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2015 ; 49
(3
): 242-9
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Central nervous system imaging in childhood Langerhans cell histiocytosis - a
reference center analysis
#MMPMID26401129
Porto L
; Schöning S
; Hattingen E
; Sörensen J
; Jurcoane A
; Lehrnbecher T
Radiol Oncol
2015[Sep]; 49
(3
): 242-9
PMID26401129
show ga
BACKGROUND: The aim of our study was (1) to describe central nervous system (CNS)
manifestations in children with Langerhans cell histiocytosis (LCH) based on
images sent to a reference center and meeting minimum requirements and (2) to
assess the inter-rater agreement of CNS-MRI results, which represents the overall
reproducibility of this investigation. METHODS: We retrospectively reviewed brain
MRI examinations in children with LCH, for which MRI minimum requirements were
met. Abnormalities were rated by two experienced neuroradiologists, and the
inter-rater agreement was assessed. RESULTS: Out of a total of 94 imaging
studies, only 31 MRIs met the minimum criteria, which included T2w, FLAIR, T1w
images before/after contrast in at least two different section planes, and thin
post contrast sagittal slices T1w through the sella. The most common changes were
osseous abnormalities, followed by solid enlargement of the pineal gland,
thickened enhancing stalk and signal changes of the dentate nucleus. Whereas
inter-rater agreement in assessing most of the CNS lesions was relatively high (?
> 0.61), the application of minimum criteria often did not allow to evaluate the
posterior pituitary. CONCLUSIONS: The diversity of radiological protocols from
different institutions leads to difficulties in the diagnosis of CNS
abnormalities in children with LCH. Although the inter-rater agreement between
neuroradiologists was high, not all the LCH manifestations could be completely
ruled out when using the minimum criteria. Brain MRIs should therefore follow LCH
guideline protocols and include T1 pre-gadolinium sagittal images, and be
centrally reviewed in order to improve the comparison of clinical trials.