Imaging of fetal brain tumors
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FETAL IMAGING
Imaging of fetal brain tumors Patricia Cornejo 1,2,3,4,5 & Tamara Feygin 6 & Jennifer Vaughn 1,2,3,5 & Cory M. Pfeifer 7 & Alexandra Korostyshevska 8 & Mittun Patel 1,3,5 & Dianna M. E. Bardo 1,2,3,4,5 & Jeffrey Miller 1,2,3,4,5 & Luis F. Goncalves 1,3,5 Received: 29 November 2019 / Revised: 13 May 2020 / Accepted: 8 July 2020 / Published online: 19 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Congenital brain tumors, defined as those diagnosed prenatally or within the first 2 months of age, represent less than 2% of pediatric brain tumors. Their location, prevalence and pathophysiology differ from those of tumors that develop later in life. Imaging plays a crucial role in diagnosis, tumor characterization and treatment planning. The most common lesions diagnosed in utero are teratomas, followed by gliomas, choroid plexus papillomas and craniopharyngiomas. In this review, we summarize the pathogenesis, diagnosis, management and prognosis of the most frequent fetal brain tumors. Keywords Brain . Congenital . Fetus . Magnetic resonance imaging . Tumor . Ultrasonography
Introduction Prenatal diagnosis of fetal neoplasms has increased over the last few decades as a direct result of continuous advances in fetal imaging [1–6]. Despite this trend, timely and accurate diagnosis remains challenging for several reasons. First, congenital neoplasms are rare, with a reported incidence for all tumors ranging 1.7–13.5 per 100,000 live births [1, 2]; the true
* Patricia Cornejo [email protected] 1
Department of Radiology, Phoenix Children’s Hospital, 1919 E. Thomas Road, Phoenix, AZ 85016, USA
2
Department of Neuroradiology, Barrows Neurological Institute, Phoenix, AZ, USA
3
Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA
4
Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
5
Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA
6
Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
7
Department of Radiology, UT Southwestern, Dallas, TX, USA
8
International Tomography Center of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russian Federation
incidence might be underestimated because cases of fetal demise, miscarriage and pregnancy termination tend to be underreported. Second, congenital tumors often differ histologically, pathophysiologically and in imaging appearance from tumors that develop later in life [1, 6–8]. Third, most of the information available about congenital tumors is based on postnatal imaging following symptomatic presentation after birth because the majority of these lesions do not cause signs and symptoms during pregnancy that would warrant additional obstetric imaging. Congenital brain tumors are even more rare compared to body tumors, accounting for 0.5% to 1.9% of all pediatric tumors [4, 5]. Most are incidentally diagnosed by prenatal US during the second or third trimester. Thus, the limited
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