title: Neuroradiologic characteristics of astroblastoma and systematic review of the literature: 2 new cases and 125 cases reported in 59 publications.
abstract: BACKGROUND
  Astroblastoma is a rare tumor of uncertain origin most commonly presenting in the cerebrum of children and young adults. The literature contains only case reports and small series regarding its radiologic features. This systematic review is the largest study of imaging findings of astroblastoma to date and serves to identify features that might differentiate it from other neoplasms.
  
  
  OBJECTIVE
  This study describes the imaging features of astroblastoma based on a systematic review of the literature and two new cases.
  
  
  METHODS
  We conducted a PubMed and Google Scholar database search that identified 59 publications containing 125 cases of pathology-confirmed astroblastoma, and we also added two new cases from our own institution. Data collected include patient age, gender, tumor location, morphology, calcifications and calvarial changes. We recorded findings on CT, MRI, diffusion-weighted imaging (DWI), MR spectroscopy, positron emission tomography (PET) and catheter angiography.
  
  
  RESULTS
  Age at diagnosis ranged 0-70 years (mean 18 years; median 14 years). Female-to-male ratio was 8:1. Of 127 cases, 66 reported CT, 78 reported MRI and 47 reported both findings. Not all authors reported all features, but the tumor features reported included supratentorial in 96% (122/127), superficial in 72% (48/67), well-demarcated in 96% (79/82), mixed cystic-solid in 93% (79/85), and enhancing in 99% (78/79). On CT, 84% (26/31) of astroblastomas were hyperattenuated, 73% (27/37) had calcifications and 7 cases reported adjacent calvarial erosion. Astroblastomas were hypointense on T1-W in 58% (26/45) and on T2-W in 50% (23/46) of MRI sequences. Peritumoral edema was present in 80% (40/50) of cases but was typically described as slight. Six cases included DWI findings, with 100% showing restricted diffusion. On MR spectroscopy, 100% (5/5) showed nonspecific tumor spectra with elevated choline and decreased N-acetylaspartate (NAA). PET revealed nonspecific reduced uptake of [F-18] 2-fluoro-2-deoxyglucose ((18)F-FDG) and increased uptake of [11C]-Methionine in 100% (3/3) of cases. Catheter angiography findings (n=12) were variable, including hypervascularity in 67%, arteriovenous shunting in 33% and avascular areas in 25%.
  
  
  CONCLUSIONS
  Astroblastomas occur most often in adolescent girls. Imaging often shows a supratentorial, superficial, well-defined, cystic-solid enhancing mass. On CT, most are hyperattenuated, have calcifications, and may remodel adjacent bone if superficial. MRI characteristically reveals a hypointense mass on T1-W and T2-W sequences with restricted diffusion. MR spectroscopy, PET and catheter angiography findings are nonspecific.
authors.affiliation: University of Missouri-Kansas City School of Medicine, 2411 Holmes St., Kansas City, MO, 64108, USA. dacg2d@mail.umkc.edu.
authors.forename: Danielle A
authors.identifier: http://orcid.org/0000-0002-7679-7824
authors.initials: DA
authors.lastname: Cunningham
authors.affiliation: University of Missouri-Kansas City School of Medicine, 2411 Holmes St., Kansas City, MO, 64108, USA.|Department of Radiology, Children's Mercy Hospital and Clinics, Kansas City, MO, USA.
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Lowe
authors.affiliation: University of Missouri-Kansas City School of Medicine, 2411 Holmes St., Kansas City, MO, 64108, USA.|Department of Pathology, Children's Mercy Hospital and Clinics, Kansas City, MO, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Shao
authors.affiliation: University of Missouri-Kansas City School of Medicine, 2411 Holmes St., Kansas City, MO, 64108, USA.|Department of Radiology, Truman Medical Center, Kansas City, MO, USA.
authors.forename: Natasha R
authors.initials: NR
authors.lastname: Acosta
mesh_terms: D001932:Brain Neoplasms / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D006801:Humans; D018302:Neoplasms, Neuroepithelial / Q000000981:diagnostic imaging*; D059906:Neuroimaging / Q000379:methods*
keywords: Adults; Astroblastoma; Brain tumor; Children; Computed tomography; Imaging; Magnetic resonance imaging; Systematic review