A Case-control Study of MRI Features in Pediatric Atypical Teratoid Rhabdoid Tumor and Medulloblastoma

Background Compared to medulloblastoma (MB), atypical teratoid rhabdoid tumor (AT/RT) is characterized by a lower incidence, younger age at onset, and a poorer prognosis. Preoperative clinical and neuroimaging differentiation between these tumors remains challenging. This study aimed to evaluate the diagnostic utility of conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in distinguishing AT/RT from MB in children. Methods We retrospectively included 32 patients with AT/RT and 82 patients with MB confirmed by surgery and pathology in our hospital between 2010 and 2023. We analyzed the clinical data, preoperative MRI characteristics, and apparent diffusion coefficient (ADC) values of these patients to evaluate their diagnostic value. Results The overall survival time of AT/RT patients was significantly shorter than that of MB patients ( P  < 0.001), with a higher mortality rate (81.4% vs. 35.5%, P  = 0.007). Significant differences were found between AT/RT and MB in T2WI signal, off-midline growth, supratentorial ventriculomegaly, cystic degeneration, hemorrhage, peritumoral edema, tumor boundary clarity, and metastasis/dissemination ( P  < 0.05). No significant differences were observed in gender, age, lesion size, T1WI signal, or enhancement pattern ( P  > 0.05). The mean ADC value differed significantly between the two groups ( P  < 0.001), with an optimal cut-off value of 0.622 × 10⁻³ mm²/s. Conclusion MRI features, including more cystic degeneration, hemorrhage, supratentorial ventriculomegaly, and peritumoral edema, combined with a lower ADC value may provide reliable information to differentiate AT/RT from MB in children.