Quantitative craniospinal MRI tumor burden predicts outcomes in recurrent medulloblastoma

In a retrospective 40-patient trial, higher baseline tumor burden on craniospinal MRI trends toward predicting progression (OR 1.18, p=0.08) and volume ≥5.5 mL tied to shorter overall survival (p=0.003).

• Retrospective analysis of 40 patients from the MEMMAT trial (2014–2021) assessed baseline T1CE and DWI lesion count and volume; response categories (complete, partial, stable, progressive) showed distinct tumor burden trajectories.
• Agreement between T1CE and DWI was poor (ICC 0.35–0.47), with 23% of patients misclassified using a single sequence; combined intracranial and intraspinal T1CE and intracranial DWI improved response evaluation.
• Small sample size, borderline statistical significance, and lack of external validation limit generalizability; the findings are exploratory and require confirmation in larger cohorts.

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