MRI features predict tumor grade in isocitrate dehydrogenase (IDH)–mutant astrocytoma and oligodendroglioma

Joyner, David; Garrett, John W.; Batchala, Prem P.; Rama, Bharath; Ravicz, Joshua R.; Patrie, James T.; Lopes, M. Beatriz S.; Fadul, Camilo E.; Schiff, David; Jain, Rajan; Patel, Sohil H.

doi:10.1007/s00234-022-03038-0

Cited by 17 publications

(19 citation statements)

References 44 publications

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“…The number, volume, proliferation rate, and nuclear atypia of tumor cells increase significantly with an increase in tumor grade. Previous studies have found that the more restricted the intracellular and extracellular water molecules, the lower the ADC values (11)(12)(13)(24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

The role of apparent diffusion coefficient in the grading of adult isocitrate dehydrogenase-mutant astrocytomas: relationship with the Ki-67 proliferation index

She,

Liu,

Jiang

et al. 2024

Acta Radiol

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Background The grading of adult isocitrate dehydrogenase (IDH)-mutant astrocytomas is a crucial prognostic factor. Purpose To investigate the value of conventional magnetic resonance imaging (MRI) features and apparent diffusion coefficient (ADC) in the grading of adult IDH-mutant astrocytomas, and to analyze the correlation between ADC and the Ki-67 proliferation index. Material and Methods The clinical and MRI data of 82 patients with adult IDH-mutant astrocytoma who underwent surgical resection and molecular genetic testing with IDH and 1p/19q were retrospectively analyzed. The conventional MRI features, ADCmin, ADCmean, and nADC of the tumors were compared using the Kruskal–Wallis single factor ANOVA and chi-square tests. Receiver operating characteristic (ROC) curves were drawn to evaluate conventional MRI and ADC accuracy in differentiating tumor grades. Pearson correlation analysis was performed to determine the correlation between ADC and the Ki-67 proliferation index. Results The difference in enhancement, ADCmin, ADCmean, and nADC among WHO grade 2, 3, and 4 tumors was statistically significant (all P <0.05). ADCmin showed the preferable diagnostic accuracy for grading WHO grade 2 and 3 tumors (AUC=0.724, sensitivity=63.4%, specificity=80%, positive predictive value (PPV)=62.0%; negative predictive value (NPV)=82.5%), and distinguishing grade 3 from grade 4 tumors (AUC=0.764, sensitivity=70%, specificity=76.2%, PPV=75.0%, NPV=71.4%). Enhancement + ADC model showed an optimal predictive accuracy (grade 2 vs. 3: AUC = 0.759; grade 3 vs. 4: AUC = 0.799). The Ki-67 proliferation index was negatively correlated with ADCmin, ADCmean, and nADC (all P <0.05), and positively correlated with tumor grade. Conclusion Conventional MRI features and ADC are valuable to predict pathological grading of adult IDH-mutant astrocytomas.

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Section: Discussionmentioning

confidence: 99%

The role of apparent diffusion coefficient in the grading of adult isocitrate dehydrogenase-mutant astrocytomas: relationship with the Ki-67 proliferation index

She,

Liu,

Jiang

et al. 2024

Acta Radiol

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“…So far, the interpretation of radiological tumor grading has been mainly based on histological data [ 2 ]. Although several studies have already shown a correlation between molecular image markers such as CBV, ADC, or ITSS (intratumoral susceptibility signals, indicating neo-angiogenesis) and tumor type and grade [ 6 , 22 , 23 ], these data are based on the old WHO classification of 2016 [ 24 ]. Only a few groups elaborated on differences based on the novel WHO classification of 2021.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have already shown correlations between imaging biomarkers such as ADC (apparent diffusion coefficient), contrast uptake, and rCBV (relative cerebral blood volume) and tumor types and grading. These data, except for Yang et al [ 3 ], refer to the older WHO classifications [ 4 , 5 , 6 , 7 , 8 ]. Although diagnosis can now usually be made accurately using EPIC array methylation analysis (Illumina Inc., San Diego, CA, USA) or single marker testing, these molecular methods provide only a temporal and regional snapshot of the tumor, confined by the extent of the provided histopathological sample and the date of resection, and do not necessarily capture the aspect of intratumoral heterogeneity and evolution [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Imaging the WHO 2021 Brain Tumor Classification: Fully Automated Analysis of Imaging Features of Newly Diagnosed Gliomas

