Association of dynamic susceptibility magnetic resonance imaging at initial tumor diagnosis with the prognosis of different molecular glioma subtypes

Abstract

Purpose The updated 2016 CNS World Health Organization classification differentiates three main groups of diffuse glioma according to their molecular characteristics: astrocytic tumors with and without isocitrate dehydrogenase (IDH) mutation and 1p/19q co-deleted oligodendrogliomas. The present study aimed to determine whether dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) is an independent prognostic marker within the molecular subgroups of diffuse glioma. Methods Fifty-six patients with treatment-naive gliomas and advanced preoperative MRI examination were assessed retrospectively. The mean and maximal normalized cerebral blood volume values from DSC-MRI within the tumors were measured. Optimal cutoff values for the 1-year progression-free survival (PFS) were defined, and Kaplan-Meier analyses were performed separately for the three glioma subgroups. Results IDH wild-type astrocytic tumors had a higher mean and maximal perfusion than IDH-mutant astrocytic tumors and oligodendrogliomas. Patients with IDH wild-type astrocytic tumors and a low mean or maximal perfusion had a significantly shorter PFS than patients of the same group with high perfusion (p = 0.0159/0.0112). Furthermore, they had a significantly higher risk for early progression (hazard ratio = 5.6/5.1). This finding was independent of the methylation status of O6-methylguanin-DNA-methyltransferase and variations of the therapy. Within the groups of IDH-mutant astrocytic tumors and oligodendrogliomas, the PFS of low and highly perfused tumors did not differ. Conclusion High perfusion upon initial diagnosis is not compellingly associated with worse short-term prognosis within the different molecular subgroups of diffuse glioma. Particularly, the overall highly perfused group of IDH wild-type astrocytic tumors contains tumors with low perfusion but unfavorable prognosis.

A systematic review and meta-analysis on the differentiation of glioma grade and mutational status by use of perfusion-based magnetic resonance imaging

“…Eight papers used DSC perfusion MRI [ 20 , 21 , 24 – 28 , 30 ]; three papers used both DCE and DSC perfusion MRI [ 22 , 23 , 29 ]; one paper used DCE perfusion MRI only [ 26 ]. Two papers used artificial intelligence methods to assess different perfusion metrics between various subtypes of gliomas [ 20 , 25 ], whereas the other publications used more traditional statistics.…”

“…As assessed by DSC perfusion MRI, IDHmut glioma displayed significantly lower rCBV values as compared to IDHwt glioma [ 21 , 26 – 28 , 30 ]. When using a retrospectively determined rCBVmax threshold value of < 2.35, the authors described a sensitivity/specificity of 100%/61% and AUC of 0.82 (95%-CI: 0.66–0.93) when differentiating IDHmut (either WHO 2021 Astroctytoma grade 2, 3 or 4 or WHO 2021 Oligodendroglioma grade 2 or 3) and IDHwt gliomas [ 27 ].…”

DSC-PWI presurgical differentiation of grade 4 astrocytoma and glioblastoma in young adults: rCBV percentile analysis across enhancing and non-enhancing regions

“…Several studies have attempted to identify IDH-mutation status using rCBV while analysing a range of adult diffuse gliomas. Some suggest the feasibility of discerning IDH mutation status, generally reporting higher rCBV values in both enhancing and non-enhancing regions for IDH-wildtype [ 17 , 26 , 27 ]. However, interpreting these findings requires caution, as these studies do not account for potential confounding with age or histological grade which are only reported as descriptive statistics, thereby preventing the optimal discernment of the specific differential in the current study.…”

ADC-Based Stratification of Molecular Glioma Subtypes Using High b-Value Diffusion-Weighted Imaging

“…B 500 ADC maps showed better results than the B 0 ADC maps, which may be explained by the perfusion influence described to impair DWI at lower b-values [10,34,35]. Different types of perfusion imaging, such as arterial spin labeling and dynamic contrast-enhanced perfusion, have been described in recent studies as a potential approach to grading and determining IDH-mutation status [21,36]. Comparing the different evaluation strategies in this study, the results provided slightly higher levels of significance in the kurtosis-based evaluation.…”