Quantitative MRI in post-operative paediatric cerebellar mutism syndrome. Issue 108 (November 2018)

• Record Type: Journal Article
• Authors: Toescu, Sebastian M.; Hales, Patrick W.; Aquilina, Kristian; Clark, Chris A.
• Is Part Of: European journal of radiology. Issue 108(2018)
• Page Start: 43
• Page End: 51
• Publication Date: 2018-11
• Subjects: DTI diffusion tensor imaging -- pCMS post-operative paediatric cerebellar mutism syndrome -- ASL arterial spin labeling -- dMRI diffusion MRI -- PFS posterior fossa syndrome -- ECP efferent cerebellar pathway -- DRTC dentato-rubro-thalamo-cortical -- SMA supplementary motor area -- HOD hypertrophic olivary degeneration -- ION inferior olivary nucleus -- FA fractional anisotropy -- MD mean diffusivity -- SCP superior cerebellar peduncle -- ADC apparent diffusion coefficient -- SPECT single photon emission computed tomography -- DSC-MRI dynamic susceptibility-weighted contrast-enhanced perfusion MRI -- fMRI functional MRI; Cerebellar mutism -- Posterior fossa syndrome -- Medulloblastoma -- Tractography -- Arterial spin labelling; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2018.09.007
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Post-operative paediatric cerebellar mutism syndrome is a well-recognised complication of posterior fossa tumour surgery. Diffusion tractography shows damage to cerebellar outflow pathways are implicated in the development of pCMS. Perfusion imaging has shown widespread bloodflow deficits in patients with pCMS, which reverses when symptoms improve. Timely application of diffusion and perfusion MRI studies may help us to answer several remaining questions in pCMS. Abstract: Post-operative paediatric cerebellar mutism syndrome (pCMS) occurs in around 25% of children undergoing surgery for cerebellar and fourth ventricular tumours. Reversible mutism is the hallmark of a syndrome which comprises severe motor, cognitive and linguistic deficits. Recent evidence from advanced neuroimaging studies has led to the current theoretical understanding of the condition as a form of diaschisis contingent on damage to efferent cerebellar circuitry. Tractography data derived from diffusion MRI studies have shown disruption of the dentato-rubro-thalamo-cortical tract in patients with pCMS, and perfusion studies have indicated widespread supratentorial regions which may give rise to the florid signs and symptoms of pCMS. Given the difficulties in predicting pCMS from standard structural MRI, this review discusses findings from quantitative MRI modalities which have contributed to our understanding of this debilitating syndrome, and considers the goals and challenges which lie ahead in the field.