Less Invasive Phenotype Found in Isocitrate Dehydrogenase–mutated Glioblastomas than in Isocitrate Dehydrogenase Wild-Type Glioblastomas: A Diffusion-Tensor Imaging Study

Abstract

Purpose To explore the diffusion-tensor (DT) imaging-defined invasive phenotypes of both isocitrate dehydrogenase (IDH-1)-mutated and IDH-1 wild-type glioblastomas. Materials and Methods Seventy patients with glioblastoma were prospectively recruited and imaged preoperatively. All patients provided signed consent, and the local research ethics committee approved the study. Patients underwent surgical resection, and tumor samples underwent immunohistochemistry for IDH-1 R132H mutations. DT imaging data were coregistered to the anatomic magnetic resonance study and reconstructed to provide the anisotropic and isotropic components of the DT. The invasive phenotype was determined by using previously published criteria and correlated with IDH-1 mutation status by using the Freeman-Halton extension of the Fisher exact probability test. Results Nine patients had an IDH-1 mutation and 61 had IDH-1 wild type. All of the patients with IDH-1 mutation had a minimally invasive DT imaging phenotype. Among the IDH-1 wild-type tumors, 42 of 61 (69%) were diffusively invasive glioblastomas, 14 of 61 (23%) were locally invasive, and five of 61 (8%) were minimally invasive (P < .001). Conclusion IDH-mutated glioblastomas have a less invasive phenotype compared with IDH wild type. This finding may have implications for individualizing the extent of surgical resection and radiation therapy volumes.

Intratumoral Heterogeneity of Glioblastoma Infiltration Revealed by Joint Histogram Analysis of Diffusion Tensor Imaging

“…11 This technique has shown its utility in detecting the subtle change caused by tumor invasion and predicting progression. 9 Consistent with previous studies, 8 our univariate results showed increased DTI-p and decreased DTI-q can be found in the majority of tumor area. Additionally, the non-enhancing tumor may display increased DTIq, which was not observed in contrast-enhancing region and may characterize the infiltrative region.…”

“…8 Diffusion tensor imaging (DTI) is a method that measures the magnitude and direction of water molecule movement, and has been shown to be sensitive in detecting tumor infiltration. 9 Glioblastoma may preferentially migrate along white matter tracts and cause disruption. 10 The diffusion of water molecules in tumor and peritumoral brain is consequently altered.…”

“…One previous study has shown that IDH mutant glioblastoma is less invasive determined by DTI maps. 9 Whether the DTI markers, particularly DTI-p and -q, can provide additional prognostic value to molecular markers is unclear.…”

Low Perfusion Compartments in Glioblastoma Quantified by Advanced Magnetic Resonance Imaging and Correlated with Patient Survival

“…To further explore the relation between hypoxic compartments and tumor invasiveness, we investigated DTI invasive phenotypes of 64 patients which overlap with a previously reported cohort and have been correlated to isocitrate dehydrogenase (IDH) mutation status. 27 Three invasive phenotypes were classified using previously described criteria 28 based on the decomposition of diffusion tensor into isotropic (p) and anisotropic components (q): (a) diffuse invasive phenotype; (b) localized invasive phenotype; and (c) minimal invasive phenotype. ( Figure S1).…”

Multi-Parametric and Multi-Regional Histogram Analysis of MRI: Revealing Imaging Phenotypes of Glioblastoma Correlated with Patient Survival

“…This method measures the isotropic and anisotropic diffusion of water molecules and has shown its utility in predicting tumor progression [13] and patient survival [14]. More recently, integrating these modalities was considered useful in revealing the intratumoral invasive component [15] and predicting IDH genotype in high-grade gliomas [16]. In this study, we used the histogram features extracted from above multi-parametric and multi-regional quantitative MRI to stratify patient groups and assess the relevance to treatment outcome.…”