Paediatric brain-stem gliomas: MRI, FDG-PET and histological grading correlation

Kwon, Jong Won; Kim, In One; Cheon, Jung Hee; Kim, Woo Sun; Moon, Sung Gyu; Kim, Tae Jung; G., Je; Wang, Kyu-Chang; Chung, June Key; Yeon, Kyung Mo

doi:10.1007/s00247-006-0256-5

Cited by 44 publications

(31 citation statements)

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“…Papers have shown that the intensity of 18 F-FDG uptake is associated with tumor grade and survival (10)(11)(12)(13)(14). Kwon et al found that hypermetabolic tumors were more likely to be glioblastoma than were tumors with little or no 18 F-FDG uptake, which were anaplastic or low-grade astrocytomas (14). Pirotte et al found that brain stem gliomas with high 18 F-FDG uptake were associated with a shorter survival than were brain stem gliomas with absence of or moderate 18 F-FDG uptake (35).…”

Section: Discussionmentioning

confidence: 99%

“…PET with 18 F-FDG shows sites of metabolically active disease, albeit with limited anatomic detail. Further, the intensity of 18 F-FDG uptake may reflect malignancy grade and predict survival (10)(11)(12)(13)(14). Thus, there is a potential benefit to fused PET and MR images, with the ADC values on MRI and the intensity of 18 F-FDG uptake on PET possibly providing synergistic information on tumor grade and prognosis.…”

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confidence: 99%

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Correlation of ¹⁸F-FDG PET and MRI Apparent Diffusion Coefficient Histogram Metrics with Survival in Diffuse Intrinsic Pontine Glioma: A Report from the Pediatric Brain Tumor Consortium

et al. 2017

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See an invited perspective on this article on page 1262.The purpose of this study was to describe baseline 18 F-FDG PET voxel characteristics in pediatric diffuse intrinsic pontine glioma (DIPG) and to correlate these metrics with baseline MRI apparent diffusion coefficient (ADC) histogram metrics, progression-free survival (PFS), and overall survival. Methods: Baseline brain 18 F-FDG PET and MRI scans were obtained in 33 children from Pediatric Brain Tumor Consortium clinical DIPG trials. 18 F-FDG PET images, postgadolinium MR images, and ADC MR images were registered to baseline fluid attenuation inversion recovery MR images. Three-dimensional regions of interest on fluid attenuation inversion recovery MR images and postgadolinium MR images and 18 F-FDG PET and MR ADC histograms were generated. Metrics evaluated included peak number, skewness, and kurtosis. Correlation between PET and MR ADC histogram metrics was evaluated. PET pixel values within the region of interest for each tumor were plotted against MR ADC values. The association of these imaging markers with survival was described. Results: PET histograms were almost always unimodal (94%, vs. 6% bimodal). None of the PET histogram parameters (skewness or kurtosis) had a significant association with PFS, although a higher PET postgadolinium skewness tended toward a less favorable PFS (hazard ratio, 3.48; 95% confidence interval [CI], 0.75-16.28 [P 5 0.11]). There was a significant association between higher MR ADC postgadolinium skewness and shorter PFS (hazard ratio, 2.56; 95% CI, 1.11-5.91 [P 5 0.028]), and there was the suggestion that this also led to shorter overall survival (hazard ratio, 2.18; 95% CI, 0.95-5.04 [P 5 0.067]). Higher MR ADC postgadolinium kurtosis tended toward shorter PFS (hazard ratio, 1.30; 95% CI, 0.98-1.74 [P 5 0.073]). PET and MR ADC pixel values were negatively correlated using the Pearson correlation coefficient. Further, the level of PET and MR ADC correlation was significantly positively associated with PFS; tumors with higher values of ADC-PET correlation had more favorable PFS (hazard ratio, 0.17; 95% CI, 0.03-0.89 [P 5 0.036]), suggesting that a higher level of negative ADC-PET correlation leads to less favorable PFS. A more significant negative correlation may indicate higher-grade elements within the tumor leading to poorer outcomes. Conclusion: 18 F-FDG PET and MR ADC histogram metrics in pediatric DIPG demonstrate different characteristics with often a negative correlation between PET and MR ADC pixel values. A higher negative correlation is associated with a worse PFS, which may indicate higher-grade elements within the tumor.

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Section: Discussionmentioning

confidence: 99%

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Correlation of ¹⁸F-FDG PET and MRI Apparent Diffusion Coefficient Histogram Metrics with Survival in Diffuse Intrinsic Pontine Glioma: A Report from the Pediatric Brain Tumor Consortium

et al. 2017

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“…The intensity of 18 F-FDG uptake in brain tumours may reflect the grade of malignancy and even predict survival [8,9]. Preliminary data indicate that 18 F-FDG uptake may correlate with tumour grade and add prognostic information on BSG and related brain tumours [10,11,12]. …”

