosed intracranial mass lesion underwent MRI, including DWI, before and immediately after surgical treatment.
Results
The median patient age was 9.9 years (range 0.2–18 years). Supratentorial and infratentorial lesions were identified in 22 and 11 patients, respectively. Infiltrative and noninfiltrative, as well as benign and malignant lesions, were included. Postoperative imaging demonstrated areas of reduced diffusion adjacent to the resection cavity in 20 (61%) cases. The median volume of these areas was 1.7 cm3 (range 0.3 cm3–12.0 cm3). Subsequent imaging studies in 9 of the 18 cases showed contrast enhancement in the area corresponding to the DWI abnormality. There were no clinical deficits attributable to any of the diffusion abnormalities. There was no association between the occurrence of these abnormalities and whether the lesion was infiltrative, non-infiltrative, benign, or malignant.
Conclusions
DWI abnormality on immediate postoperative MRI is common following surgery for newly diagnosed intracranial mass lesions in pediatric patients. Focal contrast enhancement in the postoperative period may be confused with recurrence for some lesions. Our study suggests that immediate postoperative DWI is useful in interpreting new areas of focal contrast enhancement on subsequent imaging in children who have had surgery for brain tumors.
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Acknowledgements
We thank our surgical and clinical colleagues who helped us acquire this clinical experience. The authors have no personal or institutional financial interest in drugs, materials, or devices described in this article. This work was presented in part at the AANS/CNS Joint Section on Pediatrics in December, 2004. This work was supported by grants from NINDS (NS045013) and Accelerate Brain Cancer Cure.
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Smith, J.S., Lin, H., Mayo, M.C. et al. Diffusion-weighted MR imaging abnormalities in pediatric patients with surgically-treated intracranial mass lesions. J Neurooncol 79, 203–209 (2006). https://doi.org/10.1007/s11060-006-9127-z
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DOI: https://doi.org/10.1007/s11060-006-9127-z