Assessment of treatment response in recurrent medulloblastoma using craniospinal MRI.

Authors

Juliane Hennenberg, Leo Hofer, Bence Nemeth, Carolin Vollbrecht, Greta Tukora, Lisa Mayr, Jewgeni Bolotin, Regina Zelei, Adrienn Racz, Frederik Barkhof, Irene Slavc, Magnus Sabel, Alvaro Lassaletta, Jaroslav Sterba, Pierre Leblond, Karsten Nyson, Ingrid Torsvik, Susan N Chi, Maria Schmook, Julia Furtner, Marius E Mayerhoefer, Gregor Kasprian, Amedeo Azizi, Johannes Gojo, Andreas Peyrl, Lukas Haider

Published in

European journal of radiology. Volume 204. Pages 113056. Jul 09, 2026. Epub Jul 09, 2026.

Abstract

To evaluate whether quantitative craniospinal MRI assessment of baseline tumor burden provides prognostic value in patients with recurrent, previously irradiated medulloblastoma undergoing MEMMAT (Metronomic Antiangiogenic) therapy.
We analyzed craniospinal MRI of 40 patients with recurrent, previously irradiated medulloblastoma enrolled in the MEMMAT trial (April 1, 2014, and March 31, 2021). Ependymal, leptomeningeal, and local relapse lesions were retrospectively manually segmented on T1-contrast-enhanced (T1CE) and diffusion-weighted imaging (DWI) at baseline and follow-up (best response). Lesion count and volume were quantified. Bland-Altman analyses and intraclass correlation coefficients (ICC) assessed inter-sequence agreement., logistic regression evaluated associations between baseline tumor burden and progressive disease.
Patients achieving Complete Response (n = 6/40) showed mean monthly decreases of - 12.7% in T1CE lesion count and - 12.9% in volume. Partial Response patients (n = 9/40) showed similar declines (-10.3% and - 13.0%). Stable Disease patients (n = 5/40) demonstrated minimal decreases (-0.8% and - 2.3%). Progressive Disease patients (n = 16/40) showed increases of 33.7% in lesion count and 56.2% in volume. Logistic regression indicated trends toward higher baseline tumor burden predicting PD (volume OR 1.18, p = 0.08; lesion count OR 1.05, p = 0.075). Agreement between T1CE and DWI was limited (ICC 0.35 for lesion count, 0.47 for volume), with 23% of patients misclassified using either modality alone. Survival analyses demonstrated significantly shorter overall survival in patients with baseline lesion volumes ≥ 5.5 ml (log-rank p = 0.003), while a similar association for progression-free survival did not reach statistical significance (p = 0.053).
Combined intracranial and intraspinal T1CE and intracranial DWI assessment improves response evaluation. Exploratory analyses suggested that higher baseline tumor burden may be associated with progression, although the observed associations were of borderline statistical significance and require validation in larger cohorts.

PMID:
42437539
Bibliographic data and abstract were imported from PubMed on 13 Jul 2026.

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