Section: Introductionmentioning

confidence: 99%

Can Multiparametric MRI and FDG-PET Predict Outcome in Diffuse Brainstem Glioma? A Report from a Prospective Phase-II Study

et al. 2013

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Purpose: To study the impact of multiparametric MRI and ¹⁸F-FDG-PET on the outcome of children with diffuse intrinsic pontine gliomas (DIPG). Materials and Methods: Imaging data from aphase-II prospective therapeutic study in children with newly diagnosed DIPG were considered for evaluation. They included baseline MRI with contrast enhancement before treatment. Functional imaging included MR spectroscopy, MR perfusion and FDG-PET studies. All patients (n = 20) had baseline MRI and 11 patients had FDG-PET. Response was assessed by MRI and PET 4 weeks after therapy. Baseline imaging findings were correlated with survival. Presence or absence of adverse parameters on MRI (heterogeneous contrast enhancement, hyperperfusion or increased choline:NAA ratio) was used to develop a cumulative radiological prognostic index (RPI). Sensitivity and specificity of each imaging modality in tumour grading was estimated. Results: The cumulative RPI was able to classify the patients into different grades and was predictive of overall survival (p = 0.02). MR perfusion also predicted survival (p = 0.039). Sensitivity and specificity of MRI and FDG-PET to detect low-grade gliomas were low to moderate (33-66%), but moderate to high in detecting high-grade gliomas (50-100%). Baseline FDG uptake on PET scan did not correlate with survival (p = 0.7). Conclusions: Cumulative RPI was able to classify tumours into different grades and predicted clinical outcome. At baseline, MR hyperperfusion indicated a shorter survival for DIPG patients. Sensitivity and specificity of imaging modalities to detect low-grade gliomas were poor.

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“…3). 23,26,63,86 In addition, FDG-PET has been used to differentiate tumor recurrence from posttreatment effects, such as radiation necrosis. 34 Diffusion tensor imaging has been investigated to assess a potential role in visualizing and quantifying white matter tract involvement in brainstem tumors.…”

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Treatment of diffuse intrinsic brainstem gliomas: failed approaches and future strategies

Frazier¹,

Lee²,

Thomale

et al. 2009

PED

126

107

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Diffuse intrinsic pontine gliomas constitute ~ 60–75% of tumors found within the pediatric brainstem. These malignant lesions present with rapidly progressive symptoms such as cranial nerve, long tract, or cerebellar dysfunctions. Magnetic resonance imaging is usually sufficient to establish the diagnosis and obviates the need for surgical biopsy in most cases. The prognosis of the disease is dismal, and the median survival is < 12 months. Resection is not a viable option. Standard therapy involves radiotherapy, which produces transient neurological improvement with a progression-free survival benefit, but provides no improvement in overall survival. Clinical trials have been conducted to assess the efficacy of chemotherapeutic and biological agents in the treatment of diffuse pontine gliomas. In this review, the authors discuss recent studies in which systemic therapy was administered prior to, concomitantly with, or after radiotherapy. For future perspective, the discussion includes a rationale for stereotactic biopsies as well as possible therapeutic options of local chemotherapy in these lesions.

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Paediatric brain-stem gliomas: MRI, FDG-PET and histological grading correlation

Abstract: MRI findings correlated well with histological grading of brain-stem gliomas and MRI may therefore predict the histological grading. FDG-PET may be helpful in differentiating between anaplastic astrocytoma and glioblastomas among high-grade tumours.

Cited by 44 publications

References 23 publications

Correlation of ¹⁸F-FDG PET and MRI Apparent Diffusion Coefficient Histogram Metrics with Survival in Diffuse Intrinsic Pontine Glioma: A Report from the Pediatric Brain Tumor Consortium

Correlation of ¹⁸F-FDG PET and MRI Apparent Diffusion Coefficient Histogram Metrics with Survival in Diffuse Intrinsic Pontine Glioma: A Report from the Pediatric Brain Tumor Consortium

Can Multiparametric MRI and FDG-PET Predict Outcome in Diffuse Brainstem Glioma? A Report from a Prospective Phase-II Study

Treatment of diffuse intrinsic brainstem gliomas: failed approaches and future strategies

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Paediatric brain-stem gliomas: MRI, FDG-PET and histological grading correlation

Abstract: MRI findings correlated well with histological grading of brain-stem gliomas and MRI may therefore predict the histological grading. FDG-PET may be helpful in differentiating between anaplastic astrocytoma and glioblastomas among high-grade tumours.

Cited by 44 publications

References 23 publications

Correlation of 18F-FDG PET and MRI Apparent Diffusion Coefficient Histogram Metrics with Survival in Diffuse Intrinsic Pontine Glioma: A Report from the Pediatric Brain Tumor Consortium

Correlation of 18F-FDG PET and MRI Apparent Diffusion Coefficient Histogram Metrics with Survival in Diffuse Intrinsic Pontine Glioma: A Report from the Pediatric Brain Tumor Consortium

Can Multiparametric MRI and FDG-PET Predict Outcome in Diffuse Brainstem Glioma? A Report from a Prospective Phase-II Study

Treatment of diffuse intrinsic brainstem gliomas: failed approaches and future strategies

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Correlation of ¹⁸F-FDG PET and MRI Apparent Diffusion Coefficient Histogram Metrics with Survival in Diffuse Intrinsic Pontine Glioma: A Report from the Pediatric Brain Tumor Consortium

Correlation of ¹⁸F-FDG PET and MRI Apparent Diffusion Coefficient Histogram Metrics with Survival in Diffuse Intrinsic Pontine Glioma: A Report from the Pediatric Brain Tumor Consortium