CC BY 4.0 · Journal of Child Science 2020; 10(01): e169-e174
DOI: 10.1055/s-0040-1718897
Original Article

The Effects of Applying Apparent Diffusion Coefficient Parameters on the Differentiation between Fourth Ventricular Ependymoma and Diffuse Intrinsic Pontine Glioma

1  Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
2  Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
3  Department of Radiology, Children's Hospital 02, Ho Chi Minh City, Vietnam
› Author Affiliations
Funding None.


Distinguishing the fourth ventricular ependymoma from diffuse intrinsic pontine glioma (DIPG) is essential to improve the treatment strategy between these two tumor types. We attempted to evaluate the effects of applying apparent diffusion coefficient (ADC) values to the distinction between pediatric fourth ventricular ependymomas and DIPGs. Brain magnetic resonance imaging, including diffusion-weighted imaging and ADC, was assessed in 26 patients, who were divided into two groups: group 1 included 8 patients with fourth ventricular ependymoma and group 2 included 18 patients with DIPG. The Mann–Whitney U test was utilized to compare tumoral maximum (ADCmax), minimum ADC (ADCmin), mean ADC (ADCmean), and standard deviation (ADCsd) values, and the ratios between the tumor and parenchyma values for each of these parameters (rADCmax, rADCmin, rADCmean, and rADCsd, respectively) between the two groups. Cutoff values were calculated based on receiver operating characteristic curve analysis and the Youden index, and the area under the curve (AUC), sensitivity, and specificity were determined. The median ADCmax, ADCmin, ADCmean, rADCmax, rADCmin, and rADCmean values were significantly lower in group 1 than in group 2 (p < 0.05). For the differential diagnosis of ependymomas and DIPGs, a cutoff ADCmean value of 1.02 × 10−3 mm2/s was determined, which produced a sensitivity of 100%, a specificity of 88.9%, and an AUC of 95.8%. ADC parameters should be considered when performing a differential diagnosis between fourth ventricular ependymomas and DIPGs. Based on our findings, a cutoff ADCmean value of 1.02 × 10−3 mm2/s was the most significant and effective parameter for this purpose.

Ethical Approval and Declaration of Patient Consent

Institutional review board of Children's Hospital 2 approved this prospective study (Ref: 352/NĐ2-CĐT). Written informed consent was obtained from the legal guardian of all participating patients.

Data Availability

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Publication History

Received: 25 July 2020

Accepted: 20 September 2020

Publication Date:
27 October 2020 (online)

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

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