Cerebellar tumor

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Cerebellar metastases.

Cerebellar hemangioblastoma.

Cerebellar pilocytic astrocytoma.

Cerebellar liponeurocytoma.

Cerebellar pilocytic astrocytoma.

Cerebellar medulloblastoma

PNET including medulloblastoma.

Infratentorial ependymoma.

Cerebellar pilocytic astrocytoma.

Atypical teratoid rhabdoid tumor.

Cerebellar lesion differential diagnosis.

Posterior fossa tumor surgery

Presurgical differentiation based on neuroimaging is crucial since management differs substantially. A comprehensive full assessment of MR dynamic-susceptibility-contrast perfusion-weighted imaging (DSC-PWI) may reveal critical differences between entities. A study aims to provide new insights into these tumors' perfusion patterns and explore the potential of DSC-PWI in their presurgical discrimination.

Adult patients with a solitary cerebellar tumor on presurgical MR and confirmed histological diagnosis of metastasis, medulloblastoma, hemangioblastoma, or pilocytic astrocytoma were retrospectively retrieved (2008-2023). Volumetric segmentation of tumors and normal-appearing white matter (for normalization) were semi-automatically performed on CE-T1WI and coregistered with DSC-PWI. Mean normalized values per patient tumor mask of relative cerebral blood volume (rCBV), percentage of signal recovery (PSR), peak height (PH), and normalized time-intensity curves (nTIC) were extracted. Statistical comparisons were done. Then, the dataset was split into training (75%) and test (25%) cohorts and a classifier was created considering nTIC, rCBV, PSR, and PH in the model.

Sixty-eight patients (31 metastases, 13 medulloblastomas, 13 hemangioblastomas, and 11 pilocytic astrocytomas) were included. Relevant differences between tumor types' nTICs were demonstrated. Hemangioblastoma showed the highest rCBV and PH, pilocytic astrocytoma had the highest PSR. All parameters showed significant differences on the Kruskal-Wallis tests (p < 0.001). The classifier yielded an accuracy of 98% (47/48) in the training and 85% (17/20) in the test sets.

Intra-axial cerebellar tumors in adults have singular and significantly different DSC-PWI signatures. The combination of perfusion metrics through data analysis rendered excellent accuracies in discriminating these entities.

The authors constructed a classifier for the non-invasive imaging presurgical diagnosis of adult intra-axial cerebellar tumors. The resultant tool can support decision-making in clinical practice and enable optimal personalized patient management ¹⁾