MR-spectroscopic imaging of glial tumors in the spotlight of the 2016 WHO classification

Diamandis, Elie; Gabriel, Carl Phillip Simon; Würtemberger, Urs; Guggenberger, Konstanze; Urbach, Horst; Staszewski, Ori; Laßmann, Silke; Schnell, Oliver; Grauvogel, Juergen; Mader, Irina; Heiland, Dieter Henrik

doi:10.1007/s11060-018-2881-x

Cited by 11 publications

(12 citation statements)

References 34 publications

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“…With the IDH1 R132 (Arginine 132) mutation leading to an accumulation of 2 hydroxyglutarate, magnetic resonance spectroscopy (MRS) allows the measurement of this oncometabolite in vivo (49, 50), which has been applied for non-invasively predicting IDH-mutation status in glioma patients (51) and for investigating remote glioma cell infiltration in vivo (52–54). Recent studies even used MRS to identify tumor-specific metabolic profiles and investigated metabolic–transcriptional alterations under consideration of genetic profiles (55–57). A multimodal approach combining MRS and a diffusion-based characterization of NAWM microarchitecture may allow future studies to further specify histopathological correlates of NAWM diffusion properties in vivo .…”

Section: Discussionmentioning

confidence: 99%

Diffusion Tensor Imaging Reveals Microstructural Heterogeneity of Normal-Appearing White Matter and Related Cognitive Dysfunction in Glioma Patients

et al. 2019

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Immunohistochemical data based on isocitrate–dehydrogenase (IDH) mutation status have redefined glioma as a whole-brain disease, while occult tumor cell invasion along white matter fibers is inapparent in conventional magnetic resonance imaging (MRI). The functional and prognostic impact of focal glioma may however relate to the extent of white matter involvement. We used diffusion tensor imaging (DTI) to investigate microstructural characteristics of whole-brain normal-appearing white matter (NAWM) in relation to cognitive functions as potential surrogates for occult white matter involvement in glioma. Twenty patients (12 IDH-mutated) and 20 individually matched controls were preoperatively examined using DTI combined with a standardized neuropsychological examination. Tumor lesions including perifocal edema were masked, and fractional anisotropy (FA) as well as mean, radial, and axial diffusivity (MD, RD, and AD, respectively) of the remaining whole-brain NAWM were determined by using Tract-Based Spatial Statistics and histogram analyses. The relationship between extratumoral white matter integrity and cognitive performance was examined using partial correlation analyses controlling for age, education, and lesion volumes. In patients, mean FA and AD were decreased as compared to controls, which agrees with the notion of microstructural impairment of NAWM in glioma patients. Patients performed worse in all cognitive domains tested, and higher anisotropy and lower MD and RD values of NAWM were associated with better cognitive performance. In additional analyses, IDH-mutated and IDH-wildtype patients were compared. Patients with IDH-mutation showed higher FA, but lower MD, AD, and RD values as compared to IDH-wildtype patients, suggesting a better preserved microstructural integrity of NAWM, which may relate to a less infiltrative nature of IDH-mutated gliomas. Diffusion-based phenotyping and monitoring microstructural integrity of extratumoral whole-brain NAWM may aid in estimating occult white matter involvement and should be considered as a complementary biomarker in glioma.

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Section: Discussionmentioning

confidence: 99%

Diffusion Tensor Imaging Reveals Microstructural Heterogeneity of Normal-Appearing White Matter and Related Cognitive Dysfunction in Glioma Patients

et al. 2019

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“…As in the case of our patient, complementary MRS and positron emitting tomography may also provide valuable data to identify the presence of glial tumors; further details on their application can be found elsewhere. [4,8]MS: Lesions are commonly found within the confinements of the posterior fossa, periventricular areas, spinal cord, and optic nerves. Dual-echo and fluid-attenuated inversion recovery (FLAIR) imaging reveal focal areas of hyperintensity while T1-weighted MRI (with Gd) help discerns between active and inactive MS-lesions, as enhancement results from an increase in blood-brain barrier permeability in areas of “active” inflammation.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A challenging case of concurrent multiple sclerosis and anaplastic astrocytoma

Sinclair

Al-saffar

Johnstone

et al. 2019

Surgical Neurology International

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Background: Cases of gliomas coexisting with multiple sclerosis (MS) have been described over the past few decades. However, due to the complex clinical and radiological traits inherent to both entities, this concurrent phenomenon remains difficult to diagnose. Much has been debated about whether this coexistence is incidental or mirrors a poorly understood neoplastic phenomenon engaging glial cells in the regions of demyelination. Case Description: We present the case of a 41-year-old patient diagnosed with a left-sided frontal contrast enhancing lesion initially assessed as a tumefactive MS. Despite systemic treatment, the patient gradually developed signs of mass effect, which led to decompressive surgery. The initial microscopic evaluation demonstrated the presence of MS and oligodendroglioma; the postoperative evolution proved complex due to a series of MS-relapses and tumor recurrence. An ulterior revaluation of the samples for the purpose of this report showed an MS-concurrent anaplastic astrocytoma. We describe all relevant clinical aspects of this case and review the medical literature for possible causal mechanisms. Conclusion: Although cases of concurrent glioma and MS remain rare, we present a case illustrating this phenomenon and explore a number of theories behind a potential causal relationship.

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“…Tissue samples were fixed using 4% phosphate buffered formaldehyde and paraffin-embedded according to standard procedures. Analysis were performed in the Institute of Neuropathology, Medical-Center University of Freiburg as detailed described in our previous works [7,8].…”

Section: Histopathological and Molecular Diagnosticsmentioning

confidence: 99%

Characterization of longitudinal transformation of T2-hyperintensity in oligodendroglioma

et al. 2020

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Background: Oligodendroglioma (ODG) are CNS resistant tumors characterized by their unique molecular signature, namely a combined deletion of 1p and 19q simultaneously to an IDH1/2 mutation. These tumors have a more favorable clinical outcome compared to other gliomas and a long-time survival that ranges between 10 and 20 years. However, during the course of the disease, multiple recurrences occur and the optimal treatment at each stage of the disease remains unclear. Here we report a retrospective longitudinal observation study of 836 MRI examinations in 44 ODG patients. Methods: We quantified the volume of T2-hyperintensity to compute growth behavior in dependence of different treatment modalities, using various computational models. Results: The identified growth pattern revealed dynamic changes, which were found to be patient-specific an did not correlate with clinical parameter or therapeutic interventions. Further, we showed that, surgical resection is beneficial for overall survival regardless the WHO grad or timepoint of surgery. To improve overall survival, an extent of resection above 50% is required. Multiple resections do not generally improve overall survival, except a greater extent of resection than in previous surgeries was achieved. Conclusions: Our data aids to improve the interpretation of MRI images in clinical practice.

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MR-spectroscopic imaging of glial tumors in the spotlight of the 2016 WHO classification

Cited by 11 publications

References 34 publications

Diffusion Tensor Imaging Reveals Microstructural Heterogeneity of Normal-Appearing White Matter and Related Cognitive Dysfunction in Glioma Patients

Diffusion Tensor Imaging Reveals Microstructural Heterogeneity of Normal-Appearing White Matter and Related Cognitive Dysfunction in Glioma Patients

A challenging case of concurrent multiple sclerosis and anaplastic astrocytoma

Characterization of longitudinal transformation of T2-hyperintensity in oligodendroglioma

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