Incidence of high grade gliomas presenting as radiographically non-enhancing lesions: experience in 111 surgically treated non-enhancing gliomas with tissue diagnosis

Eichberg, Daniel G.; Di, Long; Morell, Alexis A.; Shah, Ashish H.; Semonche, Alexa; Chin, Christopher N.; Bhatia, Rita; Jamshidi, Aria; Luther, Evan; Komotar, Ricardo J.; Ivan, Michael E.

doi:10.1007/s11060-020-03474-z

Cited by 18 publications

(14 citation statements)

References 43 publications

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“… 2 This is problematic, because—while the majority of these nonenhancing tumors are indeed low-grade and less aggressive—19–44% have a highly aggressive course due to a high-grade like or a so-called glioblastoma genetic profile, requiring rapid intervention. 3 , 4 Therefore, information even prior to surgery about the molecular profile (i.e. possible presence of a glioblastoma genetic profile) of in particular asymptomatic patients with nonenhancing glioma, can contribute to better-informed treatment decision making.…”

mentioning

confidence: 99%

Noninvasive differentiation of molecular subtypes of adult nonenhancing glioma using MRI perfusion and diffusion parameters

Pruis,

Koene,

van der Voort

et al. 2022

Neuro-Oncology Advances

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Background Non-enhancing glioma typically have a favorable outcome, but approximately 19-44% have a highly aggressive course due to a glioblastoma genetic profile. The aim of this retrospective study is to use physiological MRI parameters of both perfusion and diffusion to distinguish the molecular profiles of glioma without enhancement at presentation. Methods Ninety-nine patients with non-enhancing glioma were included, in whom molecular status (including 1p/19q co-deletion status and IDH mutation) and pre-operative MRI (T2w/FLAIR, dynamic susceptibility weighted and diffusion weighted imaging) were available. Tumors were segmented semi-automatically using ITK-SNAP to derive whole tumor histograms of relative Cerebral Blood Volume (rCBV) and Apparent Diffusion Coefficient (ADC). Tumors were divided into three clinically relevant molecular profiles: IDH mutation (IDHmt) with (n=40) or without (n=41) 1p/19q co-deletion, and (n=18) IDH-wildtype (IDHwt). ANOVA, Kruskal-Wallis and Chi-Square analyses were performed using SPSS. Results rCBV (mean, median, 75 th and 85 th percentile) and ADC (mean, median, 15 th and 25 th percentile) showed significant differences across molecular profiles (p<0.01). Post-hoc analyses revealed that IDHwt and IDHmt 1p/19q co-deleted tumors showed significantly higher rCBV compared to IDHmt 1p/19q intact tumors: mean rCBV (mean, SD) 1.46 (0.59) and 1.35 (0.39) versus 1.08 (0.31), p<0.05. Also, IDHwt tumors showed significantly lower ADC compared to IDHmt 1p/19q co-deleted and IDHmt 1p/19q intact tumors: mean ADC (mean, SD) 1.13 (0.23) versus 1.27 (0.15) and 1.45 (0.20), p<0.001). Conclusions A combination of low ADC and high rCBV, reflecting high cellularity and high perfusion respectively, separates IDHwt from in particular IDHmt 1p/19q intact glioma.

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confidence: 99%

Noninvasive differentiation of molecular subtypes of adult nonenhancing glioma using MRI perfusion and diffusion parameters

Pruis,

Koene,

van der Voort

et al. 2022

Neuro-Oncology Advances

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“…Finally, VEGF-A showed a broader association with kinetic parameters in tissue of the infiltration zone rather than in the vital tumor tissue. Substantial percentages of high-grade gliomas do not show avid contrast enhancement [31]. The exchange of contrast agent between the extravascular and intravascular spaces is a multifactorial process influenced by the BBB, quantitative and qualitative aspects of the microvascular network and cerebral blood flow (i.e., perfusion; ESM 1) [32].…”