Griessmair

Delbridge

Ziegenfeuter

et al. 2023

Cancers

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Background: The fifth version of the World Health Organization (WHO) classification of tumors of the central nervous system (CNS) in 2021 brought substantial changes. Driven by the enhanced implementation of molecular characterization, some diagnoses were adapted while others were newly introduced. How these changes are reflected in imaging features remains scarcely investigated. Materials and Methods: We retrospectively analyzed 226 treatment-naive primary brain tumor patients from our institution who received extensive molecular characterization by epigenome-wide methylation microarray and were diagnosed according to the 2021 WHO brain tumor classification. From multimodal preoperative 3T MRI scans, we extracted imaging metrics via a fully automated, AI-based image segmentation and processing pipeline. Subsequently, we examined differences in imaging features between the three main glioma entities (glioblastoma, astrocytoma, and oligodendroglioma) and particularly investigated new entities such as astrocytoma, WHO grade 4. Results: Our results confirm prior studies that found significantly higher median CBV (p = 0.00003, ANOVA) and lower median ADC in contrast-enhancing areas of glioblastomas, compared to astrocytomas and oligodendrogliomas (p = 0.41333, ANOVA). Interestingly, molecularly defined glioblastoma, which usually does not contain contrast-enhancing areas, also shows significantly higher CBV values in the non-enhancing tumor than common glioblastoma and astrocytoma grade 4 (p = 0.01309, ANOVA). Conclusions: This work provides extensive insights into the imaging features of gliomas in light of the new 2021 WHO CNS tumor classification. Advanced imaging shows promise in visualizing tumor biology and improving the diagnosis of brain tumor patients.

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“…Specifically, gemistocytic astrocytoma evaluation should be considered in patients with heterogeneous cystic lesions that display contrast enhancement and partial FLAIR suppression [107]. Recent literature has emerged on the use of MRI to predict tumor grade in IDH-mutant astrocytomas and oligodendrogliomas [108]. Joyner et al [108] suggest a positive association between contrast enhancement and the grade of astrocytomas as well as oligodendrogliomas.…”

Section: Diagnostic Imagingmentioning

confidence: 99%

“…Recent literature has emerged on the use of MRI to predict tumor grade in IDH-mutant astrocytomas and oligodendrogliomas [108]. Joyner et al [108] suggest a positive association between contrast enhancement and the grade of astrocytomas as well as oligodendrogliomas. Additionally, their study suggests a negative association with ADC and a positive association with rCBV in predicting astrocytoma grade, but not oligodendroglioma grade [108].…”

Section: Diagnostic Imagingmentioning

confidence: 99%

Update for astrocytomas: medical and surgical management considerations

Willman

Figg

et al. 2023

Explor Neurosci

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Astrocytomas include a wide range of tumors with unique mutations and varying grades of malignancy. These tumors all originate from the astrocyte, a star-shaped glial cell that plays a major role in supporting functions of the central nervous system (CNS), including blood-brain barrier (BBB) development and maintenance, water and ion regulation, influencing neuronal synaptogenesis, and stimulating the immunological response. In terms of epidemiology, glioblastoma (GB), the most common and malignant astrocytoma, generally occur with higher rates in Australia, Western Europe, and Canada, with the lowest rates in Southeast Asia. Additionally, significantly higher rates of GB are observed in males and non-Hispanic whites. It has been suggested that higher levels of testosterone observed in biological males may account for the increased rates of GB. Hereditary syndromes such as Cowden, Lynch, Turcot, Li-Fraumeni, and neurofibromatosis type 1 have been linked to increased rates of astrocytoma development. While there are a number of specific gene mutations that may influence malignancy or be targeted in astrocytoma treatment, O6-methylguanine-DNA methyltransferase (MGMT) gene function is an important predictor of astrocytoma response to chemotherapeutic agent temozolomide (TMZ). TMZ for primary and bevacizumab in the setting of recurrent tumor formation are two of the main chemotherapeutic agents currently approved in the treatment of astrocytomas. While stereotactic radiosurgery (SRS) has debatable implications for increased survival in comparison to whole-brain radiotherapy (WBRT), SRS demonstrates increased precision with reduced radiation toxicity. When considering surgical resection of astrocytoma, the extent of resection (EoR) is taken into consideration. Subtotal resection (STR) spares the margins of the T1 enhanced magnetic resonance imaging (MRI) region, gross total resection (GTR) includes the margins, and supramaximal resection (SMR) extends beyond the margin of the T1 and into the T2 region. Surgical resection, radiation, and chemotherapy are integral components of astrocytoma treatment.

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MRI features predict tumor grade in isocitrate dehydrogenase (IDH)–mutant astrocytoma and oligodendroglioma

Cited by 17 publications

References 44 publications

The role of apparent diffusion coefficient in the grading of adult isocitrate dehydrogenase-mutant astrocytomas: relationship with the Ki-67 proliferation index

The role of apparent diffusion coefficient in the grading of adult isocitrate dehydrogenase-mutant astrocytomas: relationship with the Ki-67 proliferation index

Imaging the WHO 2021 Brain Tumor Classification: Fully Automated Analysis of Imaging Features of Newly Diagnosed Gliomas

Update for astrocytomas: medical and surgical management considerations

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