Steven P. Meyers
Zarir P. Khademian
Sylvester H. Chuang
Ian F. Pollack
David N. Korones
Robert A. Zimmerman
Choroid plexus carcinomas in children:
MRI features and patient outcomes
Received: 29 November 2003
Accepted: 20 April 2004
Published online: 12 August 2004
Ó Springer-Verlag 2004
Abstract Choroid plexus carcino-
mas (CPC) are rare malignant
intracranial neoplasms usually
occurring in young children. The
objectives of this study were to
characterize the preoperative MRI
features of CPC, determine the fre-
quency of disseminated disease in the
CNS at diagnosis, and assess patient
outcomes. The preoperative cranial
MR images of 11 patients with CPC
were retrospectively reviewed for
lesion location, lesion size, un-en-
hanced and enhanced MRI signal
characteristics, and presence of dis-
seminated intracranial tumor. Post-
operative cranial and spinal MRI
images were reviewed for residual,
recurrent, and/or disseminated
tumor. The study group included six
male and five female patients ranging
in age from 5 months to 5.3 years
(median= 1.8 years). CPC were lo-
cated in the lateral (n=8), fourth
(n=1), and third (n=1) ventricles,
and foramen of Luschka (n=1).
Mean tumor size was 5.2cm·4.9cm·
5.0 cm. On short-TR images, CPC
had heterogeneous, predominantly
intermediate signal with foci of high
signal in 45% of lesions from areas
of hemorrhage. On long-TR/long-
TE images, solid portions of CPC
typically had heterogeneous, inter-
mediate-to-slightly-high signal.
Small zones of low signal on long-
TR/long-TE images were seen in
55% of the lesions secondary to
areas of hemorrhage and/or calcifi-
cations. Tubular flow voids repre-
senting blood vessels were seen in
55% of the lesions. Zones of high
signal comparable to CSF were seen
in 64% of CPC secondary to cystic/
necrotic zones. All CPC showed
prominent contrast enhancement.
Irregular enhancing margins sug-
gesting subependymal invasion were
seen in 73% of the lesions. Findings
consistent with edema in the brain
adjacent to the enhancing lesions
were seen in 73% of CPC. CPC
caused hydrocephalus in 82% of
patients at diagnosis. Two patients
died from hemorrhagic complica-
tions from surgical biopsies.
Disseminated tumor in the leptome-
ninges was present in 45% of
patients at diagnosis and was asso-
ciated with a poor prognosis. The
1-year and 5-year survival probabil-
ities were 55% and 45%, respec-
tively. In conclusion, MRI features
commonly associated with CPC
include large intraventricular lesions
with irregular enhancing margins;
heterogeneous signal on long TR/
long TE images and short-TR
images; edema in adjacent brain;
hydrocephalus; and presence of dis-
seminated tumor. MRI evidence of
disseminated tumor at diagnosis is
associated with a poor prognosis.
Keywords Choroid plexus
carcinomas Æ Intracranial
neoplasms Æ MRI Æ Children Æ
Hydrocephalus
Neuroradiology (2004) 46: 770–780
DOI 10.1007/s00234-004-1238-7
DIAGNOSTIC NEURORADIOLOGY
S. P. Meyers
Department of Radiology,
University of Rochester School
of Medicine, Strong Memorial Hospital,
Rochester, NY, USA
D. N. Korones
Department of Pediatrics,
University of Rochester School
of Medicine, Strong Memorial Hospital,
Rochester, NY, USA
Z. P. Khademian Æ R. A. Zimmerman
Department of Radiology, Children’s
Hospital of Philadelphia,
Philadelphia, PA, USA
S. H. Chuang
Department of Radiology,
Hospital for Sick Children,
Toronto, ON, Canada
I. F. Pollack
Department of Pediatric Neurosurgery,
Children’s Hospital of Pittsburgh,
Pittsburgh, PA, USA
S. P. Meyers (&)
Department of Radiology,
University of Rochester Medical Center,
601 Elmwood Avenue, P.O. Box 648,
Rochester, NY 14642, USA
E-mail:
steven_meyers@urmc.rochester.edu
Tel.: +1-585-3419065
Fax: +1-585-7601582