Section: Discussionmentioning

confidence: 99%

DCE-MRI in Glioma, Infiltration Zone and Healthy Brain to Assess Angiogenesis: A Biopsy Study

et al. 2021

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Purpose To explore the focal predictability of vascular growth factor expression and neovascularization using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in glioma. Methods 120 brain biopsies were taken in vital tumor, infiltration zone and normal brain tissue of 30 glioma patients: 17 IDH(isocitrate dehydrogenase)-wildtype glioblastoma (GBM), 1 IDH-wildtype astrocytoma °III (together prognostic group 1), 3 IDH-mutated GBM (group 2), 3 anaplastic astrocytomas IDH-mutated (group 3), 4 anaplastic oligodendrogliomas and 2 low-grade oligodendrogliomas (together prognostic group 4). A mixed linear model evaluated the predictabilities of microvessel density (MVD), vascular area ratio (VAR), mean vessel size (MVS), vascular endothelial growth factor and receptors (VEGF-A, VEGFR‑2) and vascular endothelial-protein tyrosine phosphatase (VE-PTP) expression from Tofts model kinetic and model-free curve parameters. Results All kinetic parameters were associated with VEGF‑A (all p < 0.001) expression. Ktrans, kep and ve were associated with VAR (p = 0.006, 0.004 and 0.01, respectively) and MVS (p = 0.0001, 0.02 and 0.003, respectively) but not MVD (p = 0.84, 0.74 and 0.73, respectively). Prognostic groups differed in Ktrans (p = 0.007) and ve (p = 0.004) values measured in the infiltration zone. Despite significant differences of VAR, MVS, VEGF‑A, VEGFR‑2, and VE-PTP in vital tumor tissue and the infiltration zone (p = 0.0001 for all), there was no significant difference between kinetic parameters measured in these zones. Conclusion The DCE-MRI kinetic parameters show correlations with microvascular parameters in vital tissue and also reveal blood-brain barrier abnormalities in the infiltration zones adequate to differentiate glioma prognostic groups.

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“…This pitfall might be due to wrong ROI placement based on the standard enhancing portion on CEMRI rather than planning on either DWI or PET. Non-enhancing recurrence foci can be missed by using CEMRI if used as criteria to identify tumor foci (2).…”

Section: Using Mrpet In Glioma To Differentiate Recurrence From Radiation Necrosismentioning

confidence: 99%

“…The hybrid whole-body magnetic resonance positron emission tomography (MRPET) system is a new diagnostic tool. It enables the simultaneous acquisition of morphologic and multiple functional data and thus a diversified characterization of oncological diseases (1,2).…”

Section: Introductionmentioning

confidence: 99%

Can High b Value Diffusion Be a Surrogate Marker for PET—A MR/PET Study in Neurooncology Set Up

et al. 2021

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Purpose: Hybrid whole-body magnetic resonance/positron emission tomography (MR/PET) systems are new diagnostic tools enabling the simultaneous acquisition of morphologic and multiparametric functional data, which allow for a diversified characterization of oncological diseases. This study aimed to compare the diagnostic ability of MRI with the diffusion-weighted image (DWI), and simultaneous integrated positron emission tomography MR/PET to detect malignant lesions and elucidate the utility and limitations of these imaging modalities in preoperative and postoperative follow up in cancer patients.Material and Methods: A total of 45 patients undergoing simultaneous MR/PET for CNS ICSOL in our institution between January 2016 and July 2020 were considered in this study. Post-processing was done in Siemens syngo software to generate a b2000 image. This image was then inverted to grayscale and compared with the NAC image of PET.Results: The lesion-based sensitivity, specificity, positive predictive value, and negative predictive value for DWI were 92.3, 83.3, 97.3, and 62.5%, respectively (at 95% CI and p was 0.000). The lesion-based sensitivity, specificity, positive predictive value, and negative predictive value for PET were 97.4, 71.4, 94.9, and 83.3%, respectively (at 95% CI and p was 0.000). The lesion-based sensitivity and specificity of DWI were comparable with those of PET.Conclusions: Although DWI and FDG-PET reflect different tissue properties, there is an association between the measures of both methods in CNS tumors probably because of the coupling of cellularity with tumor metabolism as seen on FDG and other PET tracers. Our study shows that DWI acts as a surrogate biomarker for FDG PET and other tracers in tumors. The method of DWI image generation is simple, radiation-free, and cost-effective in a clinical setup. The simultaneous DWI-PET study provides evidence and confirms the role of DWI in surveillance imaging of tumors.

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Incidence of high grade gliomas presenting as radiographically non-enhancing lesions: experience in 111 surgically treated non-enhancing gliomas with tissue diagnosis

Cited by 18 publications

References 43 publications

Noninvasive differentiation of molecular subtypes of adult nonenhancing glioma using MRI perfusion and diffusion parameters

Noninvasive differentiation of molecular subtypes of adult nonenhancing glioma using MRI perfusion and diffusion parameters

DCE-MRI in Glioma, Infiltration Zone and Healthy Brain to Assess Angiogenesis: A Biopsy Study

Can High b Value Diffusion Be a Surrogate Marker for PET—A MR/PET Study in Neurooncology Set Up

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