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Purpose To evaluate for predictive neuroimaging features of pediatric brain tumor development and quantify tumor growth characteristics. Methods Retrospective review of 1098 consecutive pediatric patients at a single institution with newly diagnosed brain tumors from January 2009 to October 2021was performed. Pre-diagnostic and diagnostic neuroimaging features (e.g., tumor size, apparent diffusion coefficient (ADC) values), clinical presentations, and neuropathology were recorded. High- and low-grade tumor sizes were fit to linear and exponential growth regression models. Results Fourteen of 1098 patients (1%) had neuroimaging before diagnosis of a brain tumor (8 females, mean age 8.1 years, imaging interval 0.2-8.7 years). Tumor types included low-grade glioma (n = 4), embryonal tumors (n = 3), ependymoma (n = 3), and others (n = 4). Pre-diagnostic imaging of corresponding tumor growth sites were abnormal in four cases (28%) and demonstrated higher ADC values in diagnostically high-grade tumors (p = 0.05). Growth regression analyses demonstrated R2-values of 0.92 and 0.91 using a linear model and 0.64 and 0.89 using an exponential model for high- and low-grade tumors, respectively; estimated minimum velocity of diameter expansion was 2.4 cm/year for high-grade tumors and 0.4 cm/year for low-grade tumors. High-grade tumors demonstrated faster growth rate of diameter and solid tumor volume compared to low-grade tumors (p = 0.02, p = 0.03, respectively). Conclusions This is the first study to utilize pre-diagnostic neuroimaging to demonstrate that linear and exponential growth rate models can be used to estimate pediatric brain tumor growth velocity and should be validated in a larger cohort.

We report the case of a seven year old girl with 22q11 deletion mosaicism who presented with a sudden onset rapidly enlarging left parotid mass and ipsilateral facial nerve paresis. MRI and cytology were inconclusive. She underwent partial superficial parotidectomy to obtain definitive histopathology, which was reported as suggestive of acute Epstein Barr infection. A subsequent quantitative Epstein–Barr Virus (EBV) PCR clinched the diagnosis four weeks after her initial presentation. She was stared on oral Valgancyclovir and her facial nerve showed recovery. We discuss the challenges faced in managing this case with delayed conclusive diagnosis of acute Epstein Barr virus infection.